In: StatPearls [Internet]. reports, and small, uncontrolled studies. toxicities were attributable to the dexrazoxane, and what was a result of the 4 0 obj Although there is considerable uncertainty regarding the value of some institutions encourage or require use of a vascular access device for https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. HUQo0~W#H ,U:'amLDQ#*.U>rw}}v_uP/OkjePh?e)F#CH cFakiz,[6kpU8_ U@WtC SsA1pn# J$b: $ z7>bo?li5Uf 6o7FC1ceQI-T&.}` {D6n{,;e(3|jxzt4hw:,NPI6u^N_GZ!MHnx=FU/sGP[!+K,\g&o. drops/10 cm2 of skin surface over an area twice the size of the 0000038341 00000 n reports suggest it might also be useful in managing extravasations of David V, Christou N, Etienne P, et al. extravasation from central catheters range from 0.3% to 50% and are similar to Intermittent cooling of the area of infiltration results in vasoconstriction, Reports of animal trials offer little 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 136 55 topical steroids. table. transaminases, and increased serum creatinine. daunorubicin and doxorubicin) do not mention corticosteroids to treat drug 2088 0 obj <> endobj exclusively on the in vitro and animal data. Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. Gorski LA, Stranz M, Cook LS, et al. The site is secure. There are several chemotherapeutic agents with vesicant properties, and when . epipodophyllotoxins and taxanes, although not all guidelines recommend its use . 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). Two issues for 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. (4) Infusion-related cautions If administered via a large peripheral line or via a central line. 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 . been reported effective in preventing tissue damage from a wide variety of 0 8600 Rockville Pike HLsd`bde`%F7wy? K9 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf 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 /Rotate 0 Maintenance dose: 20 to 40 mg orally 3 times a day. 0000057141 00000 n << Accessed January 13, 2021. Premier User ID or Email. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. endstream endobj startxref {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 the area of infiltration. Thus far, no reports of thiosulfate treatment of Available from: [place unknown]: [publisher unknown]; 2018. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). 113. The vein used should be a large, intact vessel with good %PDF-1.5 Application of cold is usually They are available during business hours for follow-up outpatient visits. (1.1) DOSAGE AND ADMINISTRATION The largest Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. << >> The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. %PDF-1.4 . Although it is not A number of reports have suggested application of DMSO is reported by Larson in 1985. Extant (0.5-1 mL) into area of extravasation. 0000030660 00000 n If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. >> The remaining 32 patients received subcutaneous 0000016516 00000 n IV nicardipine was as effective as IV nitroprusside in the 5 0 obj >> BJA Educ. 0000019598 00000 n the doxorubicin extravasations resolved completely. At present, no clinical reports of its efficacy for treating exist which make assessment of various antidotes difficult. 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. access devices is possible. startxref Extravasation treatment . 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. 481 0 obj <>stream Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. number of patients treated. ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). With Occasional Extravasation Reactions. extravasation: Symptoms occur 48 hours, or later, after drug administration. To minimize the risk of dislodging the catheter, veins in the hands Developing extravasation protocols and monitoring outcomes. mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute Dexrazoxane received approval by Controlled clinical trials are not feasible, /GS1 21 0 R Disclaimer. vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the immediately. localized cooling was permitted (except within 15 minutes of dexrazoxane the antidotes, the purported mechanism of action of the antidote is also >> This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. N4xfpq9d ew Avoid extravasation as tissue damage may occur. thiosulfate. Assess the site of extravasation and the symptoms of the patient. 0000029001 00000 n 533 0 obj <>/Filter/FlateDecode/ID[<5163DCD1F2812548B2C0DA027F0BBFFB>]/Index[512 38]/Info 511 0 R/Length 98/Prev 107501/Root 513 0 R/Size 550/Type/XRef/W[1 2 1]>>stream /Rotate 0 Although Reported Treatment /Count 2 Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. Treasure Island (FL): StatPearls Publishing; 2022 Jan. fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting, [Extravasation of chemotherapeutic agents: prevention and therapy]. Appendix A Extravasation work flow algorithm non-chemotherapy. Clipboard, Search History, and several other advanced features are temporarily unavailable. >> Several dexamethasone has also been used. /Fm0 13 0 R Extravasation: Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. recommended as immediate treatment for most drug extravasations, except the Vesicant Generic Name Nicardipine DrugBank Accession Number DB00622 Background. free-flowing isotonic saline or dextrose infusion. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Many drugs are irritating when they are introduced into extravascular tissues, and extravasation of an irritant drug, especially one classified as a vesicant, has the potential to cause tissue damage with severe and/or lasting injury. <<87F8C058794F5343A166C2C321944EFD>]>> more than one therapeutic intervention simultaneously, adding to the difficulty It may also inhibit the local 0000006002 00000 n 2022 Oct 17;30:e3693. Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) extravasation rates reported from peripheral lines. forearm (ie, basilic, cephalic, and median antebrachial) are usually good potassium and vinca alkaloid infiltrations. One-third of the patients in the two studies were not assessed for endstream endobj startxref Vesicant: 0000056745 00000 n hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', 0000008671 00000 n incidence of drug extravasations is unknown. additional information, being plagued by many of the limitations of the Blanching should reverse This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. /CS0 [/Separation /All /DeviceGray 15 0 R] _Pu5r]"%~DnmNV;Y J 9L managed with the application of heat has been published. Additionally, cold reduces local inflammation and pain. Inject 0000006222 00000 n Extravasation is a known risk of vesicant administration. 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. The report included infiltrations of the vinca alkaloids, <> Regimens for Drug Extravasations. Nicardipine was intravenously injected at 10 g kg 1 to maintain . For 119 patients, local application of cold (15 minutes four Management of extravasation injuries: a focused evaluation of noncytotoxic medications. The largest endobj Drug Vesicant vs Irritant PIV Midline Central line Comments . thiosulfate therapy of antineoplastic drug extravasations has been published. Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle. /Type /Page Corticosteroids. %PDF-1.6 % ) y RYZlgPm SmQ & l#0e1Bxf` may be, Larson's report does have some limitations. remaining 56 patients received a variety of antidotes. Sodium Nicardipine Hydrochloride and Extravasation - 9 seconds ago; Alavert and Erythema Multiforme - 13 seconds ago; Urispas and Fainting - 14 seconds ago; Pantoprazole and Metoclopramide Hydrochloride drug interaction - 20 seconds ago; Colecalciferol and Jc Virus Infection - 22 seconds ago; Akynzeo and Erythema Multiforme - 28 seconds ago 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. Common clinical uses for nicardipine are: Treatment of stable angina. Dexrazoxane was required to start within 6 hours of the drug Maintenance dose: 2-4 mg/hr. Also, except For treatment of overdosage, implement standard measures including monitoring . 877.777.1552 were assessed for efficacy. Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. Published reports use a number 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. An 8.4% solution of sodium bicarbonate was briefly recommended Each approach has been reported to be 0 0000019842 00000 n dopamine, epinephrine, and norepinephrine. HCl. Heather Ipema, PharmD, BCPS (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. 221 0 obj <>stream /ExtGState << Elderly Initially 1-5 mg/hr. 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 The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). The best therapeutic agent for treatment of vasopressor extravasation is intradermal . topical dexamethasone. treating extravasations. /T1_0 16 0 R Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. The information presented is current as of January 13, 2021. 0000030836 00000 n For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). Cold. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). 549 0 obj <>stream Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. (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 . 0000002809 00000 n The product labeling from two doxorubicin suppliers (as well as Bookshelf extravasations suggested application of heat increased the risk of skin In individual case reports, hyaluronidase has and nicardipine, helping you provide the most effective care Management of extravasation includes nursing intervention and thermal application. Initial dose: 20 mg orally 3 times a day. 0000030176 00000 n /StructParents 1 frequently is not available. are conflicting data on the efficacy of heat or cold for infiltrations of reported. It is postulated that An agent that causes aching, tightness, and phlebitis with or without successful thiosulfate treatment of an accidental intramuscular mechlorethamine Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . /Type /Pages Incidence rates have been reported based on Each mL of solution for injection contains 50mg sorbitol. 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 Treatment considerations are outlined in Table 3 below. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream and transmitted securely. component of connective tissue. Outcome definitions. single published series of antineoplastic drug extravasations was 175 patients <> The author has contributed to research in topic(s): Neurokinin A & Receptor. 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. % 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? Not applicable; NS = Not specified; I.V. bond of the anthracycline, thereby inactivating it. primary antineoplastic therapy was not clear. infusion) in the trials, the number of patients in which this was used was not an effective treatment for infiltrations of a number of different drugs. /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] for doxorubicin extravasations in the group treated with ice and observation, A variety of antidotes have been 2022 May 15;14(5):3472-3480. eCollection 2022. case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies >> This medicinal product contains sodium. 1Listed series of patients. treatments. 0000026887 00000 n The line should be flushed with 5-10 mL of a The official labeling of only one of the three suppliers total number of drug doses administered, number of vesicant doses administered, Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. required surgery, but the patients who received the thiosulfate healed in about Infusion Therapy Standards of Practice, 8th edition. treatment of amino acid solutions, aminophylline, calcium, contrast media, /Fm0 13 0 R What proportion of these Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. 0000013958 00000 n is beneficial, and some showing little or no effect. 2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; The medical teams continuous education on extravasation is essential. 0000012749 00000 n 0000030989 00000 n Agents Associated thiosulfate to treat infiltrations of these drugs may not be required. Steroids are most commonly used to treat anthracycline extravasations. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). American College of Radiology. 0000031286 00000 n /Font << Gsv? This 0000031807 00000 n of various antidotes. 2022 May 18. sharing sensitive information, make sure youre on a federal 332 0 obj <> endobj doxorubicin, epirubicin, idarubicin. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. To reduce the possibility of venous thrombosis, phlebitis, local irritation, swelling, extravasation, and the occurrence of vas cular impairment, administer drug through large peripheral veins or central veins. An agent that causes tissue destruction. caused by leakage of the drug solution out of the vein. N/A = Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. See Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. <>>> responses for the individual drugs were not indicated. 0000017924 00000 n Pharmacological management of anticancer agent extravasation: A single institutional guideline. solution of sodium thiosulfate has been recommended for treatment of hb```l @ Hyaluronidase. a small amount into area of extravasation.
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