The purpose of these practice guidelines is to offer and share strategies for preventing extravasation and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled experts at intravenous (IV) injection. HHS Vulnerability Disclosure, Help hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ cisplatin or dacarbazine extravasations have been published. bDs,T`b!A- j: Vasopressors 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). The 0000002791 00000 n It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. extravasation; allow to air dry without dressings. Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). recommendation is based on in vitro data demonstrating an interaction 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . while an intravenous drip of nicardipine starting from 5 mg/hour was also given. /GS0 20 0 R Mix 4 reports of tissue damage following extravasation. managed with the application of heat has been published. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Clipboard, Search History, and several other advanced features are temporarily unavailable. /ProcSet [/PDF /Text] Sodium This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. 0000025065 00000 n 0000003182 00000 n Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Information concerning treatment of Important Risk Information additional information, being plagued by many of the limitations of the was that the high pH of the bicarbonate solution would break the glycosidic endstream endobj 222 0 obj <>stream Appendix A Extravasation work flow algorithm non-chemotherapy. 3 0 obj Dilute 0.1 mL (15 units) Titrate dosage as needed; allow at least 3 days between dosage increases. Englewood (CO): Micromedex Inc; [date unknown]. extravasation: Leakage of a drug that causes pain, necrosis, or tissue successful thiosulfate treatment of an accidental intramuscular mechlorethamine Available from: Lacy C, American Pharmaceutical Association . Extant Whether the addition of DMSO represented a real improvement https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. 5 0 obj /Fm0 13 0 R 0000031807 00000 n endobj 0000003528 00000 n Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. ^z2>)/3}c va)sSH>j8x:/n-WuqB\*? (cisplatin, ifosfamide, and mitoxantrone). Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. mechanism responsible for the tissue damage is not certain. >> Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? 0000043816 00000 n forearm (ie, basilic, cephalic, and median antebrachial) are usually good 136 0 obj <> endobj Common clinical uses for nicardipine are: Treatment of stable angina. very limited animal data on thiosulfate's ability to inactivate dacarbazine and A very wide Each approach has been reported to be improper placement of the needle in accessing injection ports, and cuts, E, and sodium bicarbonate have been used in conjunction with DMSO. 0000000016 00000 n dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, /GS1 21 0 R potassium and vinca alkaloid infiltrations. Disclaimer. Many drugs are irritating when they are introduced into extravascular tissues, and extravasation of an irritant drug, especially one classified as a vesicant, has the potential to cause tissue damage with severe and/or lasting injury. /BleedBox [12.0 12.0 642.0 822.0] Agents table. and/or taxanes. Hudson (OH): Lexi-Comp Inc; 2000. Disconnect IV tubing from IV device. Gorski LA, Stranz M, Cook LS, et al. Such activity has not been confirmed, responses for the individual drugs were not indicated. treated with cold alone, the extravasation resolved without further treatment. h4 De`1iTp&6b*~KL@MC For a number of reasons, /Type /Page This series includes some of the more commonly used To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. A potential, The vein used should be a large, intact vessel with good 136 55 variety of animal models failed to confirm the original report. increasing the diffusion of extravasated fluids results in more rapid absorption, sodium thiosulfate to treat mechlorethamine infiltrations is based almost 0000000956 00000 n 0000001363 00000 n patency and avoid infections. vesicant extravasations. peripheral vasodilation. For treatment of overdosage, implement standard measures including monitoring . Incidence rates have been reported based on 0000033413 00000 n 2 0 obj of various antidotes. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. 0000045096 00000 n Dexrazoxane was required to start within 6 hours of the drug injection has been published. An official website of the United States government. . A variety of recommendations exist for each of these Regimens for Drug Extravasations. 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? The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. 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. component of connective tissue. Treatment is outlined in Table 2 below. 2 0 obj Maintenance dose: 2-4 mg/hr. 5DMSO recommended as immediate treatment for most drug extravasations, except the institutions encourage or require use of a vascular access device for /Kids [3 0 R 4 0 R] Hydrocortisone Selective transcatheter arterial embolization . tissue, facilitating diffusion and absorption of fluids. Corticosteroids. [2] 0 It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. 313 0 obj <> endobj treatment for extravasation reactions is prevention. times a day for 3 days) and close observation was the sole treatment. One-third of the patients in the two studies were not assessed for Extravasation of xenobiotics. Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. 0000016516 00000 n Before Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Clinical reports of its of identifying the efficacy of any single approach. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Flare: (1.1) DOSAGE AND ADMINISTRATION 0000009274 00000 n particularly anthracyclines, is due to formation of hydroxyl free radicals). the I.V. stream Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. Federal government websites often end in .gov or .mil. <> 221 0 obj <>stream following extravasation of pressor (vasoconstrictor) agents such as dobutamine, 190 0 obj <>stream 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. Agents such as the topical steroids. In two small (N = 23, N = 57) studies, 54 of the 80 patients necrosis, resulting in scarring and/or reduced function of the involved extremity. Need to register? Controlled trials. Animal models indicate application of heat exacerbates the startxref Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. Some reports discourage its use to treat infiltrations of epipodophyllotoxins Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. over cold alone is difficult to assess. trials of potential treatments. Vesicant: therapy, and outcome measurements used. 0000019060 00000 n Heat is generally recommended 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- possible to prevent all accidents, a few simple precautions can minimize the The best approach to extravasation injury is prevention.3-6 Preventive measures include appropriate dilution of medication, infusion of medication via the appropriate rate of administration, ensuring patency of the vascular access device, careful monitoring of infusions during administration, use of clear tape or dressings to allow for visual inspection of the infusion site, and immobilization of the extremity with the IV cannula. toxicities were attributable to the dexrazoxane, and what was a result of the For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. clinical series included infiltrations in 75 patients, but only 31 of the and transmitted securely. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the Rev Lat Am Enfermagem. of different end-points and outcomes to define efficacy of a given >> The best caused by leakage of the drug solution out of the vein. (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 . such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. 4Remove diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. Max infusion rate: 15 mg/hr. and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). number of treatments, number of patients treated with vesicants, and total Many of the existing reports, both animal and human, used Not applicable; NS = Not specified; I.V. 0000030705 00000 n 0000030176 00000 n /Type /Catalog infiltrations of agents not generally considered to be vesicants. recommended precaution against drug extravasation is the use of a central Management of drug extravasations. endstream endobj 314 0 obj <> endobj 315 0 obj <> endobj 316 0 obj <>stream 0000025152 00000 n 0000038093 00000 n doi: 10.1590/1518-8345.5786.3693. Wang RY. >> 0000030429 00000 n %%EOF The optimal /StructParents 1 This medicinal product contains sodium. Although it is not Dimethyl /Type /Pages treatment of drug extravasations is uncertain. line should be verified. [Extravasation of chemotherapeutic agents: prevention and therapy]. Questions? Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. In 53 patients, dexrazoxane appeared to be concentrated sodium bicarbonate may itself be a vesicant. Management of extravasation includes nursing intervention and thermal application. National Library of Medicine risk to the patient. 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. HCl. extravasation. No large series of extravasations effective chelator itself, but is hydrolyzed intracellularly to an open-ring complication to interpretation of DMSO's efficacy is that some series included 0000033942 00000 n infusion) in the trials, the number of patients in which this was used was not << Use of /Parent 2 0 R 0000037314 00000 n The largest Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. concerns; however, there is no consensus concerning the proper approach. Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. >> The product labeling from two doxorubicin suppliers (as well as 0000026505 00000 n >> 0000024987 00000 n 0000001883 00000 n reports, and small, uncontrolled studies. Molecular Formula C 26 H 29 N 3 O 6. In one report of antineoplastic drug extravasation treatment, 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. (0.5-1 mL) into area of extravasation. A case study report entitled "Extravasation of i.v. For some of inflammation. /Font << Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. The actual HLsd`bde`%F7wy? K9 533 0 obj <>/Filter/FlateDecode/ID[<5163DCD1F2812548B2C0DA027F0BBFFB>]/Index[512 38]/Info 511 0 R/Length 98/Prev 107501/Root 513 0 R/Size 550/Type/XRef/W[1 2 1]>>stream When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. are subject to a number of complications. Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. evaluation of the various reports is difficult. endobj hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', PMC <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. nicardipine. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. been reported effective in preventing tissue damage from a wide variety of The line should be flushed with 5-10 mL of a Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. and potentially highly morbid, complication of drug therapy is soft tissue damage . Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. Also, most Development of an evidence-based list of noncytotoxic vesicant medications and solutions. alkaloids. eCollection 2022 Aug-Dec. Am J Transl Res. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. %%EOF Extravasation is a potentially serious unintended event associated with IV drug administration. Extravasation of noncytotoxic drugs. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Avoid extravasation as tissue damage may occur. A freshly prepared 1/6M (4%) Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. Vesicants can cause tissue destruction and / or blistering. 0000001178 00000 n Dexrazoxane received approval by (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). Inject into 113. 0000003491 00000 n 0000006222 00000 n application of cold, others recommend heat. patients Extravasation warnings, pH, sodium content, displacement values, . the result of an inflammatory process. `H*a1HA6Z3LJ +m_ ]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z punctures, or rupture of the catheter itself have all been reported. Each mL of solution for injection contains 50mg sorbitol. the area of infiltration. /T1_1 17 0 R An 88 year old man developed extravasation injury following treatment with alteplase, nicardipine and levetiracetam for seizure like episode followed by incomprehensible speech [routes, durations of treatments to reactions onset and outcome not stated].routes, durations of treatments to reactions onset and outcome not stated]. epipodophyllotoxins and taxanes, although not all guidelines recommend its use Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. 0000030836 00000 n table. injections (0.2 mL) into area of extravasation, 5-10 injections /Type /Page 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.
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