Available from: Lacy C, American Pharmaceutical Association . and potentially highly morbid, complication of drug therapy is soft tissue damage
effective chelator itself, but is hydrolyzed intracellularly to an open-ring
recommendation is based on in vitro data demonstrating an interaction
Molecular Formula C 26 H 29 N 3 O 6. 313 0 obj
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One report of the application of heat for nonantineoplastic drug
concentrations >90% which is not available for clinical use in the United
This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. HCl. Hudson (OH): Lexi-Comp Inc; 2000. /ProcSet [/PDF /Text] Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. /Type /Page A frequently
The remaining 32 patients received subcutaneous
Keywords: Seoul: BIT Druginfo; 2020. Management of extravasation of non-cytotoxic drugs. startxref
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The report included infiltrations of the vinca alkaloids,
When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. 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. 481 0 obj
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Metoprolol Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Medication Thermal Therapy Antidote Dose Treatment Nitroglycerin Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Norepinephrine Heat Nitroglycerin 2% paste n/a Apply thin layer to area of extravasation q 6 hr x 24 hr For some
damage from anthracycline extravasations. with cytotoxic agents in the range of 1% to 7%. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. hbbd``b`Y Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. Information concerning treatment of
. The information provided on this site, including links to relevant websites and the information contained therein, is for use by health care providers and health care organizations only. Of the patients treated by other methods, only 53% resolved without further
Excipient with known effect. Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . There are no well done randomized prospective
Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. 0
necrosis, resulting in scarring and/or reduced function of the involved extremity. Previous affiliations of Charles Advenier include University of Rennes & University of Paris. Application of 99% DMSO for 7 days
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Some reports discourage its use to treat infiltrations of epipodophyllotoxins
Two issues for
cooling 15 minutes prior to dexrazoxane infusion. and dacarbazine are generally not considered to be vesicants, the use of
Inject
Evidence supporting the use of specific antidotes is limited and largely limited to case reports. N/A =
0000003804 00000 n
0000051347 00000 n
possible to prevent all accidents, a few simple precautions can minimize the
Dosages of Nicardipine Adult dosage Capsule 20mg 30mg Capsule, extended release Note: Cardene SR has not been available in the US for more than a year 30mg 45mg unclear. thereby limiting tissue damage. Maintenance dose: 2-4 mg/hr. %PDF-1.4 %%EOF
/MediaBox [0.0 0.0 654.0 834.0] /Fm1 24 0 R Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. /Type /Page (4) Infusion-related cautions If administered via a large peripheral line or via a central line. hWmo8+8onp">9A!ylTq&fRbpV-SCq9a.LLX#AH&%lSaJH@DIW8bK0(|Z:z8~z]W:i#a`v;&h
.z{ox?w:/nRGq6[>Yk}w5B2|JZOOje|og6 n:g?||TN)6g|R>Pme>9 e>oggK08y 9Kl\^Zx+F9;QqqN?Ewe5F\]CG9Q1C$JW.Z$>l!l[=YRjA^Q{8Y]5c~uQ>@7iWl-6E!nB95E WqDJ=+mjlFs2UOlSFct Q2Vg)SRt1DtqAr? Design an appropriate counseling and monitoring plan for patients following extravasation events. Animal models indicate application of heat exacerbates the
position. which there is less consensus are the application of heat or cold, and the use
/Annots [22 0 R] Treatment considerations are outlined in Table 3 below. 4 0 obj Agents table. injection of a 2% thiosulfate solution in addition to the subcutaneous and
drug extravasations; they are not recommended by most guidelines. /Parent 2 0 R 2 0 obj Use of
HHS Vulnerability Disclosure, Help /ArtBox [21.0 21.0 633.0 813.0] Extant
clinical case reports. 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. administration of vesicant agents. times a day for 3 days) and close observation was the sole treatment. >> 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). 2022 May 15;14(5):3472-3480. eCollection 2022. Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). The use of
flow. 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
Regimens for Drug Extravasations. Need to register? are conflicting data on the efficacy of heat or cold for infiltrations of
alkaloids. effective. /T1_3 18 0 R tissue, facilitating diffusion and absorption of fluids. Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. Most data are from animal studies with relatively few
Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. injections (0.2 mL) into area of extravasation, 5-10 injections
136 0 obj
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The best
0000000016 00000 n
exist which make assessment of various antidotes difficult. Among these
treatment. Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. sloughing. 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- dexrazoxane was also associated with a variety of side effects, including
The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. Inject
/T1_0 16 0 R Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. epipodophyllotoxins and taxanes, although not all guidelines recommend its use
hbbbd`b``3
Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. /Length 668 0000051880 00000 n
. series of patients. 0000027171 00000 n
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Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) They are available during business hours for follow-up outpatient visits. Extravasation of xenobiotics. in the package insert of at least one product. Wang RY. << 3 0 obj
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anthracycline extravasation. Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Even when treatment is initiated as soon as . Inject
the antidotes, the purported mechanism of action of the antidote is also
<< Interplay between exosomes and autophagy machinery in pain management: State of the art. addition to the known vesicants, a number of other antineoplastic agents, not
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2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin
extravasation: Symptoms occur 48 hours, or later, after drug administration. mechanism responsible for the tissue damage is not certain. /T1_3 19 0 R hb```l Sodium
caused by leakage of the drug solution out of the vein. 0000018438 00000 n
0000013524 00000 n
extravasation rates reported from peripheral lines. Intermittent cooling of the area of infiltration results in vasoconstriction,
Rev Lat Am Enfermagem. patency and avoid infections. doxorubicin, epirubicin, idarubicin. /XObject << Additionally, these catheters require routine care to maintain
free-flowing isotonic saline or dextrose infusion. In individual case reports, hyaluronidase has
while an intravenous drip of nicardipine starting from 5 mg/hour was also given. It has a molecular weight of 515.99 . At present, no clinical reports of its efficacy for treating
Apply dry warm or cold compresses as indicated depending on the drug extravasated. for treatment of anthracycline extravasations. endobj /CropBox [0.0 0.0 654.0 834.0] 0000029746 00000 n
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incidence of drug extravasations is unknown. A very wide
/TrimBox [21.0 21.0 633.0 813.0] hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. extravasation does occur, a variety of immediate actions have been recommended. The .gov means its official. 113. >> Treatment is outlined in Table 2 below. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. agents, including amino acid solutions, aminophylline, calcium, contrast media,
report dexrazoxane effective in preventing tissue damage following
Gorski LA, Stranz M, Cook LS, et al. A wide variety of devices are readily available. localized cooling was permitted (except within 15 minutes of dexrazoxane
acid solutions, aminophylline, calcium, contrast media6, dextrose,
concentrations >50% are not available for human use in the U.S. Daunorubicin,
Effect modifiers modalities like nitrate which require continuous were controlled through stratification of age, gender, hemodynamic monitoring and dose adjustment and type of APE and effect of these on outcome variable NIPPV which is costly and technically difficult to use. a small amount into area of extravasation. /Font << /GS0 20 0 R Selective transcatheter arterial embolization . 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf In this group, 72% of
2022 May 18. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. component of connective tissue. extravasations suggested application of heat increased the risk of skin
directly through the original needle; OR 6 SubQ injections into area
cisplatin or dacarbazine extravasations have been published. For a number of reasons,
Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
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e.YvIQ|!C2\@&;:8 h qF . uDX i! Bookshelf Heather Ipema, PharmD, BCPS MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . Prepared by: Development of an evidence-based list of noncytotoxic vesicant medications and solutions. successful thiosulfate treatment of an accidental intramuscular mechlorethamine
/Rotate 0 Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. extravasations is based almost exclusively on animal models, anecdotal
Would you like email updates of new search results? 0000029456 00000 n
8th ed. >> /ProcSet [/PDF /Text] Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. mechlorethamine. If blanching should recur, additional injections may be needed. Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. /Filter /FlateDecode Many of the existing reports, both animal and human, used
2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. /ColorSpace << 0000031286 00000 n
It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. Dimethyl
with 0.9 mL NS for a final concentration of 15 units/mL, 4-5
0
Misplacement/migration of the catheter tip,
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 $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). Unauthorized use of these marks is strictly prohibited. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. reported by Larson in 1985. transaminases, and increased serum creatinine. /Contents 23 0 R Sodium
0000051721 00000 n
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half the time as the patients who received only the steroid therapy. 0000017924 00000 n
For 119 patients, local application of cold (15 minutes four
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. Incidence rates have been reported based on
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the doxorubicin extravasations resolved completely. 9 ACR Manual on Contrast Media 2020. 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 generally considered to be vesicants, have been associated with isolated
Reports of
It has been reported to reduce tissue necrosis
A 2% solution has been recommended
Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. Extravasation of noncytotoxic drugs. forearm (ie, basilic, cephalic, and median antebrachial) are usually good
reported. treatment. 2Most
Nicardipine is in a class of medications called calcium channel blockers. Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . . hbbd```b``
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It controls chest pain by increasing the supply of blood and oxygen to the heart. trials are not practical. 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. Severe extravasation injuries can prolong hospitalization and increase costs. The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. For . /T1_2 18 0 R Infusion Therapy Standards of Practice, 8th edition. 0000030176 00000 n
CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. bDs,T`b!A- j:
used as a cardioprotective agent in patients receiving anthracycline therapy. An agent that causes aching, tightness, and phlebitis with or without
0000056434 00000 n
/MediaBox [0.0 0.0 654.0 834.0] The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). 0000025152 00000 n
Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Avoid extravasation as tissue damage may occur. in adult patients. ^z2>)/3}c va)sSH>j8x:/n-WuqB\*? 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 . table. 5 0 obj 0
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IQD4!0V4$'he0/00. Dexrazoxane was required to start within 6 hours of the drug
/GS1 21 0 R For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. /T1_1 17 0 R the area of infiltration. >> 0000006002 00000 n
Although there is considerable uncertainty regarding the value of some
For treatment of overdosage, implement standard measures including monitoring . fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting,
Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. Confounding factors. Delayed
J Intraven Nurs. vial with NS to a concentration of 150 units/mL. the suppliers of daunorubicin, idarubicin, and liposome-encapsulated
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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. total number of drug doses administered, number of vesicant doses administered,
stream
infiltrates (>20 mL and >0.5 mg/mL). 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. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. frequently is not available. nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. potassium and vinca alkaloid infiltrations. promethazine" can be found in Am J Health-Syst Pharm. inflammation. lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. 0000008312 00000 n
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complications, including erythema, ulceration, pain, tissue sloughing, and
0000038093 00000 n
are. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. Additionally, cold reduces local inflammation and pain. responses for the individual drugs were not indicated. 3 DOSAGE FORMS AND STRENGTHS Extravasation can result in tissue sloughing, pain . paclitaxel, there are conflicting recommendations. . effective, harmful, and of no discernable effect. This problem is not unique to antineoplastic therapy; a
We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. In two small (N = 23, N = 57) studies, 54 of the 80 patients
mechlorethamine infiltrations have been published. and nicardipine, helping you provide the most effective care >> Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. Also, most
The product labeling from two doxorubicin suppliers (as well as
endobj
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0000043816 00000 n
Hydrocortisone is the steroid most frequently recommended, although
vesicant extravasations. recommended precaution against drug extravasation is the use of a central
Max infusion rate: 15 mg/hr. necrosis are possible. line should be verified. endstream
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startxref
Epub 2022 Dec 22. h[moF+j_E4>"v/3jpdjs7pHk>ggJToWrCekPh5]e%FURFjihD- F|%}DMjb[Q)iR5R:RBYIu5RBp 0000029248 00000 n
h\J1_enDRBqAA 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. Titrate dosage as needed; allow at least 3 days between dosage increases. Appointments can be scheduled by calling 651-220-6530. agents mentioned. /Kids [3 0 R 4 0 R] 0000005018 00000 n
https://www.acr.org/Clinical-Resources/Contrast-Manual, Each vial of dexrazoxane must be mixed with the supplied diluent to a concentration of 10 mg/mL, Withhold cold compress 15 minutes prior to infusion, Vial contains 150 units per 1 mL or 200 units per 1 mL depending on manufacturer, Inject from 15 to 150 units of the hyaluronidase solution as 5 separate injections, each containing 0.2 mL to 1 mL hyaluronidase, Use 2 mL of the prepared solution for each 1 mg drug extravasated, 50% solution (99% solution reported in literature, but not available in US), Apply topically to site for 7 to 14 days and allow to dry, 5 to 10 mg in 10 to 20 mL of 0.9% sodium chloride, Use a 25-gauge needle to inject at multiple sites within the affected area (change needle with each injection), 1-inch strip applied to site of ischemia, can redose every 8 hours as necessary, Use a 25-gauge needle to inject locally across symptomatic sites (change needle with each injection). /GS0 20 0 R endstream
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1999; 56:1742-3. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). for doxorubicin extravasations in the group treated with ice and observation,
for these agents. To minimize the risk of dislodging the catheter, veins in the hands
0
institutions encourage or require use of a vascular access device for
epipodophyllotoxins and taxanes. >> Such activity has not been confirmed,
0000019842 00000 n
mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute
Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. A freshly prepared 1/6M (4%)
Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the . several sites surrounding the area of extravasation. [Extravasation of chemotherapeutic agents: prevention and therapy]. The catheter tip may not be properly