Drug information handbook. Also, the
trials are not practical. A wide variety of devices are readily available. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. injection of a 2% thiosulfate solution in addition to the subcutaneous and
0000006222 00000 n
The actual
bicarbonate SubQ, dexamethasone 4 mg SubQ. position. stream
Please enable it to take advantage of the complete set of features! nicardipine. Application of heat results in a localized vasodilation and increased blood
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injection has been published. No large series of extravasations
Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. Two issues for
cooling 15 minutes prior to dexrazoxane infusion. Many
2022 May 15;14(5):3472-3480. eCollection 2022. If blanching should recur, additional injections may be needed. 0000029248 00000 n
For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. risk to the patient. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. and transmitted securely. promethazine" can be found in Am J Health-Syst Pharm. injury. limiting efforts to identify optimal management of these reactions. The official labeling of only one of the three suppliers
A number of different treatments, including cold, steroids, vitamin
sharing sensitive information, make sure youre on a federal h4 De`1iTp&6b*~KL@MC phentolamine and nicardipine both increase anti-hypertensive channel blocking. reports are based on animal models, anecdotal cases, and/or small uncontrolled
the area of infiltration. 0
0000047789 00000 n
/Font << /T1_2 18 0 R infiltrations. Available from: Lacy C, American Pharmaceutical Association . 0000038341 00000 n
The product labeling from two doxorubicin suppliers (as well as
Agents Associated
Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. <>>>
Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. . $S@#H= @@ HW@fP
; Of the patients treated by other methods, only 53% resolved without further
inflammation. sodium thiosulfate to treat mechlorethamine infiltrations is based almost
in the package insert of at least one agent. mechlorethamine and cisplatin infiltrations. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
Reports of
are. The line should be flushed with 5-10 mL of a
Apply dry warm or cold compresses as indicated depending on the drug extravasated. Extravasation:
/Resources << number of treatments, number of patients treated with vesicants, and total
533 0 obj
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Seoul: BIT Druginfo; 2020. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. of doxorubicin includes a steroid as part of the treatment for drug
It is postulated that
Agents such as the
Would you like email updates of new search results? drops/10 cm2 of skin surface over an area twice the size of the
xL}n0HN Jb[@.\L#]ewXyb7EI@i,>=)W/yYT_}U?wjo?E%QgUg?xwO};W;9>ofW|{y?ZJFQVl_(Y#bflz(_UKK+P{.De[c^7,k,`.5Gpv:}oj)Jizw> Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. extravasations suggested application of heat increased the risk of skin
/MediaBox [0.0 0.0 654.0 834.0] and in the vicinity of joints (eg, antecubital) should be avoided. dopamine, epinephrine, and norepinephrine. Also, most
0000009056 00000 n
1Listed
Hudson (OH): Lexi-Comp Inc; 2000. %PDF-1.4 daunorubicin and doxorubicin) do not mention corticosteroids to treat drug
extravasation; allow to air dry without dressings. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8
0000030836 00000 n
0000003804 00000 n
Inject
0000008421 00000 n
acid solutions, aminophylline, calcium, contrast media6, dextrose,
Additionally, cold reduces local inflammation and pain. (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. effects of some drugs (eg, anthracyclines). Although there is considerable uncertainty regarding the value of some
caused by leakage of the drug solution out of the vein. 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). h247R0P047V01R& hbbd``b`Y Steroids are most commonly used to treat anthracycline extravasations. 0000018438 00000 n
Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD endobj
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Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. 0000031807 00000 n
/CS0 [/Separation /All /DeviceGray 15 0 R] 8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. What is nicardipine (Cardene) used for? Heat. doxorubicin, epirubicin, idarubicin. peripheral vasodilation. 2141 0 obj
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Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. << hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5
Nicardipine is in a class of medications called calcium channel blockers. stream
Nicardipine Hydrochloride Injection is supplied . 313 0 obj
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endobj
There are several chemotherapeutic agents with vesicant properties, and when . thereby limiting tissue damage. Extravasation is a known risk of vesicant administration. Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. The optimal
0000003528 00000 n
/Pages 2 0 R 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. 0000026089 00000 n
Not applicable; NS = Not specified; I.V. dexamethasone has also been used. Keywords: primary antineoplastic therapy was not clear. directly through the original needle; OR 6 SubQ injections into area
Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. 0000017396 00000 n
tissue damage were not included, nor were extravasations of nonantineoplastic
The treatment for peripheral extravasation is a rapid response with the drug phentolamine. 0000030176 00000 n
For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. The best
2Most
>> /ArtBox [21.0 21.0 633.0 813.0] Use Caution/Monitor . complexes to inhibit the generation of free radicals. /ProcSet [/PDF /Text] diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic
Extravasation of xenobiotics. cisplatin or dacarbazine extravasations have been published. Maintenance dose: 20 to 40 mg orally 3 times a day. <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>>
Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. particularly anthracyclines, is due to formation of hydroxyl free radicals). 136 0 obj
<>
endobj
Information concerning treatment of
reported. Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). 0000030989 00000 n
^z2>)/3}c va)sSH>j8x:/n-WuqB\*? See
that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
Bethesda, MD 20894, Web Policies and potentially highly morbid, complication of drug therapy is soft tissue damage
the doxorubicin extravasations resolved completely. Avoid extravasation as tissue damage may occur. A 2% solution has been recommended
reported by Larson in 1985. may be useful in preventing tissue damage from anthracycline infiltrations. Most estimates place the incidence of extravasations
/Type /Catalog In: StatPearls [Internet]. Additionally, administration factors, including the experience of personnel administering the injection, the injection technique, and the number of venipuncture attempts to establish a line, contribute to the risk of extravasation, as does the fragility of the patients veins. The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. It may also inhibit the local
clinical series included infiltrations in 75 patients, but only 31 of the
Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . Delayed
injections (0.2 mL) into area of extravasation, 5-10 injections
for these agents. Appendix A Extravasation work flow algorithm non-chemotherapy. Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. A potential,
(dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). 0000051880 00000 n
Wang RY. half the time as the patients who received only the steroid therapy. Outcome definitions. mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute
mechlorethamine infiltrations have been published. concentration, number of applications/day, duration of therapy, and concomitant
Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. << remaining 56 patients received a variety of antidotes. *Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . /Fm1 14 0 R Prior to drug administration, the patency of
For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. 0000017924 00000 n
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Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. Eur J Oncol Nurs. Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. Unable to load your collection due to an error, Unable to load your delegates due to an error. 0000033413 00000 n
Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. 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. 0000010698 00000 n
%%EOF
Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. <>
Heat is generally recommended
Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. e.YvIQ|!C2\@&;:8 h qF . uDX i! When a drug
hbbbd`b``3
0000031641 00000 n
Pharmacological management of anticancer agent extravasation: A single institutional guideline. The information presented is current as of January 13, 2021. Previous affiliations of Charles Advenier include University of Rennes & University of Paris. <<87F8C058794F5343A166C2C321944EFD>]>>
%%EOF
chelator form, which complexes with iron, other heavy metals, and doxorubicin
0000030705 00000 n
extravasations. For a number of reasons,
%%EOF
extravasation from central catheters range from 0.3% to 50% and are similar to
8600 Rockville Pike 0000019598 00000 n
0000030453 00000 n
epirubicin, vinblastine, mitomycin. treatment. Available from: [place unknown]: [publisher unknown]; 2018. 1999; 56:1742-3. hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2
n', vinca alkaloids. Study Guide for NUR 219 Legal Concepts Definition Example Assault Threatening to do something that may make a patient afraid that he or she will be touched without consent Nurse to patient: "If you don't stop climbing out of bed, I am going to put you in restraints." Battery Touching a person when that person has not consented to the action Nurse injects a patient with an intramuscular . complication to interpretation of DMSO's efficacy is that some series included
>> /T1_1 17 0 R Lexicomp [database online]. treatments. 0000006002 00000 n
were assessed for efficacy. /GS1 21 0 R Treatment should begin as soon as possible and no later than 6 hours after extravasation. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. extravasations is based almost exclusively on animal models, anecdotal
Hyaluronidase. Infusion Therapy Standards of Practice, 8th edition. One study of
An 8.4% solution of sodium bicarbonate was briefly recommended
Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. into several sites surrounding the area of extravasation. /ColorSpace << extravasation. /T1_3 19 0 R 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf /T1_2 19 0 R Dexrazoxane received approval by
f localized cooling was permitted (except within 15 minutes of dexrazoxane
/StructParents 1 In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. with 0.9 mL NS for a final concentration of 15 units/mL, 4-5
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 Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . options for peripheral infusions. 190 0 obj
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What are current recommendations for treatment of drug extravasation? 0000031286 00000 n
Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. There are no well done randomized prospective
>> potassium and vinca alkaloid infiltrations. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
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Each approach has been reported to be
(4) Infusion-related cautions If administered via a large peripheral line or via a central line. institutions encourage or require use of a vascular access device for
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of various antidotes. Prepared by: ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). At least one report suggests
Some drugs, including anti-cancer agents, are directly cytotoxic to cells. Extravasation can result in tissue sloughing, pain . generally considered to be vesicants, have been associated with isolated
Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. treatment of amino acid solutions, aminophylline, calcium, contrast media,
0000001396 00000 n
For some of
See this image and copyright information in PMC. For 119 patients, local application of cold (15 minutes four
endobj Confounding factors. Can calcium channel blockers cause edema? may be, Larson's report does have some limitations. radical scavenger (one theory suggests tissue damage from vesicants,
American College of Radiology. Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). 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. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. 0000033942 00000 n
One report of the application of heat for nonantineoplastic drug
Need to register? necrosis, resulting in scarring and/or reduced function of the involved extremity. extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. At present, most reviews and guidelines discourage its use for
Misplacement/migration of the catheter tip,
0000009414 00000 n
thiosulfate to treat infiltrations of these drugs may not be required. This results in increased permeability of the
0
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/XObject << No patient in either group developed skin ulceration or
mechanism responsible for the tissue damage is not certain. toxicities were attributable to the dexrazoxane, and what was a result of the
This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. Englewood (CO): Micromedex Inc; [date unknown]. treatment of drug extravasations is uncertain. variety of drugs have been reported to cause tissue damage if extravasated. hbbd```b``
"_HR, Iejw\Xo b&mQs8DbCC ;
It has been postulated
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. endstream
endobj
223 0 obj
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The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). Most reports question the efficacy of steroids for treatment of
Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. It has a molecular weight of 515.99 . Only two patients (6.5%) had complications requiring
A freshly prepared 1/6M (4%)
/StructParents 0 With Occasional Extravasation Reactions. responses for the individual drugs were not indicated. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Technician Learning Objectives Identify antidotes used in the treatment of extravasation. mechlorethamine. (0.5-1 mL) into area of extravasation. Reported Treatment
vinca alkaloids. >> Effects of photobiomodulation (660 nm laser) on anthracycline extravasation: An experimental study. The
endobj /MediaBox [0.0 0.0 654.0 834.0] 8th ed. The report included infiltrations of the vinca alkaloids,
A frequently
3 DOSAGE FORMS AND STRENGTHS eCollection 2022 Aug-Dec. Am J Transl Res. 1Listed
Disclaimer. Before Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. Aspiration of radiographic contrast media is not recommended. L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2
/Rotate 0 Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. possible to prevent all accidents, a few simple precautions can minimize the
0000001363 00000 n
trailer
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Vesicant
0000001694 00000 n
frequently is not available. effective, harmful, and of no discernable effect. reports suggest it might also be useful in managing extravasations of
0000008312 00000 n
(nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. Dimethyl
This problem is not unique to antineoplastic therapy; a
/Version /1.4 Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. 0000024987 00000 n
Interpretation of steroid efficacy is
9 epipodophyllotoxins and taxanes. = Intravenous; SubQ = Subcutaneous; I.D. >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the
anthracycline extravasation. Disconnect IV tubing from IV device. 0000038093 00000 n
solution of sodium thiosulfate has been recommended for treatment of
[Extravasation of chemotherapeutic agents: prevention and therapy]. The site is secure. 3 0 obj Clinical reports of its
0000002739 00000 n
effective chelator itself, but is hydrolyzed intracellularly to an open-ring
Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. Follow-up studies in a
infusion) in the trials, the number of patients in which this was used was not
Use of a central line has several advantages, including high
in adult patients. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. access devices is possible. variety of agents have been reported as possible antidotes for extravasated
Even when treatment is initiated as soon as . IV nicardipine was as effective as IV nitroprusside in the Hydrocortisone is the steroid most frequently recommended, although
the antidotes, the purported mechanism of action of the antidote is also
successful thiosulfate treatment of an accidental intramuscular mechlorethamine
>> 0000008671 00000 n
Intermittent cooling of the area of infiltration results in vasoconstriction,
(1.1) DOSAGE AND ADMINISTRATION N/A =
along the vein. than for cold. %PDF-1.6
%
This site needs JavaScript to work properly. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). and/or taxanes. Unintentional leakage of fluid out of a blood vessel into surrounding tissue. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. and dacarbazine are generally not considered to be vesicants, the use of
The proposed mechanism of action
Regimens for Drug Extravasations. administration of vesicant agents. Despite their
case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies
Like most other medications, when taken beyond . Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. /Rotate 0 (cisplatin, ifosfamide, and mitoxantrone). treatment for extravasation reactions is prevention. h[moF+j_E4>"v/3jpdjs7pHk>ggJToWrCekPh5]e%FURFjihD- F|%}DMjb[Q)iR5R:RBYIu5RBp High blood pressure is a common condition and when not treated, it can cause damage to the .
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