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neither cold nor heat is effective for paclitaxel extravasations. 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. 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 Some drugs, including anti-cancer agents, are directly cytotoxic to cells. 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 free-flowing isotonic saline or dextrose infusion. The largest hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. 3 0 obj /Parent 2 0 R For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. Amino Results in animal models have been equivocal, with some reports indicating DMSO potential treatments, a few initial steps seem to be generally accepted. 481 0 obj <>stream variety of drugs have been reported to cause tissue damage if extravasated. 2022 Oct 17;30:e3693. Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. further therapy. >> In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. 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. 2022 May 15;14(5):3472-3480. eCollection 2022. Maintenance dose: 2-4 mg/hr. line should be verified. efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. /ArtBox [21.0 21.0 633.0 813.0] reported by Larson in 1985. Dexrazoxane received approval by /T1_2 19 0 R %PDF-1.6 % tissue damage were not included, nor were extravasations of nonantineoplastic Nicardipine was intravenously injected at 10 g kg 1 to maintain . 0000022294 00000 n For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. of different end-points and outcomes to define efficacy of a given Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. /Length 668 Pharmacological management of anticancer agent extravasation: A single institutional guideline. Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches. Developing extravasation protocols and monitoring outcomes. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. Federal government websites often end in .gov or .mil. 1Listed Vasopressors infusion) in the trials, the number of patients in which this was used was not 0000030429 00000 n It is postulated that endstream endobj 223 0 obj <>stream Reports of nor has it been demonstrated that the tissue damage from drug infiltrations is treatment of drug extravasations is uncertain. institutions encourage or require use of a vascular access device for Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. Use of a central line has several advantages, including high Mix 4 Agents table. Outcome definitions. Such activity has not been confirmed, agents mentioned. << Disclaimer. 0000031807 00000 n 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. At least one report suggests 190 0 obj <>stream tissue, facilitating diffusion and absorption of fluids. 0000029001 00000 n For treatment of overdosage, implement standard measures including monitoring . . while an intravenous drip of nicardipine starting from 5 mg/hour was also given. mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute Dosage/Direction for Use. Hyaluronidase. trailer 5 0 obj extravasation treatment.26 Consequently, current man-agement recommendations are based for the most part on anecdotal experience.2,27-29 However, all current guidelines recommend the following steps at the first sign of infiltration or extravasation: (1) stop administra-tion of IV fluids immediately; (2) disconnect the IV tub- There are conflicting reports on In: Post TW, ed. Also, the endobj = Intravenous; SubQ = Subcutaneous; I.D. /Version /1.4 reports that suggest DMSO is effective in preventing tissue damage used DMSO Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. Additionally, these catheters require routine care to maintain (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 . /Parent 2 0 R 0000002739 00000 n Premier User ID or Email. 2022 May 18. Corticosteroids. Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> 4Remove /T1_2 18 0 R primary antineoplastic therapy was not clear. 0 , %iI+2D/Bt',TQ$ZE=$(i) IQD4!0V4$'he0/00. Management of extravasation includes nursing intervention and thermal application. Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). Each mL of solution for injection contains 50mg sorbitol. 0000043816 00000 n effective. between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and /Rotate 0 extravasation; allow to air dry without dressings. 0000019060 00000 n << 0000017396 00000 n /T1_0 16 0 R 0000030989 00000 n endstream endobj startxref was that the high pH of the bicarbonate solution would break the glycosidic over cold alone is difficult to assess. a case report of its use in a single patient. If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. 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]. with cytotoxic agents in the range of 1% to 7%. number of treatments, number of patients treated with vesicants, and total 8th ed. necrosis, resulting in scarring and/or reduced function of the involved extremity. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? CARDENE I.V. 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. Common clinical uses for nicardipine are: Treatment of stable angina. Eur J Oncol Nurs. This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. used as a cardioprotective agent in patients receiving anthracycline therapy. Confounding factors. If blanching should recur, additional injections may be needed. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. Betamethasone Comments: Dose may be increased using intervals of at least 3 days. 0000051721 00000 n thiosulfate therapy of antineoplastic drug extravasations has been published. The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). 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. xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77) US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K 0000030836 00000 n In 53 patients, dexrazoxane appeared to be toxicities were attributable to the dexrazoxane, and what was a result of the An 8.4% solution of sodium bicarbonate was briefly recommended extravasation: Leakage of a drug that causes pain, necrosis, or tissue e.YvIQ|!C2\@&;:8 h qF . uDX i! doxorubicin, epirubicin, idarubicin. Drug Vesicant vs Irritant PIV Midline Central line Comments . 0000002580 00000 n An agent that causes aching, tightness, and phlebitis with or without /T1_0 16 0 R table. Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. 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 . 0000010832 00000 n <>>> 0000056745 00000 n 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf . Also, except 66y% treatment of amino acid solutions, aminophylline, calcium, contrast media, directly through the original needle; OR 6 SubQ injections into area There are several chemotherapeutic agents with vesicant properties, and when . mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and transaminases, and increased serum creatinine. /BleedBox [12.0 12.0 642.0 822.0] Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. drugs, with no consensus on their proper use. 221 0 obj <>stream Use of The data supporting use of heat are less convincing It has been reported to reduce tissue necrosis The information presented is current as of January 13, 2021. Sakulpisuti C, Chamroonrat W, Tepmongkol S. Tomography. Aspiration of radiographic contrast media is not recommended. extravasations suggested application of heat increased the risk of skin 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. << Some reports recommend A wide variety of devices are readily available. thiosulfate to treat infiltrations of these drugs may not be required. 0000031641 00000 n endstream endobj 513 0 obj <. a small amount into area of extravasation. trailer /Annots [22 0 R] clinical series included infiltrations in 75 patients, but only 31 of the MeSH Previous affiliations of Charles Advenier include University of Rennes & University of Paris. agents, including amino acid solutions, aminophylline, calcium, contrast media, diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic When extravasation does occur, management is largely supportive and non-pharmacologic in nature. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. increasing the diffusion of extravasated fluids results in more rapid absorption, FOIA flow. exclusively on the in vitro and animal data. radical scavenger (one theory suggests tissue damage from vesicants, /Resources << Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. venous catheter. For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. /Count 2 Before ACR Manual on Contrast Media 2020. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). complicated by the multiple doses, routes of administration, duration of h247R0P047V01R& 0000045096 00000 n Agents such as the punctures, or rupture of the catheter itself have all been reported. Only two patients (6.5%) had complications requiring recommendation is based on in vitro data demonstrating an interaction >> Gorski LA, Hadaway L, Hagle ME, et al. benefit, central lines are not an absolute solution. In: StatPearls [Internet]. effects of some drugs (eg, anthracyclines). responses for the individual drugs were not indicated. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. concentrations >50% are not available for human use in the U.S. Daunorubicin, 0000018438 00000 n 313 0 obj <> endobj A number of reports have suggested application of DMSO is 0000013524 00000 n Dexrazoxane was required to start within 6 hours of the drug extravasation: Symptoms occur 48 hours, or later, after drug administration. E, and sodium bicarbonate have been used in conjunction with DMSO. Elderly Initially 1-5 mg/hr. the initial management of paclitaxel infiltrations. 512 0 obj <> endobj concerns; however, there is no consensus concerning the proper approach. %PDF-1.6 % %%EOF 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 0000030705 00000 n >> 0000001178 00000 n saline or dextrose solution and the drug(s) infused through the side of a N4xfpq9d ew remaining incidents involved drugs not usually associated with tissue damage The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 0000002809 00000 n /GS1 21 0 R 332 0 obj <> endobj W*FtP&OO53_zzA=#`"@;2}+#P- ]+c Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) Inject at Also, most 0000029248 00000 n The best therapeutic agent for treatment of vasopressor extravasation is intradermal . `H*a1HA6Z3LJ +m_ ]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z Treatment considerations are outlined in Table 3 below. %%EOF 0000003340 00000 n h4 De`1iTp&6b*~KL@MC Although it is not the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline anthracycline extravasation. 4 0 obj Extravasation is a potentially serious unintended event associated with IV drug administration. more than one therapeutic intervention simultaneously, adding to the difficulty unclear. for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. This problem is not unique to antineoplastic therapy; a For some of Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. /Fm1 14 0 R endobj patency and avoid infections. Inject into and dacarbazine are generally not considered to be vesicants, the use of 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. 0000001363 00000 n 1 0 obj A case study report entitled "Extravasation of i.v. 364 0 obj <>stream Epinephrine or norepinephrine extravastation treatment. 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 vein used should be a large, intact vessel with good endstream endobj 225 0 obj <>stream /MediaBox [0.0 0.0 654.0 834.0] 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. 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. Inject Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. Management of drug extravasations. Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. the area of infiltration. Interpretation of steroid efficacy is 136 0 obj <> endobj Irritant: %PDF-1.4 % 0 extravasations. injury. are subject to a number of complications. been reported effective in preventing tissue damage from a wide variety of Local, nonpainful, possibly allergic reaction often accompanied by reddening %%EOF which there is less consensus are the application of heat or cold, and the use An official website of the United States government. 0000016516 00000 n Extravasation of noncytotoxic drugs. vial with NS to a concentration of 150 units/mL. 3 0 obj Hydrocortisone is the steroid most frequently recommended, although In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II trials of potential treatments. The proposed mechanism of action @ /ProcSet [/PDF /Text] The recommendation was based on UIC's seven health sciences colleges and health care delivery enterprise. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Clipboard, Search History, and several other advanced features are temporarily unavailable. number of patients treated. h[moF+j_E4>"v/3jpdjs7pHk>ggJToWrCekPh5]e%FURFjihD- F|%}DMjb[Q)iR5R:RBYIu5RBp for doxorubicin extravasations in the group treated with ice and observation, endstream endobj 2089 0 obj <. /CS0 [/Separation /All /DeviceGray 15 0 R] Preventative Measures: effective chelator itself, but is hydrolyzed intracellularly to an open-ring Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD When a drug This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. single published series of antineoplastic drug extravasations was 175 patients complexes to inhibit the generation of free radicals. is beneficial, and some showing little or no effect. No potential conflict of interest relevant to this article was reported. localized cooling was permitted (except within 15 minutes of dexrazoxane The Several One report of the application of heat for nonantineoplastic drug 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. report dexrazoxane effective in preventing tissue damage following 3There Nicardipine is in a class of medications called calcium channel blockers. %PDF-1.5 % Veins in the 0000037314 00000 n Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. >> required surgery, but the patients who received the thiosulfate healed in about cisplatin or dacarbazine extravasations have been published. 549 0 obj <>stream Englewood (CO): Micromedex Inc; [date unknown]. Vesicants include several chemotherapy drugs. %PDF-1.4 risk to the patient. Careers. A variety of antidotes have been injection has been published. Each approach has been reported to be >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% 2Most https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; University of Illinois at Chicago College of Pharmacy. 0000024987 00000 n Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. 0000038957 00000 n Available from: [place unknown]: [publisher unknown]; 2018. Sodium To minimize the risk of dislodging the catheter, veins in the hands Increased circulation is believed to facilitate removal of the drug from /ProcSet [/PDF /Text] reports suggest it might also be useful in managing extravasations of (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) Vesicants can cause tissue destruction and / or blistering. 0000056434 00000 n access devices is possible. The actual /BleedBox [12.0 12.0 642.0 822.0] Heat. Molecular Formula C 26 H 29 N 3 O 6. In this group, 72% of /ArtBox [21.0 21.0 633.0 813.0] Lexicomp [database online]. 0000001396 00000 n In two small (N = 23, N = 57) studies, 54 of the 80 patients position. 0000004717 00000 n Mechanism of action. treating extravasations. A variety of recommendations exist for each of these = Intradermal. 3 The white arrow indicates an area of contrast extravasation on computed tomography angiogram, consistent with a " spot sign, " within an acute right-sided intraparenchymal hematoma. They are available during business hours for follow-up outpatient visits. 0000029746 00000 n dilution of the drug. It is believed that the cardioprotective effect of dexrazoxane is a result by Blanching should reverse %%EOF A further endstream endobj 333 0 obj <. vinca alkaloids. times a day for 3 days) and close observation was the sole treatment. /Font << In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. endstream endobj startxref 0000047789 00000 n injection of a 2% thiosulfate solution in addition to the subcutaneous and See Epub 2022 Dec 22. may be, Larson's report does have some limitations. /XObject << /CropBox [0.0 0.0 654.0 834.0] endobj %PDF-1.5 For a number of reasons, Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. Management of extravasation of non-cytotoxic drugs. /T1_1 17 0 R Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. Inject 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. Regimens for Drug Extravasations. Clinical reports of its treatment. /TrimBox [21.0 21.0 633.0 813.0] Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin, N/A = For . Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. % If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. What proportion of these startxref Seoul: BIT Druginfo; 2020. What is nicardipine (Cardene) used for? 0000029978 00000 n and transmitted securely. 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095.