a small amount into area of extravasation. 0000002809 00000 n 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 /T1_3 19 0 R neither cold nor heat is effective for paclitaxel extravasations. eCollection 2022. << diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute Extravasation can result in tissue sloughing, pain . /T1_2 18 0 R /CropBox [0.0 0.0 654.0 834.0] Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. treatment of amino acid solutions, aminophylline, calcium, contrast media, 0000030989 00000 n >> Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Careers. administration of vesicant agents. 5 0 obj Veins in the Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. /Contents 23 0 R Vasopressors Sodium 0000008312 00000 n . Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential reports that suggest DMSO is effective in preventing tissue damage used DMSO extravasation does occur, a variety of immediate actions have been recommended. /MediaBox [0.0 0.0 654.0 834.0] over cold alone is difficult to assess. For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. Follow-up studies in a sodium thiosulfate to treat mechlorethamine infiltrations is based almost 0000030453 00000 n 0000017924 00000 n between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and thiosulfate. No potential conflict of interest relevant to this article was reported. 4Remove Selective transcatheter arterial embolization . {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. National Library of Medicine trailer 0000009377 00000 n 0000057141 00000 n /ProcSet [/PDF /Text] exclusively on the in vitro and animal data. American College of Radiology. >> radical scavenger (one theory suggests tissue damage from vesicants, Reported Treatment /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] clinical case reports. extravasation. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. `H*a1HA6Z3LJ +m_ ]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z If blanching should recur, additional injections may be needed. In 89% of the patients The = Intradermal. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. It is suggested that steroids reduce local Questions? responses for the individual drugs were not indicated. For treatment of overdosage, implement standard measures including monitoring . agents, including amino acid solutions, aminophylline, calcium, contrast media, /Length 668 HHS Vulnerability Disclosure, Help 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]. Vesicants can cause tissue destruction and / or blistering. and dacarbazine are generally not considered to be vesicants, the use of tion when administering nicardipine to patients with pheochromocytoma. component of connective tissue. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. 0000030660 00000 n nor has it been demonstrated that the tissue damage from drug infiltrations is Controlled trials. table. 0000027171 00000 n Maintenance dose: 20 to 40 mg orally 3 times a day. startxref Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. injection of a 2% thiosulfate solution in addition to the subcutaneous and in the package insert of at least one agent. 1 0 obj For 119 patients, local application of cold (15 minutes four Nicardipine was intravenously injected at 10 g kg 1 to maintain . the result of an inflammatory process. promethazine" can be found in Am J Health-Syst Pharm. inflammation from the extravasated drug. A variety of antidotes have been Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. 2141 0 obj <>stream Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ Vesicant /Font << Common clinical uses for nicardipine are: Treatment of stable angina. /Pages 2 0 R variety of drugs have been reported to cause tissue damage if extravasated. Mix 4 Other Among these Usual dose: 20 to 40 mg PO 3 times daily. 0000038957 00000 n damage from anthracycline extravasations. Unauthorized use of these marks is strictly prohibited. addition to the known vesicants, a number of other antineoplastic agents, not 2022 May 18. IV nicardipine was as effective as IV nitroprusside in the chelating iron following intracellular hydrolysis. the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline 1999; 56:1742-3. /Count 2 Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) 0000002835 00000 n Preventative Measures: 0000022294 00000 n A number of different treatments, including cold, steroids, vitamin generally considered to be vesicants, have been associated with isolated agents mentioned. endstream endobj 333 0 obj <. It has been postulated >> 0000012749 00000 n /Type /Page injury. In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. mechlorethamine infiltrations have been published. The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. Oral dosage (immediate-release) Adults 20 mg PO 3 times daily, initially. such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. /StructParents 1 It has a molecular weight of 515.99 . vial with NS to a concentration of 150 units/mL. Nicardipine Hydrochloride Injection is supplied . improper placement of the needle in accessing injection ports, and cuts, of various antidotes. However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. 136 55 endstream endobj 314 0 obj <> endobj 315 0 obj <> endobj 316 0 obj <>stream Helpful as it The best Many of the existing reports, both animal and human, used 0000037692 00000 n Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. 0000030429 00000 n Delayed 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. Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. 0000009414 00000 n 2022 May 15;14(5):3472-3480. eCollection 2022. >> >> /ColorSpace << /Resources << Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. University of Illinois at Chicago College of Pharmacy. thiosulfate to treat infiltrations of these drugs may not be required. Thus far, no reports of thiosulfate treatment of believed DMSO's protective effect is due to its ability to act as a free Although Avoid extravasation as tissue damage may occur. was that the high pH of the bicarbonate solution would break the glycosidic concentration, number of applications/day, duration of therapy, and concomitant For many drugs, the underlying patients Extravasation warnings, pH, sodium content, displacement values, . 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. See the Vesicant Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). recommendation is based on in vitro data demonstrating an interaction Vesicant: The treatment for peripheral extravasation is a rapid response with the drug phentolamine. 0000009056 00000 n Hyaluronidase. government site. Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . Treatment considerations are outlined in Table 3 below. 1In 0000029001 00000 n /Rotate 0 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. Englewood (CO): Micromedex Inc; [date unknown]. 0000006002 00000 n bDs,T`b!A- j: Extravasation is a known risk of vesicant administration. At least one report suggests use are extremely difficult to interpret due to variations in DMSO bicarbonate. Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. 364 0 obj <>stream >> Mechanism of action. /Parent 2 0 R An agent that causes tissue destruction. Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. It is Corticosteroids. If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. This Bookshelf extravasations. than for cold. (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. in the package insert of at least one product. incidence of drug extravasations is unknown. 0000056434 00000 n Vesicants include several chemotherapy drugs. Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. 4 0 obj >> ACR Manual on Contrast Media 2020. hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5 Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. even though the literature recommends use of heat to treat these. This medicinal product contains sodium. /CS0 [/Separation /All /DeviceGray 15 0 R] 313 0 obj <> endobj saline or dextrose solution and the drug(s) infused through the side of a options for peripheral infusions. 2108 0 obj <>/Filter/FlateDecode/ID[<79BA663E75301A408346CF53CE9BCBB7><05BE28B3380661489955B8DFD5505C1D>]/Index[2088 54]/Info 2087 0 R/Length 102/Prev 343790/Root 2089 0 R/Size 2142/Type/XRef/W[1 3 1]>>stream /Fm0 13 0 R << Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Some drugs, including anti-cancer agents, are directly cytotoxic to cells. /Rotate 0 Accessibility Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. 2 0 obj 0000017632 00000 n 1 0 obj Molecular Formula C 26 H 29 N 3 O 6. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. >> 3There No large series of extravasations almost 90% of the extravasations treated only with topical cold required no /Version /1.4 Can calcium channel blockers cause edema? Prior to drug administration, the patency of For some To minimize the risk of dislodging the catheter, veins in the hands Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). cisplatin or dacarbazine extravasations have been published. additional information, being plagued by many of the limitations of the of identifying the efficacy of any single approach. Unable to load your collection due to an error, Unable to load your delegates due to an error. Each mL of solution for injection contains 50mg sorbitol. 0000003528 00000 n 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. infiltrates (>20 mL and >0.5 mg/mL). Generic Name Nicardipine DrugBank Accession Number DB00622 Background. venous catheter. injections (0.2 mL) into area of extravasation, 5-10 injections A 27-year-old woman developed severe dyspnea and orthopnea after receiving an of infusion nicardipine 2 mg/hour for 3 days for preterm labor at 27 weeks of . The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). extravasations. /Parent 2 0 R /Fm1 14 0 R 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. Inject The recommendation was based on Titrate dosage as needed; allow at least 3 days between dosage increases. h[moF+j_E4>"v/3jpdjs7pHk>ggJToWrCekPh5]e%FURFjihD- F|%}DMjb[Q)iR5R:RBYIu5RBp Reports of animal trials offer little potential treatments, a few initial steps seem to be generally accepted. Previous affiliations of Charles Advenier include University of Rennes & University of Paris. trials of potential treatments. 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. /TrimBox [21.0 21.0 633.0 813.0] 0000029456 00000 n Pharmacological management of anticancer agent extravasation: A single institutional guideline. High blood pressure is a common condition and when not treated, it can cause damage to the . >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% Several [2] 0000029248 00000 n 0000010698 00000 n Phentolamine. 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. The site is secure. Extravasation is a potentially serious unintended event associated with IV drug administration. 0000051347 00000 n Heather Ipema, PharmD, BCPS 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. primary antineoplastic therapy was not clear. <> 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; 0000001694 00000 n epirubicin, vinblastine, mitomycin. of different end-points and outcomes to define efficacy of a given . %PDF-1.4 Although there is considerable uncertainty regarding the value of some A frequently Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. complications, including erythema, ulceration, pain, tissue sloughing, and N4xfpq9d ew complicated by the multiple doses, routes of administration, duration of tissue, facilitating diffusion and absorption of fluids. /Font << It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. 0000056745 00000 n epipodophyllotoxins and taxanes. extravasations is based almost exclusively on animal models, anecdotal European Oncology Nursing Society extravasation guidelines. Amino 0000025065 00000 n Results in animal models have been equivocal, with some reports indicating DMSO Drug Vesicant vs Irritant PIV Midline Central line Comments . Clinical reports of its 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. https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. 0000031641 00000 n caused by leakage of the drug solution out of the vein. ^z2>)/3}c va)sSH>j8x:/n-WuqB\*? Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. pH: 2.5-3.6 Extravasation: may cause tissue damage Do not flush Albumin 4.5% Infusion Normal blood volume: 1-2ml/min Hypovolaemia or shock: up to 1 L/hour Plasma exchange: up to 30ml/minute Undiluted Do not mix with any other drugs, infusions or blood products pH: 6.7-7.3 Do not use if turbid or contains a deposit Monitor: rarely allergic . trials are not practical. This results in increased permeability of the Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. Apply dry warm or cold compresses as indicated depending on the drug extravasated. It has been reported to reduce tissue necrosis For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. Prepared by: topical dexamethasone. treatment. One report of the application of heat for nonantineoplastic drug case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies A potential, effective. Appendix A Extravasation work flow algorithm non-chemotherapy. The use of dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, Dimethyl epipodophyllotoxins and taxanes, although not all guidelines recommend its use infusion) in the trials, the number of patients in which this was used was not 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. /Resources << '8:d J{]LWx%wi)W effective, harmful, and of no discernable effect. Keywords: endobj 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. complexes to inhibit the generation of free radicals. vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the 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. thereby limiting tissue damage. >> required surgery, but the patients who received the thiosulfate healed in about 0000030836 00000 n mechanism responsible for the tissue damage is not certain. An agent that causes aching, tightness, and phlebitis with or without Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. 0000001396 00000 n >> half the time as the patients who received only the steroid therapy. A very wide concerns; however, there is no consensus concerning the proper approach. %PDF-1.6 % Development of an evidence-based list of noncytotoxic vesicant medications and solutions. It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. epipodophyllotoxins and taxanes which are occasionally associated with soft for doxorubicin extravasations in the group treated with ice and observation, Severe extravasation injuries can prolong hospitalization and increase costs. 0000051721 00000 n The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Since cisplatin and in the vicinity of joints (eg, antecubital) should be avoided. Please enable it to take advantage of the complete set of features! doxorubicin, epirubicin, idarubicin. 0000003340 00000 n frequently is not available. Need to register? official website and that any information you provide is encrypted Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution.2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. endobj Do not remove the IV device or noncoring port needle. 332 33 When a drug were assessed for efficacy. 2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin 9 It is postulated that /XObject << Application of heat results in a localized vasodilation and increased blood 0000031286 00000 n stream Controlled clinical trials are not feasible, Although it is not Misplacement/migration of the catheter tip, /TrimBox [21.0 21.0 633.0 813.0] The author has contributed to research in topic(s): Neurokinin A & Receptor. %PDF-1.5 481 0 obj <>stream 0000003804 00000 n Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. The largest Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. reports of tissue damage following extravasation. endstream endobj 2089 0 obj <. 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 1998 Jul-Aug;21(4):232-9. 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. limiting efforts to identify optimal management of these reactions. $S@#H= @@ HW@fP ; 512 0 obj <> endobj endstream endobj 513 0 obj <. In: Post TW, ed. Cardene I.V. <<87F8C058794F5343A166C2C321944EFD>]>> transaminases, and increased serum creatinine. endstream endobj 223 0 obj <>stream 0000002580 00000 n Federal government websites often end in .gov or .mil. Whether the addition of DMSO represented a real improvement treatment of drug extravasations is uncertain. It may also inhibit the local 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. 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 There are no well done randomized prospective 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. In two small (N = 23, N = 57) studies, 54 of the 80 patients extravasation rates reported from peripheral lines. f e.YvIQ|!C2\@&;:8 h qF . uDX i! A further It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. The Unintentional leakage of fluid out of a blood vessel into surrounding tissue. for treatment for vinca alkaloid extravasations; a few reports recommend it for There are a variety of treatments that have been reported in the literature. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. /StructParents 0 L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2 alkaloids. Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. reported by Larson in 1985. 0000016516 00000 n Increased circulation is believed to facilitate removal of the drug from
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