We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. Caution: excessive cold can cause tissue damage. 2018 Apr 19;6(4):e1743. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. Treatment of cutaneous injuries of neonates induced by drug extravasation with hyaluronidase and hirudoid. Gorski LA, Hadaway L, Hagle ME, et al. Heat - 15 to 20 minutes at a time for at least four times per day for 24 to 48 hours. Management of Chemotherapy Extravasations - U.S. Pharmacist 15 to 20 minutes at a time for at least four times per day for 24-48 hours, warm compresses for 30 to 60 minutes, then alternate off/on every 15 minutes for 1 day, 15 to 20 minutes at a time for at least four times per day for 24 hours. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. Midline catheters differ from other VADs with regard to their insertion and termination sites.1,3Midline catheters are inserted peripherally into the antecubital fossa or upper arm via the basilic, cephalic, or brachial vein, and extend from 8 to 20 cm centrally, where the catheter tip terminates at or below the axillary vein. Email ONSs clinical inbox at clinical@ons.org to reach one of our oncology clinical specialists, who can advise on ONS recommendations, best practices, and evidence support. Oncology Nursing Society releases updated guidelines on - Healio Flare reaction: A skin reaction to a medication which is an allergic response. Vesicant & irritant chemotherapy - A Hematology Oncology Wiki Except as expressly stated on this site or as otherwise permitted by applicable law, no content on this site may be used or reproduced without the permission of the copyright holder. Disclaimer. 8}-Fb}" "R5xPQ%Flm^%/jV
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2016 Feb 10; 7(1): 8797. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. Eur J Oncol Nurs. Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. (K k0|hzv 6gN5UzVa+91C+yTOOcV^t^IjpiOROeutcI9GOqs'."XA*c2@GfK!rKP;{4?|h=,G _wyNdfSc#A]LHq#@Gtn[YWk%1o*Bbyk'82h6~IOvvi2`6 Extravasation of noncytotoxic drugs. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Determinations regarding the administration of drugs via midline catheter should consider properties of each drug individually because no definitive guidance is available to list the appropriateness of all drugs. What are current recommendations for treatment of drug extravasation? Always double check information at the primary references linked below. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. The flush line can be used before, during, and after the infusion to verify line patency and blood return for a flush solution if the chemotherapy must be stopped because of an adverse reaction. PDF Antineoplastic Drug Administration: Vesicant and Irritant Agents 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Although relevant guidelines and policy statements existed (e.g., OSHA'sControlling Occupational Exposure to Hazardous Drugs, Chapter 2: Safe Handling of Chemotherapy Drugs, the ONSChemotherapy and Biotherapy Guidelines and Recommendations for Practice, ASCO'sCriteria for Facilities and Personnel for the Administration of Parenteral Systemic Antineoplastic Therapy), specific requirements to promote patient safety had not been well-defined by key stakeholders. 2016 Updated American Society of Clinical Oncology/Oncology Including Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital 1 The https:// ensures that you are connecting to the Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. Rev.12/2/2014. Once the infusion is complete, the short set is dropped to backfill the line with saline and then the remaining drug is infused. Package insert for vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial. Another option is to aspirate with a syringe via the lowest Y-site and clamp off fluid from the minibag. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Intravascular catheter-related infection (BSI). Preventing and Managing Vesicant Chemotherapy Extravasations Rev. 2. 2008 Sep;12(4):357-61. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. 3/26/2014 5. 1990 Mar;4(1):41-60. doi: 10.1016/0268-960x(90)90015-k. Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. National Library of Medicine For primary infusions, the agents should be administered by direct connection to the access site using primary tubing, a Luer lock connection should be used, and a compatible IV flush solution should be readily available for emergent administration issues and to clear the line after completion. PDF Vesicant Chemotherapy Extravasation Antidotes and Treatments - ResearchGate 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET 2012;18(1):155-7. The Hospira Brand of vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial package insert2 states: 2006;12(2):113-8. MeSH Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Patients often seek explanations for why their extravasations occurred. Trissel LA. 2. Answer:In regard to duration of administration: It is true that the process of administering a vinca alkaloid via a syringe is probably of shorter duration when compared to administering via a minibag. Central VADs may also be more appropriate in patients needing longer-term therapy.3 Although some evidence has supported lower thrombosis risk with midline catheters compared with CVCs,1 a recent systematic review of 12 studies in 40,871 patients found that risk of venous thromboembolism was significantly higher with a midline catheter compared with a PICC (3.97% versus 2.29%; relative risk, 1.53; 95% CI, 1.33 to 1.76; p<0.00001).4 However, evidence evaluating the risk of catheter-related bloodstream infections (CRBSI) continues to find similar or improved rates of infection with midline catheters compared with PICCs.5, Compared with midline catheters, peripheral IV catheters are inserted more distally and most often utilize veins of the dorsum of the hand for cannulation.1-3Peripheral IV catheters have high first-attempt failure rates (26% in adults, 54% in children) and often require recannulation in larger more proximal sites.1,2Therefore, midline catheters may reduce the need for recannulation and thereby afford a longer dwell time. Do not pinch the IV administration tubing because this can cause the vein to rupture. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. Tubing features can present another challenge when considering how to best administer chemotherapy agents. Reference: 1. In order from most likely to least likely to cause damage when extravasation occurs: vesicants (most likely), exfoliants, irritants, inflammitants, and neutrals (least likely). Answer:For those patients who do not have a PICC or central venous access device, a peripheral IV line can still be used to administer vinCRIStine in a minibag. Centers for Disease Control and Prevention. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. 3 0 obj
2014;(Epub ahead of print). Lastly, they recommend avoidance of midline catheters in patients with a history of thrombosis, hypercoagulability, venous stasis, or with a need to preserve vein integrity, such as in patients with end-stage renal disease. Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into affected area in a pinwheel fashion. Oncol Nurs Forum. The practice of monitoring the administration of vinCRIStine and other vinca alkaloids in a minibag to avoid extravasation via a peripheral IV is essentially the same as if it was administered IV push. Epub 2014 Jul 3. Managing Vesicant Extravasations | The Oncologist | Oxford Academic %PDF-1.7
Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Conclusion Exfoliants:An agent that is capable of causing inflammation and skin shedding, but less likely to cause tissue damage. Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. Oncologist. 1,2 Recognize that when a vinca alkaloid is prepared in a minibag, it is likely more dilute than in a syringe, and thus the impact of tissue injury is even less if extravasation should occur. Additionally, the risk of cytotoxicity is reduced by intermittent compared with continuous infusion, as well as by dilution of vancomycin to concentrations of 2 to 5 mg/mL. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. Click to reveal J Oncol Pharm Pract. Pittsburg, PA: Oncology Nursing Society; 2014. No formal recommendation, but depending on clinical condition could consider extrapolating from management of other vinca alkaloids: Apply cold pack initially for 30 to 60 minutes, then repeat every 15 minutes on day 1 only. Reference: 1. Secondary infusions are safest administered with the use of secondary tubing attached with a Luer lock connector to the primary line containing a compatible IV solution. This review provides an overview of midline catheters and a summary of properties that influence the determination of whether a drug is appropriate for administration via midline catheter. Ryan Rodriguez, PharmD, BCPS Hyaluronidase may be used in extreme scenarios such as large volume extravasation or severe irritation. government site. Accessibility 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. What are other facilities doing to avoid excessive drug loss in the tubing? Midline catheters represent a unique vascular access device (VAD) for patients requiring intravenous (IV) administration of drugs or other infusates.1,2After their introduction in the 1950s, hypersensitivity and phlebitis reactions to the manufacturing materials led to a temporary decline in the use of midline catheters through the 1990s; however, a redesign of these products in recent years has led to their renewed adoption. Access to this article is restricted. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Clin J Oncol Nurs. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Depending on treatment complexity, ONS's Chemotherapy and Biotherapy Guidelines and Recommendations for Practice state that chemotherapy agents being administered by infusion "may be connected directly to the IV catheter or to a line of compatible maintenance solution." Infusion therapy standards of practice. Overview, prevention and management of chemotherapy extravasation. Extravasation injury from chemotherapy and other non - UpToDate Minor updates to administration and patient education. Vesicant Administration Guidelines 1. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. The vinCRIStine is infused via gravity through the peripheral line. 1. This decision must be weighed in light of certain death if the drug is administered via the wrong route. Rev. Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. Pediatr Rep. 2012 Aug 1;4(3):e28. Antidotes to vesicant chemotherapy extravasations. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. Blood Rev. 2088 0 obj
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If chemical phlebitis occurs, consideration should be given to the need for alternative vascular access, an alternative medication, a slower infusion rate, or further dilution of the medication.6. 8600 Rockville Pike The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. Clipboard, Search History, and several other advanced features are temporarily unavailable. The 2008 European Oncology Nursing Society extravasation guidelines[ recommend this management for the following medications: From HemOnc.org - A Hematology Oncology Wiki, Chemotherapy vesicant & irritant properties and suggested management for extravasation, "Localize and neutralize" or "disperse and dilute". The main consideration in determining whether a drug is appropriate for administration via midline catheter is its propensity for causing phlebitis.2Phlebitis is inflammation of a vein caused by damage to the tunica intima, which may be accompanied by erythema, swelling, pain, heat, and a palpable cord if thrombosis is present. Cold (different suggestions for anthracyclines depending on reference): (off-label, based on general management strategies for anthracyclines), Cold - 15 to 20 minutes at a time for at least four times per day for 24 hours, Irritant or neutral, depending on reference, Cold - Every 8 hours for 3 days; if using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate, Vesicant/Irritant (depending on reference). One randomized controlled trial found that the incidence of total complications, phlebitis, and thrombosis did not significantly differ when vancomycin was administered for less than 6 days via midline catheter versus PICC.3,14. Dosing Guidelines for Drugs Used to Manage Extravasations: Dexrazoxane: 1000mg/m2 (maximum dose= 2000mg/day) by intravenous infusion on days 1 and 2, followed by 500mg/m2 (maximum dose = 1000mg/day) by intravenous infusion on day 3. 3/26/2014, 4. Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. 4. Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. ASCO/ONS Chemotherapy Administration Safety Standards Eur J Oncol Nurs. Bookshelf This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. Reference If using a peripheral vein, allow the infusion to flow via gravity. Vesicants and irritants with vesicant . J Oncol Pharm Pract. Heat - Apply warm compresses to extravasation site for 1 hour. Find the answers to questions regarding symptoms, side effects, and more. Avoid the "blame game.". Best Practice #1 FAQ | Institute For Safe Medication Practices Ex: Name & date of birth 2. Calcium Chloride. Nurses, Chemotherapy, and Pregnancy: What Do We Know? 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . 3. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. 4 0 obj
Nonetheless, a review of literature of known vesicants and drugs reported to cause vascular injury or extravasation indicates some drugs that may present higher risk when administered via midline catheter. This section focuses on drug administration, including cycle definition (which contains the cycle length, number of cycles, and other schedule-related information), dosing, frequency, and routes of administration. Handbook of Injectable Drugs 17th Edition. Additionally, patient mobility is greater with midline catheters because of the location of their insertion site.2 Lastly, compared with drug administration via peripheral IV catheter, the risk of phlebitis may be reduced with administration via midline catheter because of its termination in an area with a higher rate of blood flow.2The rates of CRBSI have also been reported to be lower with midline versus peripheral catheters (0 to 0.2 versus 0.5 per 1,000 catheter days).1, Overall, the properties of midline catheters may make them preferable for specific durations of therapy. Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. Your IP: <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>>
In general--aside from the exceptions listed below--keeping the extravasation cold is preferable to cause vasoconstriction, to prevent spread of the medication, and to decrease inflammation/pain. Managing Extravasation During Chemotherapy Administration
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