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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
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free-flowing isotonic saline or dextrose infusion. The largest
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Results in animal models have been equivocal, with some reports indicating DMSO
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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
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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
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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
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Agents table. Outcome definitions. Such activity has not been confirmed,
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2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. At least one report suggests
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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
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= 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>>
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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
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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)
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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
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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
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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
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/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
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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
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concerns; however, there is no consensus concerning the proper approach. %PDF-1.6
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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
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The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 0000002809 00000 n
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0000029248 00000 n
The best therapeutic agent for treatment of vasopressor extravasation is intradermal . `H*a1HA6Z3LJ +m_
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0000003340 00000 n
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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
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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
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/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
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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
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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
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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
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<. /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
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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
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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
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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``
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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
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<. 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
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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.