Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. A number of confounding factors
endobj Usual dose: 20 to 40 mg PO 3 times daily. /ProcSet [/PDF /Text] /Rotate 0 If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. evaluation of the various reports is difficult. Development of an evidence-based list of noncytotoxic vesicant medications and solutions. Although there is considerable uncertainty regarding the value of some
Cardene I.V. << /Resources << the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline
clinical case reports. N/A =
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An agent that causes aching, tightness, and phlebitis with or without
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Use of a central line has several advantages, including high
efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. Need to register? Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. 0000025065 00000 n
/ExtGState << Although
recommended as immediate treatment for most drug extravasations, except the
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Steroids are most commonly used to treat anthracycline extravasations. the doxorubicin extravasations resolved completely. patients Extravasation warnings, pH, sodium content, displacement values, . A number of reports have suggested application of DMSO is
/Parent 2 0 R Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. %%EOF
damage from anthracycline extravasations. further therapy. 332 0 obj
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Unauthorized use of these marks is strictly prohibited. /Length 668 https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. University of Illinois at Chicago College of Pharmacy. increasing the diffusion of extravasated fluids results in more rapid absorption,
more than one therapeutic intervention simultaneously, adding to the difficulty
In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. >> Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. /Font << (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). The .gov means its official. infiltrations.
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Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. report dexrazoxane effective in preventing tissue damage following
In a series of 63 patients with extravasation of doxorubicin, epirubicin,
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Sodium
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saline or dextrose solution and the drug(s) infused through the side of a
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dilution of the drug. Heat. However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. 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. Dexrazoxane received approval by
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. 0000006002 00000 n
official website and that any information you provide is encrypted Agents Associated
2022 Oct 17;30:e3693. 66y% Extravasation is a potentially serious unintended event associated with IV drug administration. Blanching should reverse
. Careers. government site. half the time as the patients who received only the steroid therapy. human case reports. Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. The recommendation was based on
Additionally, these catheters require routine care to maintain
2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. localized cooling was permitted (except within 15 minutes of dexrazoxane
*Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . endobj Elderly Initially 1-5 mg/hr. line should be verified. limiting efforts to identify optimal management of these reactions. Application of 99% DMSO for 7 days
a small amount into area of extravasation. Additionally, cold reduces local inflammation and pain. 0000002809 00000 n
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The adverse effect occurred . are. Prospective, randomized controlled
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treating extravasations. stream
Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . 0000000016 00000 n
/Type /Pages Intermittent cooling of the area of infiltration results in vasoconstriction,
Generic Name Nicardipine DrugBank Accession Number DB00622 Background. endstream
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inflammation. 3 0 obj A potent calcium channel blockader with marked vasodilator action. h\J1_enDRBqAA They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. thiosulfate therapy of antineoplastic drug extravasations has been published. /StructParents 0 Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. >> 2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin
The author has contributed to research in topic(s): Neurokinin A & Receptor. << No patient in either group developed skin ulceration or
@
h247R0P047V01R& The product labeling from two doxorubicin suppliers (as well as
risk to the patient. /StructParents 1 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 One study of
Warm compresses are preferred for extravasation of specific drugs including vinca alkaloids, etoposide, vasopressors, and oxaliplatin to increase local blood flow and enhance drug removal. Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
Vesicant
Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. mechlorethamine. Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. /Rotate 0 doxorubicin, epirubicin, idarubicin. that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
eCollection 2022. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule >> 0000019842 00000 n
treatment. treatment of drug extravasations is uncertain. . 0000051721 00000 n
extravasation: Symptoms occur 48 hours, or later, after drug administration. Wang RY. doi: 10.1590/1518-8345.5786.3693. Extravasation of noncytotoxic drugs. L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2
paclitaxel, there are conflicting recommendations. necrosis are possible. 113. This site needs JavaScript to work properly. What is nicardipine (Cardene) used for? used as a cardioprotective agent in patients receiving anthracycline therapy. One report of the application of heat for nonantineoplastic drug
dexamethasone has also been used. /XObject << Prior to drug administration, the patency of
It has a molecular weight of 515.99 . are conflicting data on the efficacy of heat or cold for infiltrations of
The largest
2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Before 1In
>> 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) eCollection 2022 Aug-Dec. Am J Transl Res. E, and sodium bicarbonate have been used in conjunction with DMSO. acid solutions, aminophylline, calcium, contrast media6, dextrose,
Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. endstream
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Most reports question the efficacy of steroids for treatment of
solution of sodium thiosulfate has been recommended for treatment of
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concentration, number of applications/day, duration of therapy, and concomitant
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Extravasation can result in tissue sloughing, pain . One-third of the patients in the two studies were not assessed for
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/GS0 20 0 R Mechanism of action. CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. zw ~rBz p41A iK14w,:Xr}ZzW4i]3E66}b8``f Y9x:9;PwuA^x{l.kpZy[Lo|-YEto~UEqV'qh@:!gy+pusn|enfoZ{aa>8^%Rm8u `t;M4bPUPM(\&|bw?+`w reR}nTBRi9)+ o
tissue damage were not included, nor were extravasations of nonantineoplastic
extravasation does occur, a variety of immediate actions have been recommended. .,gzTwgV- *m
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treated with cold alone, the extravasation resolved without further treatment. 0
/T1_3 18 0 R Evidence supporting the use of specific antidotes is limited and largely limited to case reports. Vesicant:
>> 3There
It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. 0000013524 00000 n
Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. exist which make assessment of various antidotes difficult. Inject
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At present, most reviews and guidelines discourage its use for
cooling 15 minutes prior to dexrazoxane infusion. effective chelator itself, but is hydrolyzed intracellularly to an open-ring
sloughing. The optimal
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To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. Drug information handbook. Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the . 0000003491 00000 n
Hydrocortisone
Introduction. %PDF-1.5
neither cold nor heat is effective for paclitaxel extravasations. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. Sakulpisuti C, Chamroonrat W, Tepmongkol S. Tomography. The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). 0000016516 00000 n
Technician Learning Objectives Identify antidotes used in the treatment of extravasation. For some of
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 . Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). proposed; however, objective clinical evidence to support these recommendations
Only two patients (6.5%) had complications requiring
Damage from extravasation can progress to a significant degree, causing permanent disability and disfigurement, and necessitating surgical debridement or skin grafting.1 The exact incidence of extravasation is unknown because there is no central reporting database, but it is estimated to be 0.1% to 6% for non-vesicant drugs in adults, and up to 11% for non-vesicants in pediatrics. (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 . There are no well done randomized prospective
Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? thiosulfate. 0000027171 00000 n
flow. (cisplatin, ifosfamide, and mitoxantrone). Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. 8th ed. Remove the peripheral IV device or port needle. 0000002739 00000 n
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For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. promethazine" can be found in Am J Health-Syst Pharm. into several sites surrounding the area of extravasation. 0000008312 00000 n
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responses for the individual drugs were not indicated. 221 0 obj
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/T1_1 17 0 R Eur J Oncol Nurs. Phentolamine is an alpha1-adrenergic antagonist which produces
Available from: [place unknown]: [publisher unknown]; 2018. `H*a1HA6Z3LJ +m_
]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z thereby limiting tissue damage. . BJA Educ. may be, Larson's report does have some limitations. Application of cold is usually
Also, except
Extravasation is a known risk of vesicant administration. Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. hb```l /BleedBox [12.0 12.0 642.0 822.0] 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. institutions encourage or require use of a vascular access device for
Extravasation of xenobiotics. such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. The use of
Two issues for
2Most
Dosage/Direction for Use. /XObject << 0000017924 00000 n
Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. 0
number of patients treated. /CS0 [/Separation /All /DeviceGray 15 0 R] It is
Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. extravasation: Leakage of a drug that causes pain, necrosis, or tissue
Information concerning treatment of
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When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. /T1_2 19 0 R This medicinal product contains sodium. Since cisplatin
over cold alone is difficult to assess. A further
cisplatin or dacarbazine extravasations have been published. Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. Contrast injections were performed at 2-5-mg intervals to assess effective response (a 60% increase in arterial diameter of the most severely decreased in caliber vessel compared with the very first angiographic run). For . drops/10 cm2 of skin surface over an area twice the size of the
for doxorubicin extravasations in the group treated with ice and observation,
improper placement of the needle in accessing injection ports, and cuts,
Clinical reports of its
Most estimates place the incidence of extravasations
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thiosulfate to treat infiltrations of these drugs may not be required. 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. The information provided on this site, including links to relevant websites and the information contained therein, is for use by health care providers and health care organizations only. >> mechlorethamine and cisplatin infiltrations. variety of agents have been reported as possible antidotes for extravasated
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Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Reports of
treatments. vinca alkaloids. infiltrates (>20 mL and >0.5 mg/mL). /ArtBox [21.0 21.0 633.0 813.0] Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. /T1_1 17 0 R trailer
If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. 0000044739 00000 n
2022 May 18. Metoprolol Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Medication Thermal Therapy Antidote Dose Treatment Nitroglycerin Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Norepinephrine Heat Nitroglycerin 2% paste n/a Apply thin layer to area of extravasation q 6 hr x 24 hr Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. access devices is possible. treatment of amino acid solutions, aminophylline, calcium, contrast media,
Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD