Rev. In general--aside from the exceptions listed below--keeping the extravasation cold is preferable to cause vasoconstriction, to prevent spread of the medication, and to decrease inflammation/pain. David V, Christou N, Etienne P, et al. Accessibility Sodium Chloride. endobj Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment information, and advocated for patient care, all in an effort to improve the quality of life and outcomes for patients with cancer and their families. The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. endobj Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. There are non-chemo medications and solutions that have vesicant properties as well and can cause extravasation. Rev. These medications are generally considered to be unlikely to cause injury when extravasation occurs: These medications are generally described as causing mild to moderate inflammation when extravasation occurs. 4. When the institution implements the use of minibags to administer vinCRIStine, the following nursing guidelines should be followed to further reduce the risk of harm from extravasation. References and bibliography updated. Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. 2023 Institute for Safe Medication Practices. Rev. Copyright 2023 Oncology Nursing Society. The site is secure. Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. Preparation for flexible plastic container VinCRIStine sulfate injection, USP when diluted with 0.9% sodium chloride injection in concentrations from 0.0015 mg/mL to 0.08 mg/mL is stable for up to 24 hours when protected from light or 8 hours under normal light at 25C. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. References: 1. The action you just performed triggered the security solution. Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. Tubing features can present another challenge when considering how to best administer chemotherapy agents. Irritants and Vesicants Guide to Intravenous Administration via Midline Catheters . MeSH An official website of the United States government. Lastly, they recommend avoidance of midline catheters in patients with a history of thrombosis, hypercoagulability, venous stasis, or with a need to preserve vein integrity, such as in patients with end-stage renal disease. Prevention is the most important approach to extravasation management. An official website of the United States government. MeSH Eur J Oncol Nurs. Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. PMC Trissel LA. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. Overview, prevention and management of chemotherapy extravasation. 6. References: 1. Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. Gilbar PJ. Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. Eur J Oncol Nurs. To discuss the information in this article with other oncology nurses, visit the ONS Communities. This section focuses on drug administration, including cycle definition (which contains the cycle length, number of cycles, and other schedule-related information), dosing, frequency, and routes of administration. 1998 Jul-Aug;21(4):232-9. Boulanger J, Ducharme A, Dufour A, et al. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. Answer: To prevent excessive drug loss, some organizations are utilizing a back flushing method to infuse the remaining volume of drug that may remain in the IV tubing. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. University of Illinois at Chicago College of Pharmacy. Pittsburg, PA: Oncology Nursing Society; 2014. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. Section V: Immediate Complications of cytotoxic therapy, p.105. Additionally, the risk of cytotoxicity is reduced by intermittent compared with continuous infusion, as well as by dilution of vancomycin to concentrations of 2 to 5 mg/mL. Rev. The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. All rights reserved. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. Performance & security by Cloudflare. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. No formal recommendation, but depending on clinical condition could consider extrapolating from management of other vinca alkaloids: Apply cold pack initially for 30 to 60 minutes, then repeat every 15 minutes on day 1 only. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. <> x][8~Gi"K6$Yd cG_")X=@zdbXb"f]FyMQrt2i[Fl')o:{pO^}~[~9>aP,p"yKxb}t+~{x:?OA9?tvK:0+M*7y wg|[]okN(6cw1gQX$|6x5Q^Xn{~(8klFaL8?k|9}YjO"?}M8OC?}T-Qezi^D1@olKSw8E[D7:z,eQ,rY!'HT|9,}O$. 2006;12(2):113-8. Bookshelf Avoid continuous vesicants or irritants (chemotherapy, vasopressors) . Reviewed electronically by nursing reference committee. Pediatr Rep. 2012 Aug 1;4(3):e28. References: 1. Oncologist. 2141 0 obj <>stream Determinations regarding the administration of drugs via midline catheter should consider properties of each drug individually because no definitive guidance is available to list the appropriateness of all drugs. Please enable it to take advantage of the complete set of features! Development of an evidence-based list of noncytotoxic vesicant medications and solutions. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Question:Wouldnt the administration of vinCRIStine IV push using a syringe be much shorter in duration and with less chance of extravasation than administration using a minibag? 866-257-4ONS (866-257-4667). American College of Radiology. Depending on treatment complexity, ONS's Chemotherapy and Biotherapy Guidelines and Recommendations for Practice state that chemotherapy agents being administered by infusion "may be connected directly to the IV catheter or to a line of compatible maintenance solution." A similar sized bag for the back flushing, such as a 25 mL bag of 0.9% saline is used for both adults and pediatric patients. Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. Due to some references not using this classification, the only drugs listed in this section are ones which were unclassified by some resources, yet classified by others as inflammitants. 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. Cold (different suggestions for anthracyclines depending on reference): (off-label, based on general management strategies for anthracyclines), Cold - 15 to 20 minutes at a time for at least four times per day for 24 hours, Irritant or neutral, depending on reference, Cold - Every 8 hours for 3 days; if using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate, Vesicant/Irritant (depending on reference). This page was last edited 14:24, 26 April 2023 by. Rev.12/2/2014. Use VADs for vesicant administration, continuous infusions of vesicants, anticipated long-term administration of chemotherapy, poor venous access, and for children or older adult patients.a,b Ensure clear visualization of the site throughout the infusion. Version number changed to v.5. The ASCO/ONS Chemotherapy Administration Safety Standards are intended to reduce the risk of error when providing adult patients with chemotherapy, and to provide a framework for best practices in cancer care. 2009]. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. 2. The procedure includes connecting the bag of saline to a long straight infusion set. Calcium Chloride. Listed below are a few non-chemo agents: Vancomycin. 2022 Dec 2;12:1021488. doi: 10.3389/fonc.2022.1021488. Clinical exam may reveal warmth, erythema, or tenderness. If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. **Some case reports of extravasation and injection site reactions or inflammation have been reported. Access to this article is restricted. Gilbar PJ, Carrington CV. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Extravasation is a known risk of vesicant administration. Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants. Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. UIC's seven health sciences colleges and health care delivery enterprise. References: 1. 8600 Rockville Pike If an antidote is not going to be used, the venous access can be removed after aspiration of the extravasated fluid has been attempted. This review provides an overview of midline catheters and a summary of properties that influence the determination of whether a drug is appropriate for administration via midline catheter. Caution: excessive heat can cause tissue damage. 3/26/2014 5. and transmitted securely. Extravasation of antineoplastic agents: prevention and treatments. Introduction Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and recommendations There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. Gilbar PJ, Carrington CV. A central line is always required for vesicant or any chemotherapy in the home. Oncologist. In addition, whenever an extravasation occurs or is suspected, vesicant administration must immediately cease, and the appropriate antidote or treatment needs to be promptly administered. The 2021 INS guidelines recommend against the use of midline catheters for continuous administration of vesicant therapy, parenteral nutrition, or other infusates with "extremes" of pH or osmolarity. For every 1 mg of mechlorethamine suspected to have extravasated, inject 2 mL of the 1/6 molar sodium thiosulfate solution subcutaneously into the extravasation site using a 25 gauge or smaller needle. 8600 Rockville Pike HHS Vulnerability Disclosure, Help According to Trissels Handbook on Injectable Drugs 17th Edition, vinCRIStine is stable at a concentration of 20 mg/L in dextrose 5% in water, Lactated Ringers, and 0.9% sodium chloride for at least 24 hours and up to 21 days with little or no drug loss (under 10%) at 4C and 25C when in the dark.
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