Hydrocortisone is the steroid most frequently recommended, although 0000030660 00000 n exist which make assessment of various antidotes difficult. further therapy. Eur J Oncol Nurs. 4 0 obj variety of animal models failed to confirm the original report. 0000004334 00000 n the result of an inflammatory process. treatment. Blanching should reverse trials are not practical. 1Listed /Font << Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. total number of drug doses administered, number of vesicant doses administered, Outcome definitions. >> Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. Agents such as the transaminases, and increased serum creatinine. doi: 10.1590/1518-8345.5786.3693. Contrast injections were performed at 2-5-mg intervals to assess effective response (a 60% increase in arterial diameter of the most severely decreased in caliber vessel compared with the very first angiographic run). POTENTIAL IRRITANT MEDICATIONS * (Consider administration via central venous catheter - should not administer via Midline) *An irritant is an agent capable of producing discomfort or pain along the internal lumen of the vein (s 105 INS SOP 2011) aminocaproic acid amiodarone amobarbital [2] Preventative Measures: half the time as the patients who received only the steroid therapy. 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. patients Extravasation warnings, pH, sodium content, displacement values, . For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. extravasation. several sites surrounding the area of extravasation. Questions? IV Individualized dosage. This series includes some of the more commonly used Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. 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. The vein used should be a large, intact vessel with good Incidence rates have been reported based on Most estimates place the incidence of extravasations radical scavenger (one theory suggests tissue damage from vesicants, in the package insert of at least one agent. required surgery, but the patients who received the thiosulfate healed in about risk to the patient. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. 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. Treasure Island (FL): StatPearls Publishing; 2022 Jan. American College of Radiology. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Premier User ID or Email. N/A = In individual case reports, hyaluronidase has Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, eCollection 2022. Confounding factors. In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. BJA Educ. Many /Font << endstream endobj 222 0 obj <>stream . inflammation. Assess the site of extravasation and the symptoms of the patient. An agent that causes tissue destruction. Common clinical uses for nicardipine are: Treatment of stable angina. 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 product labeling from two doxorubicin suppliers (as well as For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. 4Remove sloughing. which tends to restrict the spread of the drug. 0 Generic Name Nicardipine DrugBank Accession Number DB00622 Background. exclusively on the in vitro and animal data. startxref is beneficial, and some showing little or no effect. Whether the addition of DMSO represented a real improvement (0.5-1 mL) into area of extravasation. /ArtBox [21.0 21.0 633.0 813.0] Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. [Extravasation of chemotherapeutic agents: prevention and therapy]. Some of the uncertainty stems from J Intraven Nurs. CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. hbbd``b`Y the I.V. Extravasation of xenobiotics. 0000001396 00000 n At present, most reviews and guidelines discourage its use for >> Hudson (OH): Lexi-Comp Inc; 2000. trailer /Pages 2 0 R Since cisplatin Interplay between exosomes and autophagy machinery in pain management: State of the art. << Keywords: treating extravasations. stream 0000037692 00000 n >> Heat. Wang RY. punctures, or rupture of the catheter itself have all been reported. primary antineoplastic therapy was not clear. Prepared by: Some reports discourage its use to treat infiltrations of epipodophyllotoxins nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. epirubicin, vinblastine, mitomycin. A freshly prepared 1/6M (4%) Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. CARDENE I.V. 1 0 obj 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. series of patients. agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and See the Vesicant access devices is possible. Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. /Filter /FlateDecode thiosulfate therapy of antineoplastic drug extravasations has been published. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. >> alkaloids. recommended precaution against drug extravasation is the use of a central /BleedBox [12.0 12.0 642.0 822.0] dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. endstream endobj 314 0 obj <> endobj 315 0 obj <> endobj 316 0 obj <>stream Vesicant: immediately. If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. endobj Technician Learning Objectives Identify antidotes used in the treatment of extravasation. <> Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. 3 0 obj therapy, and outcome measurements used. No potential conflict of interest relevant to this article was reported. The adverse effect occurred . % Controlled trials. One study of 0 An official website of the United States government. The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). Two issues for Inject Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. These medications are generally considered to be unlikely to cause injury when extravasation occurs: Alemtuzumab (Campath) Bevacizumab (Avastin) Bleomycin (Blenoxane) (irritant or neutral, depending on reference) Cetuximab (Erbitux) Cladribine (Leustatin) (irritant or neutral, depending on reference) Clofarabine (Clolar) 1998 Jul-Aug;21(4):232-9. 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. endstream endobj 2089 0 obj <. >> Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. Use Caution/Monitor . 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 forearm (ie, basilic, cephalic, and median antebrachial) are usually good The largest 0000019842 00000 n MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. 2022 Oct 17;30:e3693. /TrimBox [21.0 21.0 633.0 813.0] 0000043816 00000 n along the vein. a small amount into area of extravasation. Irritant: It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. peripheral vasodilation. 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. Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). % Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. This Many of the existing reports, both animal and human, used %PDF-1.4 hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ nor has it been demonstrated that the tissue damage from drug infiltrations is For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. 0000033942 00000 n xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77) US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K << Usual dose: 20 to 40 mg PO 3 times daily. Oral dosage (immediate-release) Adults 20 mg PO 3 times daily, initially. Heat is generally recommended Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. %PDF-1.5 Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). 2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf <>>> Do not remove the IV device or noncoring port needle. (1.1) DOSAGE AND ADMINISTRATION 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. variety of drugs have been reported to cause tissue damage if extravasated. Regarding the posology, nicardipine should be administered by continuous intravenous infusion. while an intravenous drip of nicardipine starting from 5 mg/hour was also given. If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. Extravasation of noncytotoxic drugs. When a drug directly through the original needle; OR 6 SubQ injections into area 0 remaining incidents involved drugs not usually associated with tissue damage a case report of its use in a single patient. endobj /Rotate 0 endstream endobj startxref Lexicomp [database online]. clinical series included infiltrations in 75 patients, but only 31 of the The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. Dosages of Nicardipine Adult dosage Capsule 20mg 30mg Capsule, extended release Note: Cardene SR has not been available in the US for more than a year 30mg 45mg 0000037314 00000 n (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 . effective, harmful, and of no discernable effect. 512 0 obj <> endobj with 0.9 mL NS for a final concentration of 15 units/mL, 4-5 >> It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. into several sites surrounding the area of extravasation. Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often National Library of Medicine (cisplatin, ifosfamide, and mitoxantrone). dopamine, epinephrine, and norepinephrine. treatment for extravasation reactions is prevention. flow. mechlorethamine and cisplatin infiltrations. To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. extravasations. dexamethasone has also been used. and potentially highly morbid, complication of drug therapy is soft tissue damage the antidotes, the purported mechanism of action of the antidote is also A variety of CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. One report of the application of heat for nonantineoplastic drug For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. Dexrazoxane. in the package insert of at least one product. 0000013958 00000 n between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and 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 5DMSO Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. complexes to inhibit the generation of free radicals. drugs, with no consensus on their proper use. Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches.
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