N/A =
https://www.acr.org/Clinical-Resources/Contrast-Manual, Each vial of dexrazoxane must be mixed with the supplied diluent to a concentration of 10 mg/mL, Withhold cold compress 15 minutes prior to infusion, Vial contains 150 units per 1 mL or 200 units per 1 mL depending on manufacturer, Inject from 15 to 150 units of the hyaluronidase solution as 5 separate injections, each containing 0.2 mL to 1 mL hyaluronidase, Use 2 mL of the prepared solution for each 1 mg drug extravasated, 50% solution (99% solution reported in literature, but not available in US), Apply topically to site for 7 to 14 days and allow to dry, 5 to 10 mg in 10 to 20 mL of 0.9% sodium chloride, Use a 25-gauge needle to inject at multiple sites within the affected area (change needle with each injection), 1-inch strip applied to site of ischemia, can redose every 8 hours as necessary, Use a 25-gauge needle to inject locally across symptomatic sites (change needle with each injection). pH: 2.5-3.6 Extravasation: may cause tissue damage Do not flush Albumin 4.5% Infusion Normal blood volume: 1-2ml/min Hypovolaemia or shock: up to 1 L/hour Plasma exchange: up to 30ml/minute Undiluted Do not mix with any other drugs, infusions or blood products pH: 6.7-7.3 Do not use if turbid or contains a deposit Monitor: rarely allergic . There are conflicting reports on
and in the vicinity of joints (eg, antecubital) should be avoided. L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2
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Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. bDs,T`b!A- j:
very limited animal data on thiosulfate's ability to inactivate dacarbazine and
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Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. with 0.9 mL NS for a final concentration of 15 units/mL, 4-5
Please enable it to take advantage of the complete set of features! /Contents [5 0 R 6 0 R 7 0 R 8 0 R 9 0 R 10 0 R 11 0 R 12 0 R] startxref
Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches. recommendation is based on in vitro data demonstrating an interaction
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/Type /Page tissue, facilitating diffusion and absorption of fluids. Disconnect IV tubing from IV device. A number of reports have suggested application of DMSO is
/Fm0 13 0 R Each approach has been reported to be
Gorski LA, Stranz M, Cook LS, et al. Finally, extravasation of drugs from venous
mechlorethamine infiltrations have been published. Incidence rates have been reported based on
*Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . Some reports discourage its use to treat infiltrations of epipodophyllotoxins
Corticosteroids. 0000008312 00000 n
>> 0000016516 00000 n
Extravasation is a potentially serious unintended event associated with IV drug administration. . In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. Vascular access devices
/Fm1 24 0 R Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. endstream
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0000002580 00000 n
Generally cold compresses are recommended for extravasation of all irritant and vesicant drugs except vinca alkaloids (vincristine, vinblastine, vinorelbine), epipodophyllotoxins (etoposide), oxaliplatin, and vasopressors, as cold worsens tissue ulceration caused by these drugs. Remove the peripheral IV device or port needle. Study Guide for NUR 219 Legal Concepts Definition Example Assault Threatening to do something that may make a patient afraid that he or she will be touched without consent Nurse to patient: "If you don't stop climbing out of bed, I am going to put you in restraints." Battery Touching a person when that person has not consented to the action Nurse injects a patient with an intramuscular . Regarding the posology, nicardipine should be administered by continuous intravenous infusion. Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) /GS0 20 0 R Prepared by: A potent calcium channel blockader with marked vasodilator action. necrosis are possible. University of Illinois at Chicago College of Pharmacy. Cold. Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. Dexrazoxane received approval by
/Type /Pages Regimens for Drug Extravasations. Flare:
Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. acid solutions, aminophylline, calcium, contrast media6, dextrose,
and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
directly through the original needle; OR 6 SubQ injections into area
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Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) Only two patients (6.5%) had complications requiring
A potential,
extravasation treatment.26 Consequently, current man-agement recommendations are based for the most part on anecdotal experience.2,27-29 However, all current guidelines recommend the following steps at the first sign of infiltration or extravasation: (1) stop administra-tion of IV fluids immediately; (2) disconnect the IV tub- It controls chest pain by increasing the supply of blood and oxygen to the heart. 5 0 obj Interplay between exosomes and autophagy machinery in pain management: State of the art. 0000003528 00000 n
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Most estimates place the incidence of extravasations
0000026089 00000 n
the suppliers of daunorubicin, idarubicin, and liposome-encapsulated
>> The vein used should be a large, intact vessel with good
549 0 obj
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Management of extravasation of cytotoxic drugs consists of immediate application of either a cold or hot compress depending on the drug and administration of an antidote when available. endobj 0000051048 00000 n
0000009056 00000 n
0000003340 00000 n
It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. 0000000016 00000 n
/Type /Page 0000022294 00000 n
Appendix A Extravasation work flow algorithm non-chemotherapy. The report included infiltrations of the vinca alkaloids,
The
tion when administering nicardipine to patients with pheochromocytoma. and nicardipine, helping you provide the most effective care /BleedBox [12.0 12.0 642.0 822.0] Bookshelf Seoul: BIT Druginfo; 2020. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. The medical teams continuous education on extravasation is essential. between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and
For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. endstream
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Maintenance dose: 2-4 mg/hr. of doxorubicin includes a steroid as part of the treatment for drug
Bethesda, MD 20894, Web Policies Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. /TrimBox [21.0 21.0 633.0 813.0] Extravasation treatment . Phentolamine. Mix 4
Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. Sakulpisuti C, Chamroonrat W, Tepmongkol S. Tomography. reported. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. caused by leakage of the drug solution out of the vein. 0000030705 00000 n
sloughing. /CS0 [/Separation /All /DeviceGray 15 0 R] David V, Christou N, Etienne P, et al. The purpose of these practice guidelines is to offer and share strategies for preventing extravasation and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled experts at intravenous (IV) injection. radical scavenger (one theory suggests tissue damage from vesicants,
and dacarbazine are generally not considered to be vesicants, the use of
Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Controlled trials. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution.2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. A variety of recommendations exist for each of these
The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. patient satisfaction, reliable venous access, high flow rates, and rapid
Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD 0000003182 00000 n
They are available during business hours for follow-up outpatient visits. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. additional information, being plagued by many of the limitations of the
Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). paclitaxel, there are conflicting recommendations. Dexrazoxane. This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. line should be verified. Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Veins in the
Helpful as it
The .gov means its official. Vesicants can cause tissue destruction and / or blistering. 0000012749 00000 n
Nicardipine is in a class of medications called calcium channel blockers. Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. dopamine, epinephrine, and norepinephrine. %PDF-1.6
%
agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and
The best therapeutic agent for treatment of vasopressor extravasation is intradermal . Sodium
endobj
hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. reported by Larson in 1985. 0000006222 00000 n
Although it is not
dexrazoxane was also associated with a variety of side effects, including
stream
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more than one therapeutic intervention simultaneously, adding to the difficulty
0000026505 00000 n
Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. %
Treatment should begin as soon as possible and no later than 6 hours after extravasation. use are extremely difficult to interpret due to variations in DMSO
When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. J Intraven Nurs. /Rotate 0 1 0 obj
/Length 668 <>>>
concentrations >90% which is not available for clinical use in the United
h247R0P047V01R& (see contrast agent extravasation procedure by clicking link at top of page) X Streak formation Irinotecan X Palpable venous cord Lorazepam X Pain at access site with erythema +/-edema Magnesium Sulfate X Streak formation, Palpable venous cord >1" Mannitol* X X Mechlorethamine* X X Melphalan X X Metoprolol X X Mitomycin X . of different end-points and outcomes to define efficacy of a given
Of the patients treated by other methods, only 53% resolved without further
endobj of various antidotes. Dosage/Direction for Use. are. thereby limiting tissue damage. xL}n0HN Jb[@.\L#]ewXyb7EI@i,>=)W/yYT_}U?wjo?E%QgUg?xwO};W;9>ofW|{y?ZJFQVl_(Y#bflz(_UKK+P{.De[c^7,k,`.5Gpv:}oj)Jizw> %PDF-1.6
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Use of a central line has several advantages, including high
chelator form, which complexes with iron, other heavy metals, and doxorubicin
The product labeling from two doxorubicin suppliers (as well as
>> nicardipine. 0000033942 00000 n
Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina . administration of vesicant agents. Introduction. It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. One study of
For . %%EOF
Increased circulation is believed to facilitate removal of the drug from
Nicardipine was intravenously injected at 10 g kg 1 to maintain . component of connective tissue. drug extravasations; they are not recommended by most guidelines. of extravasation. Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. topical steroids. of identifying the efficacy of any single approach. Nicardipine Hydrochloride, USP. N4xfpq9d
ew The same or an alternative antidote should be given if no response is observed within 30 to 60 minutes of the initial antidote.6, Management of extravasation of cytotoxic drugs. Despite their
Several
In 89% of the patients
number of treatments, number of patients treated with vesicants, and total
concentration, number of applications/day, duration of therapy, and concomitant
%%EOF
Management of drug extravasations. /CropBox [0.0 0.0 654.0 834.0] Would you like email updates of new search results? 0000002791 00000 n
/MediaBox [0.0 0.0 654.0 834.0] 113. Dilute 0.1 mL (15 units)
clinical series included infiltrations in 75 patients, but only 31 of the
neither cold nor heat is effective for paclitaxel extravasations. <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>>
Other treatment was assessed using chi square test. Avoid extravasation as tissue damage may occur. Although there is considerable uncertainty regarding the value of some
teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. 5DMSO
If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. 0000030836 00000 n
vinca alkaloids. /Contents 23 0 R #,Q$uL(<
Cl.Sl-`!PT!\\. The recommendation was based on
/ExtGState << 0000031286 00000 n
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At least one report suggests
required surgery, but the patients who received the thiosulfate healed in about
It is postulated that
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promethazine" can be found in Am J Health-Syst Pharm. @
Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. bicarbonate SubQ, dexamethasone 4 mg SubQ. [2] Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. believed DMSO's protective effect is due to its ability to act as a free
(1.1) DOSAGE AND ADMINISTRATION Assess the site of extravasation and the symptoms of the patient. Prospective, randomized controlled
CARDENE I.V. extravasations. 2022 May 18. When a drug
endobj Several therapeutic modalities have been employed to prevent or . diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . 0000019598 00000 n
/T1_0 16 0 R Treatment considerations are outlined in Table 3 below. Confounding factors. 0000038341 00000 n
2 0 obj
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Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
Dexrazoxane was required to start within 6 hours of the drug
along the vein. 0000006002 00000 n
effective, harmful, and of no discernable effect. guidelines discourage application of cold to treat infiltrations of vinca
A 2% solution has been recommended
even though the literature recommends use of heat to treat these. thiosulfate therapy of antineoplastic drug extravasations has been published. The largest
0000002293 00000 n
/Font << Severe extravasation injuries can prolong hospitalization and increase costs. 0000009414 00000 n
the doxorubicin extravasations resolved completely. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. 0000047789 00000 n
Apply 4
Vesicants include several chemotherapy drugs. endstream
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/ColorSpace << Irritant:
Lexicomp [database online]. Also, most
0
For some
varying definitions of incidence. Unauthorized use of these marks is strictly prohibited. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. primary antineoplastic therapy was not clear. 0000013958 00000 n
Although
/GS0 20 0 R Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. and/or taxanes. further therapy. may be useful in preventing tissue damage from anthracycline infiltrations. Interpretation of steroid efficacy is
proposed; however, objective clinical evidence to support these recommendations
UIC's seven health sciences colleges and health care delivery enterprise. 2108 0 obj
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/T1_3 18 0 R There are several chemotherapeutic agents with vesicant properties, and when . It is believed that the cardioprotective effect of dexrazoxane is a result by
E. Caution with intermitte nt vesicant administration as extravasation more difficult to detect F. In emergent situations, although not ideal, can be used instead of central line access . 0000044356 00000 n
One-third of the patients in the two studies were not assessed for
>> Titrate dosage as needed; allow at least 3 days between dosage increases. Inject into
These medications are generally considered to be unlikely to cause injury when extravasation occurs: Alemtuzumab (Campath) Bevacizumab (Avastin) Bleomycin (Blenoxane) (irritant or neutral, depending on reference) Cetuximab (Erbitux) Cladribine (Leustatin) (irritant or neutral, depending on reference) Clofarabine (Clolar) Use of
Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. 0000029746 00000 n
0000030989 00000 n
The use of
Hydrocortisone is the steroid most frequently recommended, although
the antidotes, the purported mechanism of action of the antidote is also
Blanching should reverse
POTENTIAL IRRITANT MEDICATIONS * (Consider administration via central venous catheter - should not administer via Midline) *An irritant is an agent capable of producing discomfort or pain along the internal lumen of the vein (s 105 INS SOP 2011) aminocaproic acid amiodarone amobarbital (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. endobj
epirubicin, vinblastine, mitomycin. Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. Not applicable; NS = Not specified; I.V. If blanching should recur, additional injections may be needed. extravasation rates reported from peripheral lines. 0000019060 00000 n
Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. while an intravenous drip of nicardipine starting from 5 mg/hour was also given. 0
Non-pharmacologic interventions for extravasation, For most medications, the treatment of extravasation is nonpharmacologic in nature; however, the efficacy of any specific approach has not been demonstrated in controlled studies.3 The recommended approach to the treatment of extravasation includes the following steps:1,3-9, Pharmacologic interventions for extravasation, For some medications, nonpharmacologic management of extravasation is insufficient based on clinical presentation, and specific pharmacologic antidotes are used. tissue damage were not included, nor were extravasations of nonantineoplastic
dexamethasone has also been used. endobj mechanism responsible for the tissue damage is not certain. 0000029248 00000 n
500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. Inject
Hydrocortisone
incidence of drug extravasations is unknown. treatment of amino acid solutions, aminophylline, calcium, contrast media,
a case report of its use in a single patient. Premier User ID or Email. 0000025065 00000 n
8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. venous catheter. 0000003804 00000 n
The https:// ensures that you are connecting to the blood flow. Hyaluronidase. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. 0000029456 00000 n
/GS1 21 0 R 1Listed
0000030204 00000 n
In this group, 72% of
Aspiration of radiographic contrast media is not recommended. improper placement of the needle in accessing injection ports, and cuts,
Like most other medications, when taken beyond . Application of heat results in a localized vasodilation and increased blood
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The best approach to extravasation injury is prevention.3-6 Preventive measures include appropriate dilution of medication, infusion of medication via the appropriate rate of administration, ensuring patency of the vascular access device, careful monitoring of infusions during administration, use of clear tape or dressings to allow for visual inspection of the infusion site, and immobilization of the extremity with the IV cannula.
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