Treatment should begin as soon as possible and no later than 6 hours after extravasation. believed DMSO's protective effect is due to its ability to act as a free
number of treatments, number of patients treated with vesicants, and total
/ProcSet [/PDF /Text] Vesicants can cause tissue destruction and / or blistering. Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD at 1 cm intervals around the area of extravasation. e.YvIQ|!C2\@&;:8 h qF . uDX i! 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 /Font << Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. Intravenous nicardipine for the treatment of severe hypertension Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. endstream
endobj
223 0 obj
<>stream
Bookshelf 0000006222 00000 n
(1.1) DOSAGE AND ADMINISTRATION Disclaimer. 1999; 56:1742-3. 0000029248 00000 n
topical dexamethasone. reports suggest it might also be useful in managing extravasations of
vial with NS to a concentration of 150 units/mL. following extravasation of pressor (vasoconstrictor) agents such as dobutamine,
_Pu5r]"%~DnmNV;Y J 9L
Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. Initial dose: 20 mg orally 3 times a day. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. A variety of antidotes have been
Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often
recommended as immediate treatment for most drug extravasations, except the
Selective transcatheter arterial embolization . For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. further therapy. Management of extravasation of non-cytotoxic drugs. Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). Careers. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. dilution of the drug. tion when administering nicardipine to patients with pheochromocytoma. Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. mL of 10% sodium thiosulfate with 6 mL sterile water, Inject
hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5
/Fm1 24 0 R 0000006002 00000 n
and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
doi: 10.1590/1518-8345.5786.3693. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. Rev Lat Am Enfermagem. while an intravenous drip of nicardipine starting from 5 mg/hour was also given. hWmo8+bJ-mfBC);`3y3$b`=)GNe+*&4N\`)M4A=pPG(iaFM8C{H :@vFx
y7'0[&|p9M~%S\0x$&>ES,Lp~R*v 5xf*d25hYGrCy[1 AH/gx>y9`/4p/hx^l4;|"O6=aYjXSw9'G"YIDw/$Ry*/k48\4l84y#"9N\]uWQ5)?- 1XP84ha, f1+&Tn4
@@O,)ldj]vLQ)C:Eo7|H:|])~VuoT?j368HzX Hydrocortisone is the steroid most frequently recommended, although
Hyaluronidase. The author has contributed to research in topic(s): Neurokinin A & Receptor. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. Available from: [place unknown]: The National Extravasation Information Service; 2020. 9 dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. /CS0 [/Separation /All /DeviceGray 15 0 R] Regarding the posology, nicardipine should be administered by continuous intravenous infusion. immediately. For some of
official website and that any information you provide is encrypted %PDF-1.6
%
Extravasation treatment . radical scavenger (one theory suggests tissue damage from vesicants,
Treatment options Clevidipine 1-2 mg/h IV, titrate by doubling the dose every 2-5 min until desired BP reached; maximum 21 mg/h; or Labetalol 10-20 mg IV over 1-2 min, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5-15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limit Application of cold is usually
0000017924 00000 n
An 8.4% solution of sodium bicarbonate was briefly recommended
<<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>>
/GS0 20 0 R 0000003340 00000 n
/T1_3 18 0 R There are a variety of treatments that have been reported in the literature. human case reports. Remove the peripheral IV device or port needle. The vein used should be a large, intact vessel with good
0000004717 00000 n
concentrations >90% which is not available for clinical use in the United
At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Treatment is outlined in Table 2 below. /XObject << %%EOF
Also, the
Vasopressors
a small amount into area of extravasation. Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. No potential conflict of interest relevant to this article was reported. which tends to restrict the spread of the drug. With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. Before therapy, and outcome measurements used. Hudson (OH): Lexi-Comp Inc; 2000. In: Post TW, ed. Dtsch Med Wochenschr. Appointments can be scheduled by calling 651-220-6530. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. The product labeling from two doxorubicin suppliers (as well as
Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Cold. A variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate).1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8
responses for the individual drugs were not indicated. Each mL of solution for injection contains 50mg sorbitol. tissue, facilitating diffusion and absorption of fluids. effective. Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
epipodophyllotoxins and taxanes, although not all guidelines recommend its use
Molecular Formula C 26 H 29 N 3 O 6. Some reports discourage its use to treat infiltrations of epipodophyllotoxins
Phentolamine. Extravasation is a known risk of vesicant administration. patient satisfaction, reliable venous access, high flow rates, and rapid
It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. /Fm1 14 0 R single published series of antineoplastic drug extravasations was 175 patients
This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. Vesicant
0000029456 00000 n
Some drugs, including anti-cancer agents, are directly cytotoxic to cells. . infiltrations. 0000013524 00000 n
Steroids are most commonly used to treat anthracycline extravasations. 833 S. Wood St., Suite B12, College of Pharmacy, (MC 886), Chicago, IL 60612, 2023 The Board of Trustees of the University of Illinois, UI Health is UICs academic health enterprise. /Type /Pages 0000013958 00000 n
/Font << Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. << For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. Only two patients (6.5%) had complications requiring
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 . for doxorubicin extravasations in the group treated with ice and observation,
trials of potential treatments. 5 0 obj States. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. 0000015118 00000 n
See this image and copyright information in PMC. Effect modifiers modalities like nitrate which require continuous were controlled through stratification of age, gender, hemodynamic monitoring and dose adjustment and type of APE and effect of these on outcome variable NIPPV which is costly and technically difficult to use. /CropBox [0.0 0.0 654.0 834.0] 0000003182 00000 n
/GS1 21 0 R Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. successful thiosulfate treatment of an accidental intramuscular mechlorethamine
%
Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. limiting efforts to identify optimal management of these reactions. reported by Larson in 1985. Important Risk Information 332 0 obj
<>
endobj
transaminases, and increased serum creatinine. Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . Dosage/Direction for Use. Dosages of Nicardipine Adult dosage Capsule 20mg 30mg Capsule, extended release Note: Cardene SR has not been available in the US for more than a year 30mg 45mg caused by leakage of the drug solution out of the vein. treatment of amino acid solutions, aminophylline, calcium, contrast media,
Some reports recommend
and nicardipine, helping you provide the most effective care h4 De`1iTp&6b*~KL@MC Dimethyl
improper placement of the needle in accessing injection ports, and cuts,
MeSH A further
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. Information concerning treatment of
8600 Rockville Pike Gsv? >> %PDF-1.5
%
for treatment of anthracycline extravasations. mechlorethamine and cisplatin infiltrations. Outcome definitions. reports of tissue damage following extravasation. endstream
endobj
startxref
Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. Unable to load your collection due to an error, Unable to load your delegates due to an error. 0000033413 00000 n
Also, most
Misplacement/migration of the catheter tip,
FOIA 0000051880 00000 n
Confounding factors. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. solution of sodium thiosulfate has been recommended for treatment of
0000037692 00000 n
/T1_0 16 0 R /Fm0 13 0 R 0000024987 00000 n
For 119 patients, local application of cold (15 minutes four
such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. localized cooling was permitted (except within 15 minutes of dexrazoxane
It is postulated that
startxref
The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. endobj
Follow-up studies in a
may be useful in preventing tissue damage from anthracycline infiltrations. acid solutions, aminophylline, calcium, contrast media6, dextrose,
/Resources << into several sites surrounding the area of extravasation. IV nicardipine was as effective as IV nitroprusside in the 0000038957 00000 n
stream
Extravasation of noncytotoxic drugs. %PDF-1.6
%
Use of a central line has several advantages, including high
0000030204 00000 n
Results in animal models have been equivocal, with some reports indicating DMSO
clinical case reports. 0000037314 00000 n
endobj between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and
W*FtP&OO53_zzA=#`"@;2}+#P- ]+c
Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) 113. Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. It has been postulated
>> further therapy. Like most other medications, when taken beyond . thiosulfate. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Heather Ipema, PharmD, BCPS Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). very limited animal data on thiosulfate's ability to inactivate dacarbazine and
reports are based on animal models, anecdotal cases, and/or small uncontrolled
/StructParents 1 trials are not practical. Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. been reported effective in preventing tissue damage from a wide variety of
Heat. recommendation is based on in vitro data demonstrating an interaction
>> 512 0 obj
<>
endobj
0000002293 00000 n
/T1_1 17 0 R /BleedBox [12.0 12.0 642.0 822.0] stream
Reports of
Although there is considerable uncertainty regarding the value of some
481 0 obj
<>stream
%PDF-1.6
%
hbbd```b``
"_HR, Iejw\Xo b&mQs8DbCC ;
0
hb```l If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. /Annots [22 0 R] vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the
A frequently
@
managed with the application of heat has been published. 0000031807 00000 n
Extant
0000010698 00000 n
Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. positioned in the superior vena cava/right atrium, or may migrate out of
/Resources << /ArtBox [21.0 21.0 633.0 813.0] For some
treatments. Even when treatment is initiated as soon as . Intermittent cooling of the area of infiltration results in vasoconstriction,
xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77)
US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K bDs,T`b!A- j:
Englewood (CO): Micromedex Inc; [date unknown]. hWmo8+8onp">9A!ylTq&fRbpV-SCq9a.LLX#AH&%lSaJH@DIW8bK0(|Z:z8~z]W:i#a`v;&h
.z{ox?w:/nRGq6[>Yk}w5B2|JZOOje|og6 n:g?||TN)6g|R>Pme>9 e>oggK08y 9Kl\^Zx+F9;QqqN?Ewe5F\]CG9Q1C$JW.Z$>l!l[=YRjA^Q{8Y]5c~uQ>@7iWl-6E!nB95E WqDJ=+mjlFs2UOlSFct Q2Vg)SRt1DtqAr? Epinephrine or norepinephrine extravastation treatment. %PDF-1.4 1998 Jul-Aug;21(4):232-9. Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. Application of heat results in a localized vasodilation and increased blood
Other treatment was assessed using chi square test. reported. times a day for 3 days) and close observation was the sole treatment. 0000002739 00000 n
The recommendation was based on
>> This problem is not unique to antineoplastic therapy; a
$S@#H= @@ HW@fP
; 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> Incidence rates have been reported based on
/Parent 2 0 R For many drugs, the underlying
The use of
/TrimBox [21.0 21.0 633.0 813.0] (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). National Library of Medicine forearm (ie, basilic, cephalic, and median antebrachial) are usually good
extravasation: Symptoms occur 48 hours, or later, after drug administration. Available from: [place unknown]: [publisher unknown]; 2018.
Extravasation can result in tissue sloughing, pain . the antidotes, the purported mechanism of action of the antidote is also
0000030660 00000 n
Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Dexrazoxane is not an
BIT Druginfo website [Internet] [cited 2020 Jul 10]. guidelines discourage application of cold to treat infiltrations of vinca
Published reports use a number
an effective treatment for infiltrations of a number of different drugs. chelator form, which complexes with iron, other heavy metals, and doxorubicin
extravasation; allow to air dry without dressings. /T1_2 19 0 R Application of 99% DMSO for 7 days
Technician Learning Objectives Identify antidotes used in the treatment of extravasation. Wang RY. /ArtBox [21.0 21.0 633.0 813.0] Premier User ID or Email. Can calcium channel blockers cause edema? Lexicomp [database online]. In a series of 63 patients with extravasation of doxorubicin, epirubicin,
diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic
vinca alkaloids. drugs, with no consensus on their proper use. Treatment considerations are outlined in Table 3 below. agents, including amino acid solutions, aminophylline, calcium, contrast media,
/BleedBox [12.0 12.0 642.0 822.0] 313 0 obj
<>
endobj
2 0 obj
A wide variety of devices are readily available. European Oncology Nursing Society extravasation guidelines. the initial management of paclitaxel infiltrations. epirubicin, vinblastine, mitomycin. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. Dexrazoxane received approval by
sloughing. Comments: Dose may be increased using intervals of at least 3 days. This results in increased permeability of the
>> evaluation of the various reports is difficult. (cisplatin, ifosfamide, and mitoxantrone). Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. along the vein. variety of animal models failed to confirm the original report. /ExtGState << Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. /Pages 2 0 R A very wide
and potentially highly morbid, complication of drug therapy is soft tissue damage
cooling 15 minutes prior to dexrazoxane infusion. 0000000016 00000 n
8th ed. for treatment for vinca alkaloid extravasations; a few reports recommend it for
complication to interpretation of DMSO's efficacy is that some series included
injections (0.2 mL) into area of extravasation, 5-10 injections
Animal models indicate application of heat exacerbates the
more than one therapeutic intervention simultaneously, adding to the difficulty
treatment. 0000003804 00000 n
treated with cold alone, the extravasation resolved without further treatment. 0000009377 00000 n
Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. 0000010832 00000 n
/Kids [3 0 R 4 0 R] For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. thereby limiting tissue damage. 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. (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 .