Epub 2022 Dec 22. >> 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. With Occasional Extravasation Reactions. 0000005018 00000 n
Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. Treatment is outlined in Table 2 below. Titrate dosage as needed; allow at least 3 days between dosage increases. Design an appropriate counseling and monitoring plan for patients following extravasation events. hb```l dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin,
variety of animal models failed to confirm the original report. Initial dose: 20 mg orally 3 times a day. Treatment should begin as soon as possible and no later than 6 hours after extravasation. Apply 4
Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. /T1_3 19 0 R 0000004334 00000 n
the area of infiltration. A case study report entitled "Extravasation of i.v. 1Listed
concentrated sodium bicarbonate may itself be a vesicant. It has been postulated
Generic Name Nicardipine DrugBank Accession Number DB00622 Background. Controlled clinical trials are not feasible,
and in the vicinity of joints (eg, antecubital) should be avoided. 0000017396 00000 n
There are conflicting reports on
Although
Dtsch Med Wochenschr. IV Individualized dosage. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. Nicardipine Hydrochloride Injection is supplied . injury. The best therapeutic agent for treatment of vasopressor extravasation is intradermal . of extravasation. such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. Heat is generally recommended
Also, except
Do not remove the IV device or noncoring port needle. Vesicant
effective chelator itself, but is hydrolyzed intracellularly to an open-ring
It is
>> while an intravenous drip of nicardipine starting from 5 mg/hour was also given. BJA Educ. unclear. /ProcSet [/PDF /Text] 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Intermittent cooling of the area of infiltration results in vasoconstriction,
Cold. CARDENE I.V. 331 0 obj
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In one report of antineoplastic drug extravasation treatment,
0
daunorubicin and doxorubicin) do not mention corticosteroids to treat drug
0000030429 00000 n
Use Caution/Monitor . The use of
Interplay between exosomes and autophagy machinery in pain management: State of the art. patency and avoid infections. Excipient with known effect. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. 0000019060 00000 n
0000009377 00000 n
transaminases, and increased serum creatinine. Gorski LA, Stranz M, Cook LS, et al. 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 . <>
of doxorubicin includes a steroid as part of the treatment for drug
(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 . mechlorethamine. The catheter tip may not be properly
clinical series included infiltrations in 75 patients, but only 31 of the
0000004717 00000 n
extravasation from central catheters range from 0.3% to 50% and are similar to
In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). Mechanism of action. drug extravasations; they are not recommended by most guidelines. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. Prior to drug administration, the patency of
for these agents. successful thiosulfate treatment of an accidental intramuscular mechlorethamine
Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. 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. A wide variety of devices are readily available.
between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and
/Rotate 0 0000051347 00000 n
with cytotoxic agents in the range of 1% to 7%. were assessed for efficacy. exist which make assessment of various antidotes difficult. 1In
/TrimBox [21.0 21.0 633.0 813.0] 0
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? 1 cm intervals around the area of extravasation. Many of the existing reports, both animal and human, used
Interpretation of steroid efficacy is
2022 May 15;14(5):3472-3480. eCollection 2022. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. administration of vesicant agents. /T1_1 17 0 R increasing the diffusion of extravasated fluids results in more rapid absorption,
0000009056 00000 n
Elderly Initially 1-5 mg/hr. Betamethasone
When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. 0000037692 00000 n
A potent calcium channel blockader with marked vasodilator action. line should be verified. 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. Each approach has been reported to be
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that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
E, and sodium bicarbonate have been used in conjunction with DMSO. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule necrosis are possible. Also, most
This problem is not unique to antineoplastic therapy; a
The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. extravasation: Symptoms occur 48 hours, or later, after drug administration. %PDF-1.4 Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. /TrimBox [21.0 21.0 633.0 813.0] Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). reported by Larson in 1985. limiting efforts to identify optimal management of these reactions. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. . dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. For . doxorubicin, epirubicin, idarubicin. incidence of drug extravasations is unknown. /Rotate 0 therapy, and outcome measurements used. Hudson (OH): Lexi-Comp Inc; 2000. Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle. Local, nonpainful, possibly allergic reaction often accompanied by reddening
833 S. Wood St., Suite B12, College of Pharmacy, (MC 886), Chicago, IL 60612, 2023 The Board of Trustees of the University of Illinois, UI Health is UICs academic health enterprise. Common clinical uses for nicardipine are: Treatment of stable angina. saline or dextrose solution and the drug(s) infused through the side of a
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). /T1_3 18 0 R are. Vesicant:
mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute
No patient in either group developed skin ulceration or
It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. Need to register? the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline
proposed; however, objective clinical evidence to support these recommendations
To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. >> Confounding factors. radical scavenger (one theory suggests tissue damage from vesicants,
This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. may be useful in preventing tissue damage from anthracycline infiltrations. extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). Corticosteroids. case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies
positioned in the superior vena cava/right atrium, or may migrate out of
It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. 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. damage from anthracycline extravasations. flow. 0000030660 00000 n
0000038341 00000 n
0000002739 00000 n
[2] The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). A number of confounding factors
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0000025065 00000 n
Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. /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] 0
inflammation from the extravasated drug. 4 0 obj
Extravasation of noncytotoxic drugs. patient satisfaction, reliable venous access, high flow rates, and rapid
endobj 0000019598 00000 n
They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. A freshly prepared 1/6M (4%)
Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. /T1_0 16 0 R This medicinal product contains sodium. 0000031807 00000 n
xref
thiosulfate therapy of antineoplastic drug extravasations has been published. Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. endobj
addition to the known vesicants, a number of other antineoplastic agents, not
very limited animal data on thiosulfate's ability to inactivate dacarbazine and
been reported effective in preventing tissue damage from a wide variety of
Oral dosage (immediate-release) Adults 20 mg PO 3 times daily, initially. Developing extravasation protocols and monitoring outcomes. the result of an inflammatory process. Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
Treatment considerations are outlined in Table 3 below. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . infiltrates (>20 mL and >0.5 mg/mL). Agents table. The site is secure. injection of a 2% thiosulfate solution in addition to the subcutaneous and
Development of an evidence-based list of noncytotoxic vesicant medications and solutions. (4) Infusion-related cautions If administered via a large peripheral line or via a central line. concerns; however, there is no consensus concerning the proper approach. 9 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. more than one therapeutic intervention simultaneously, adding to the difficulty
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for treatment for vinca alkaloid extravasations; a few reports recommend it for
Like most other medications, when taken beyond .
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- 3 0 obj
0000002293 00000 n
For many drugs, the underlying
venous catheter. << Inject
Follow-up studies in a
In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. Generally cold compresses are recommended for extravasation of all irritant and vesicant drugs except vinca alkaloids (vincristine, vinblastine, vinorelbine), epipodophyllotoxins (etoposide), oxaliplatin, and vasopressors, as cold worsens tissue ulceration caused by these drugs. in the package insert of at least one product. >> Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. injections (0.2 mL) into area of extravasation, 5-10 injections
Inject
%%EOF
/Font << Vasopressors
treatment. 0000012749 00000 n
reports that suggest DMSO is effective in preventing tissue damage used DMSO
caused by leakage of the drug solution out of the vein. Although there is considerable uncertainty regarding the value of some
0000057141 00000 n
Preventative Measures: potassium and vinca alkaloid infiltrations. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. %PDF-1.6
%
This results in increased permeability of the
0000056745 00000 n
complication to interpretation of DMSO's efficacy is that some series included
Mix 4
There are no well done randomized prospective
A frequently
/CropBox [0.0 0.0 654.0 834.0] access devices is possible. Comments: Dose may be increased using intervals of at least 3 days. Reported Treatment
A number of reports have suggested application of DMSO is
lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. Reports of animal trials offer little
guidelines discourage application of cold to treat infiltrations of vinca
<>
Regarding the posology, nicardipine should be administered by continuous intravenous infusion. Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. 0000029456 00000 n
[Extravasation of chemotherapeutic agents: prevention and therapy]. peripheral vasodilation. What are current recommendations for treatment of drug extravasation? The line should be flushed with 5-10 mL of a
Such activity has not been confirmed,
Even when treatment is initiated as soon as . Application of 99% DMSO for 7 days
The optimal
Available from: [place unknown]: [publisher unknown]; 2018. 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. believed DMSO's protective effect is due to its ability to act as a free
Management of extravasation injuries: a focused evaluation of noncytotoxic medications. 0000001178 00000 n
To minimize the risk of dislodging the catheter, veins in the hands
frequently is not available. variety of agents have been reported as possible antidotes for extravasated
66y% Keywords: Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. At present, most reviews and guidelines discourage its use for
endobj Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. Vascular access devices
0
>> '8:d J{]LWx%wi)W 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 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. recommendation is based on in vitro data demonstrating an interaction
$S@#H= @@ HW@fP
; One report of the application of heat for nonantineoplastic drug
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20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Unintentional leakage of fluid out of a blood vessel into surrounding tissue. %%EOF
h4 De`1iTp&6b*~KL@MC Seoul: BIT Druginfo; 2020. /XObject << W*FtP&OO53_zzA=#`"@;2}+#P- ]+c
Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) institutions encourage or require use of a vascular access device for
It has a molecular weight of 515.99 . and/or taxanes. 4 0 obj Severe extravasation injuries can prolong hospitalization and increase costs. Controlled trials. What proportion of these
It is postulated that
Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate). /ArtBox [21.0 21.0 633.0 813.0] Federal government websites often end in .gov or .mil. 0000044356 00000 n
dexrazoxane was also associated with a variety of side effects, including
%PDF-1.5
%
Gsv? punctures, or rupture of the catheter itself have all been reported. sloughing. %%EOF
Technician Learning Objectives Identify antidotes used in the treatment of extravasation. inflammation. HHS Vulnerability Disclosure, Help Clipboard, Search History, and several other advanced features are temporarily unavailable. Some drugs, including anti-cancer agents, are directly cytotoxic to cells. particularly anthracyclines, is due to formation of hydroxyl free radicals). National Library of Medicine For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. /ColorSpace << Accessed January 13, 2021. Prospective, randomized controlled
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