Hepatic Artery Infusion Program, UF Health Jacksonville. Program team only.
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What this does and the terms used
Calculates the first floxuridine dose for one 30 mL pump fill from the dose intensity (mg per kg of body weight per day), the patient's dosing weight and the pump's labeled flow rate. The pump empties its 30 mL reservoir at a fixed rate, so the amount of drug placed in the fill sets the daily dose. Later doses are not recalculated from weight; they follow the refill rules in step 2.
- Ideal body weight
- Men 50 kg, women 45.5 kg, plus 2.3 kg for every inch of height over 5 feet.
- Dosing weight
- Actual weight, unless the patient is 25% or more above ideal body weight; then the average of ideal and actual weight.
- Labeled flow rate
- The flow printed by the manufacturer for this pump, in mL per day (usually 1.2 to 1.4). The first dose uses this labeled rate, not a measured one.
| Component | Stock | Amount | Volume |
|---|
Dose per fill (mg) = intensity (mg/kg/day) × dosing weight (kg) × 30 mL ÷ labeled flow rate (mL/day); heparin 30,000 units and dexamethasone are added, then normal saline to 30 mL. For comparison, the MSK standard of 0.12 mg/kg/day gives 1.5 times the UF Jax dose for the same patient.
Source: Boston Scientific EDUCARE (the manufacturer's education program) slides 52, 54 and 58, Rao 2024. The UF Jax starting intensity of 0.08 mg/kg/day is a program decision of 3 Nov 2026; MSK (Memorial Sloan Kettering) uses 0.12.
What this does and the terms used
At every floxuridine refill, compares today's liver tests with the reference value and converts the change into a percentage of the last dose given: 100%, 80%, 50% or hold. The most restrictive lab decides. The dose never goes up after a reduction. If the previous fill was a hold, the decision is instead whether the resume criteria are met, and the dose is 25% of the last floxuridine dose given.
- Reference value
- The lab result drawn on the day the most recent floxuridine dose was placed in the pump. Immediate post-operative values and the interim flush day are not the reference.
- Current value
- The higher of the day 15 value (pump emptied) and the day 29 value (planned refill).
- Fold change
- Current value divided by the reference value. 72 ÷ 63 = 1.14x.
- AST
- Aspartate aminotransferase. ALT (alanine aminotransferase) is not part of the table.
- Hold
- No floxuridine in this fill. The pump is filled with heparinized saline plus dexamethasone 20 to 25 mg so the catheter stays open.
- Residual volume
- What is left in the reservoir when the pump is accessed, measured when the pump is emptied.
- Measured flow rate
- (30 mL minus residual volume) ÷ days since the fill: the rate the pump actually delivered. It tells how many mg per day the last fill delivered and whether the reservoir empties earlier or later than planned.
| Lab | Reference | Day 15 | Day 29 | Current | Fold | Rule |
|---|---|---|---|---|---|---|
| Alkaline phosphatase U/L | ||||||
| Total bilirubin mg/dL | ||||||
| AST U/L |
| Component | Stock | Amount | Volume |
|---|
| Lab (current ÷ reference) | 100% of last dose | 80% | 50% | Hold |
|---|---|---|---|---|
| AST | below 2x | 2x to below 3x | 3x to below 4x | 4x or more |
| Alkaline phosphatase | below 1.2x | no 80% step | 1.2x to below 1.5x | 1.5x or more |
| Total bilirubin (scored only when the reference is above 1.2 mg/dL) | below 1.2x | no 80% step | 1.2x to below 1.5x | 1.5x or more |
The percentage applies to the last dose given and the result becomes the new maximum; with a normal baseline bilirubin (1.2 mg/dL or below) the table does not score bilirubin, and a current bilirubin above 1.2 mg/dL is flagged for oncologist review instead of changing the dose.
Source: Boston Scientific EDUCARE slides 61, 63 and 64, Rao 2024; slide 63: "in the presence of low baseline bilirubin, do not use the value to adjust dose". Dr. Connell, MSK, verbal teaching Nov 2026. Flow deviation threshold: Intera advisory 2022.
What this does and the terms used
After a hold, floxuridine resumes at 25% of the last dose given, once the liver tests have recovered relative to the reference value. The resume dose is the new maximum: it is never raised back toward the old dose. Enter the last dose and the reference and current labs to check the resume criteria. Step 2 with "Previous fill: Hold" applies the same rule.
- Resume
- Restart floxuridine after a hold at 25% of the last dose given. The reference value for this comparison stays the labs from the day of that last dose.
- Resume criteria
- AST 3x the reference or less; alkaline phosphatase 1.2x or less; bilirubin 1.2x or less when the reference bilirubin is above 1.2 mg/dL (a normal baseline bilirubin is not scored; a current value above 1.2 mg/dL is flagged for review).
| Lab | Reference | Current | Fold | Criterion |
|---|---|---|---|---|
| Alkaline phosphatase U/L | ||||
| Total bilirubin mg/dL | ||||
| AST U/L |
Resume floxuridine at 25% of the last dose given when AST is 3x the reference or less, alkaline phosphatase 1.2x or less and bilirubin 1.2x or less; never rechallenge at the prior dose, and on recurrence months or years later restart at the dose the patient finished on. The resume criterion is 1.2x or less; the refill table reduces at 1.2x or more. Both follow the source wording.
Source: Boston Scientific EDUCARE slide 64, Rao 2024 (hold at 210 mg, alkaline phosphatase 205 ÷ 174 = 1.18x, resume at 53 mg); Dr. Connell, MSK, verbal teaching Nov 2026. In the worked example the AST and bilirubin values are illustrative; the slide gives only the alkaline phosphatase.
| Lab (current ÷ reference) | 100% of last dose | 80% | 50% | Hold |
|---|---|---|---|---|
| AST | below 2x | 2x to below 3x | 3x to below 4x | 4x or more |
| Alkaline phosphatase | below 1.2x | no 80% step | 1.2x to below 1.5x | 1.5x or more |
| Total bilirubin (scored only when the reference is above 1.2 mg/dL) | below 1.2x | no 80% step | 1.2x to below 1.5x | 1.5x or more |
Most restrictive lab wins. Percentage applies to the last dose given. Never re-escalate. Resume after a hold at 25% of the last dose when AST is 3x or less, alkaline phosphatase 1.2x or less and bilirubin 1.2x or less.