Introduction Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. endstream endobj startxref 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. Oncologist. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. 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. Paclitaxel, nanoparticle albumin-bound (Abraxane), Chemotherapy extravasation injury (UpToDate), ONS (Oncology Nursing Society) chemotherapy extravasation FAQs, Beatson West of Scotland Cancer Centre Chemotherapy extravasation guideline, West Suffolk Hospitals extravasation guideline, https://hemonc.org/w/index.php?title=Vesicant_%26_irritant_chemotherapy&oldid=68542, About HemOnc.org - A Hematology Oncology Wiki. stream 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 made by professional oncology organizations are useful resources in this process. 2. References: 1. 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." J Oncol Pharm Pract. Ex: Name & date of birth 2. Vesicants: not just chemo agents! | Infusion Nurse Blog 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. 2. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. This decision must be weighed in light of certain death if the drug is administered via the wrong route. Pittsburgh, PA 15275 government site. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. Intermountain Medical Center . Answer:According to a publication by the Oncology Nursing Society, 1 the easiest way to check for a blood return is to use gravity by lowering the minibag below the IV site. Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. Secondary infusions are safest administered with the use of secondary tubing attached with a Luer lock connector to the primary line containing a compatible IV solution. Pittsburg, PA: Oncology Nursing Society; 2014. Potassium Chloride. %PDF-1.6 % 2141 0 obj <>stream Eur J Oncol Nurs. Version number changed to v.5. 2108 0 obj <>/Filter/FlateDecode/ID[<79BA663E75301A408346CF53CE9BCBB7><05BE28B3380661489955B8DFD5505C1D>]/Index[2088 54]/Info 2087 0 R/Length 102/Prev 343790/Root 2089 0 R/Size 2142/Type/XRef/W[1 3 1]>>stream Bookshelf 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. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. 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. But chemo agents are not the only vesicants that cause extravasation injuries. Overview, prevention and management of chemotherapy extravasation. What are current recommendations for treatment of drug extravasation? Avoid continuous vesicants or irritants (chemotherapy, vasopressors) . 2008 Sep;12(4):357-61. Management of the extravasation of anti-neoplastic agents. There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. National Library of Medicine Exfoliants:An agent that is capable of causing inflammation and skin shedding, but less likely to cause tissue damage. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. Table 7 in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice discusses special features required for administration, but package inserts should be referred to for the most up-to-date information. Rev. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Introduction. Answer:In regard to duration of administration: It is true that the process of administering a vinca alkaloid via a syringe is probably of shorter duration when compared to administering via a minibag. 1995 Jan-Feb;22(1):57-67. All rights reserved. Reviewed electronically by nursing reference committee. 3/10/2014, 7. Gilbar PJ. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 3. Heat - 15 to 20 minutes at a time for at least four times per day for 24 to 48 hours. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. Abstract. If not clearly defined in the literature. Vesicant Chemotherapy Extravasation Antidotes and Treatments Vesicant Administration Guidelines 1. Pediatr Rep. 2012 Aug 1;4(3):e28. Boulanger J, Ducharme A, Dufour A, et al. The Oncology Nursing Society (ONS) is a professional association that represents 100,000 nurses and is the professional home to more than 35,000 members. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). Gilbar PJ, Carrington CV. Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. The action you just performed triggered the security solution. 2. Avoid the "blame game.". The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . The .gov means its official. Conclusion When assessing a chemotherapy extravasation, it is important to understand the classification of the chemotherapeutic agent in terms of its potential to cause cellular damage if extravasated. 139.59.111.99 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET It is also important to note that some medications are classified differently by different references. Reference: 1. The flush line can be used before, during, and after the infusion to verify line patency and blood return for a flush solution if the chemotherapy must be stopped because of an adverse reaction.
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