Chemotherapy administered using this route has the potential to cause great harm (Sewell et al. [230]) and has been associated with the deaths of at least 13 patients since 1985. The risks of intrathecal chemotherapy have been well documented in An Organization with a Memory (DH [43]) and the government set a target to eliminate incidents of patients dying or being paralyzed by maladministered intrathecal injections by the end of 2001 (DH [43]). Two reports on injection errors (Toft [244]) gave rise to the publication of the national guidance for the safe administration of intrathecal chemotherapy.

Following the publication of the guidance, all UK trusts that undertake to administer intrathecal cytotoxic chemotherapy (ITC) must ensure safe practice guidelines have been introduced and that they are fully compliant with the Updated National Guidance on the Safe Administration of Intrathecal Chemotherapy (DH [47]). The key requirements of the guidance are noted in Box 23.13.

The chief executive must identify a ‘designated lead’ who in turn must ensure the appropriate induction, training and continuing professional development of designated personnel authorized to administer intrathecal chemotherapy. A register of these personnel must be kept along with details of certain competency‐based tasks such as prescribing, dispensing, issuing, checking and administration. It is important to keep up to date with relevant safety alerts concerning intrathecal chemotherapy which may be issued by the Department of Health agencies such as the Medicines and Healthcare products Regulatory Agency (MHRA) or National Patient Safety Agency (NPSA). Such reports have highlighted concerns over the risk of neurological injury due to implantable drug pumps for intrathecal therapy (MHRA [155]) and the storage of vinca alkaloid minibags (NPSA [168]).