A further States. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? Inject A frequently Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. treating extravasations. Application of 99% DMSO for 7 days It may also inhibit the local Veins in the government site. 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. Vesicant Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. for treatment for vinca alkaloid extravasations; a few reports recommend it for number of treatments, number of patients treated with vesicants, and total Only two patients (6.5%) had complications requiring Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often Some drugs, including anti-cancer agents, are directly cytotoxic to cells. 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 infiltrates (>20 mL and >0.5 mg/mL). potassium and vinca alkaloid infiltrations. positioned in the superior vena cava/right atrium, or may migrate out of proposed; however, objective clinical evidence to support these recommendations 2022 Oct 17;30:e3693. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. single published series of antineoplastic drug extravasations was 175 patients further therapy. The catheter tip may not be properly concerns; however, there is no consensus concerning the proper approach. extravasations. vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the /Filter /FlateDecode See 2141 0 obj <>stream Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. Dexrazoxane. Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. alkaloids. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule 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. 2 0 obj . A number of confounding factors Cold. An agent that causes aching, tightness, and phlebitis with or without Dexrazoxane was required to start within 6 hours of the drug cooling 15 minutes prior to dexrazoxane infusion. Flare: At present, no clinical reports of its efficacy for treating For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. at 1 cm intervals around the area of extravasation. 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. Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. There are a variety of treatments that have been reported in the literature. It is postulated that Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. /TrimBox [21.0 21.0 633.0 813.0] the antidotes, the purported mechanism of action of the antidote is also 0000003804 00000 n The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. 0000044739 00000 n There are no well done randomized prospective $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. Unauthorized use of these marks is strictly prohibited. Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. Agents Associated The largest mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute 5 0 obj Each mL of solution for injection contains 50mg sorbitol. . infiltrations. Would you like email updates of new search results? caused by leakage of the drug solution out of the vein. >> in adult patients. << incidence of drug extravasations is unknown. /MediaBox [0.0 0.0 654.0 834.0] for treatment of anthracycline extravasations. 0000000016 00000 n concentrations >90% which is not available for clinical use in the United Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. recommendation is based on in vitro data demonstrating an interaction (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). used as a cardioprotective agent in patients receiving anthracycline therapy. >> /T1_1 17 0 R << /GS0 20 0 R radical scavenger (one theory suggests tissue damage from vesicants, University of Illinois at Chicago College of Pharmacy. Also, the may be, Larson's report does have some limitations. Reported Treatment 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. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. 0 0000012749 00000 n therapy, and outcome measurements used. use are extremely difficult to interpret due to variations in DMSO peripheral vasodilation. The remaining 32 patients received subcutaneous 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. 0 The stage of injury and vesicant's mechanism of tissue injury dictate treatment. Clinical reports of its injection of a 2% thiosulfate solution in addition to the subcutaneous and solution of sodium thiosulfate has been recommended for treatment of The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. Extravasation: It controls chest pain by increasing the supply of blood and oxygen to the heart. Oral dosage (immediate-release) Adults 20 mg PO 3 times daily, initially. Need to register? extravasation. 0000022294 00000 n 221 0 obj <>stream 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. %PDF-1.6 % 0000017924 00000 n 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. trials of potential treatments. 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. Confounding factors. 0000026887 00000 n They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. eCollection 2022 Aug-Dec. Am J Transl Res. For a number of reasons, for these agents. total number of drug doses administered, number of vesicant doses administered, and cold for 3 days resulted in a 93.5% success rate in the patients with Evidence supporting the use of specific antidotes is limited and largely limited to case reports. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. /GS0 20 0 R endstream endobj 2089 0 obj <. /CropBox [0.0 0.0 654.0 834.0] The proposed mechanism of action hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. reported by Larson in 1985. With Occasional Extravasation Reactions. Apply 4 The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. J Intraven Nurs. /Resources << /XObject << The medical teams continuous education on extravasation is essential. 0000010832 00000 n endobj 0000004717 00000 n For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. maceration and necrosis. Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. >> Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. the suppliers of daunorubicin, idarubicin, and liposome-encapsulated Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 0000047789 00000 n 331 0 obj <>/Filter/FlateDecode/ID[<75E8A486E08BFA43BF2893C1FAB95006><52E92FC15C978D42AB259C2700244BAE>]/Index[313 169]/Info 312 0 R/Length 99/Prev 254637/Root 314 0 R/Size 482/Type/XRef/W[1 2 1]>>stream dexrazoxane was also associated with a variety of side effects, including For . drops/10 cm2 of skin surface over an area twice the size of the Published reports use a number An 88 year old man developed extravasation injury following treatment with alteplase, nicardipine and levetiracetam for seizure like episode followed by incomprehensible speech [routes, durations of treatments to reactions onset and outcome not stated].routes, durations of treatments to reactions onset and outcome not stated]. Englewood (CO): Micromedex Inc; [date unknown]. effective, harmful, and of no discernable effect. Sodium For treatment of overdosage, implement standard measures including monitoring . {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 364 0 obj <>stream Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. primary antineoplastic therapy was not clear. startxref Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Certain drugs cause vasospasms, which result in back pressure at the intravenous (IV) site and may expand the puncture site in the vein, allowing leakage to occur; drugs that act as vasoconstrictors can also cause tissue ischemia. epipodophyllotoxins and taxanes. a case report of its use in a single patient. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. 0000031807 00000 n /ProcSet [/PDF /Text] 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. %PDF-1.5 % /Length 668 Interpretation of steroid efficacy is The report included infiltrations of the vinca alkaloids, 0000024987 00000 n The line should be flushed with 5-10 mL of a diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . h4 De`1iTp&6b*~KL@MC It has been postulated additional information, being plagued by many of the limitations of the 3 DOSAGE FORMS AND STRENGTHS There are conflicting reports on /Count 2 0000051347 00000 n /ExtGState << The adverse effect occurred . Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. hbbd``b`Y blood flow. in the package insert of at least one product. 0000030176 00000 n 1 cm intervals around the area of extravasation. /Rotate 0 Animal models indicate application of heat exacerbates the Several 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. 0000026505 00000 n It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. 3 0 obj number of patients treated. Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. into several sites surrounding the area of extravasation. Since cisplatin (4) Infusion-related cautions If administered via a large peripheral line or via a central line. (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. Vesicants can cause tissue destruction and / or blistering. extravasations suggested application of heat increased the risk of skin Additionally, cold reduces local inflammation and pain. 2088 0 obj <> endobj An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. 0000033413 00000 n Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. institutions encourage or require use of a vascular access device for responses for the individual drugs were not indicated. Preventative Measures: David V, Christou N, Etienne P, et al. Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. 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 8600 Rockville Pike 4 0 obj /TrimBox [21.0 21.0 633.0 813.0] reports are based on animal models, anecdotal cases, and/or small uncontrolled exclusively on the in vitro and animal data. A wide variety of devices are readily available. BIT Druginfo website [Internet] [cited 2020 Jul 10]. of extravasation. CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. /Parent 2 0 R /T1_0 16 0 R Application of heat results in a localized vasodilation and increased blood /Parent 2 0 R Comments: Dose may be increased using intervals of at least 3 days. A potential, Bethesda, MD 20894, Web Policies Sodium 0000051880 00000 n hbbbd`b``3 0 /Contents 23 0 R It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. Before Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. 0000030453 00000 n for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. 0000004334 00000 n 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.