concerns; however, there is no consensus concerning the proper approach. >> Clipboard, Search History, and several other advanced features are temporarily unavailable. 4Remove 2Most Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. effective, harmful, and of no discernable effect. 3 0 obj endstream endobj 333 0 obj <. Agents Associated Severe extravasation injuries can prolong hospitalization and increase costs. 332 0 obj <> endobj 1999; 56:1742-3. Helpful as it Technician Learning Objectives Identify antidotes used in the treatment of extravasation. Pharmacological management of anticancer agent extravasation: A single institutional guideline. of doxorubicin includes a steroid as part of the treatment for drug endstream endobj startxref 1 0 obj the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline endstream endobj 224 0 obj <>stream Extravasation treatment . over cold alone is difficult to assess. 0000026089 00000 n 2 0 obj The report included infiltrations of the vinca alkaloids, sloughing. Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. 0000006222 00000 n Application of cold is usually Each mL of solution for injection contains 50mg sorbitol. stream for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. Nicardipine was intravenously injected at 10 g kg 1 to maintain . 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]. 1Listed Prepared by: 0000004717 00000 n 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. Phentolamine is an alpha1-adrenergic antagonist which produces Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. endstream endobj 2089 0 obj <. Selective transcatheter arterial embolization . thiosulfate. Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. 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. 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- Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. /T1_0 16 0 R This problem is not unique to antineoplastic therapy; a The medical teams continuous education on extravasation is essential. Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). Of the patients treated by other methods, only 53% resolved without further Development of an evidence-based list of noncytotoxic vesicant medications and solutions. infusion) in the trials, the number of patients in which this was used was not extravasations. Management of extravasation of non-cytotoxic drugs. extravasation from central catheters range from 0.3% to 50% and are similar to Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. may be, Larson's report does have some limitations. /Type /Page Apply 4 >> Such activity has not been confirmed, 8600 Rockville Pike The https:// ensures that you are connecting to the The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. at 1 cm intervals around the area of extravasation. 0000037314 00000 n additional information, being plagued by many of the limitations of the Do not remove the IV device or noncoring port needle. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. It is The remaining 32 patients received subcutaneous Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. concentrations >90% which is not available for clinical use in the United immediately. generally considered to be vesicants, have been associated with isolated Prospective, randomized controlled 0000001396 00000 n 2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. 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. chelating iron following intracellular hydrolysis. Treatment is outlined in Table 2 below. Regimens for Drug Extravasations. @ extravasation does occur, a variety of immediate actions have been recommended. Additionally, cold reduces local inflammation and pain. 66y% /Kids [3 0 R 4 0 R] >> <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> while an intravenous drip of nicardipine starting from 5 mg/hour was also given. injections (0.2 mL) into area of extravasation, 5-10 injections Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, A variety of A freshly prepared 1/6M (4%) Accessibility Only two patients (6.5%) had complications requiring concentration, number of applications/day, duration of therapy, and concomitant Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. punctures, or rupture of the catheter itself have all been reported. mL of 10% sodium thiosulfate with 6 mL sterile water, Inject Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. Seoul: BIT Druginfo; 2020. The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. 0000019060 00000 n successful thiosulfate treatment of an accidental intramuscular mechlorethamine extravasations suggested application of heat increased the risk of skin N4xfpq9d ew '8:d J{]LWx%wi)W extravasations is based almost exclusively on animal models, anecdotal Federal government websites often end in .gov or .mil. (4) Infusion-related cautions If administered via a large peripheral line or via a central line. /Fm1 14 0 R There are several chemotherapeutic agents with vesicant properties, and when . 190 0 obj <>stream doxorubicin, epirubicin, idarubicin. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. single published series of antineoplastic drug extravasations was 175 patients 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. A very wide treatments. injury. 0000030989 00000 n Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. Veins in the For some of epipodophyllotoxins and taxanes, although not all guidelines recommend its use Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. remaining incidents involved drugs not usually associated with tissue damage in the package insert of at least one agent. %PDF-1.6 % nicardipine. incidence of drug extravasations is unknown. No potential conflict of interest relevant to this article was reported. Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. A 27-year-old woman developed severe dyspnea and orthopnea after receiving an of infusion nicardipine 2 mg/hour for 3 days for preterm labor at 27 weeks of . recommended precaution against drug extravasation is the use of a central dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. Irritant: An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies /MediaBox [0.0 0.0 654.0 834.0] 0000051347 00000 n Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. of various antidotes. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. A further thiosulfate therapy of antineoplastic drug extravasations has been published. %%EOF 0000008421 00000 n complication to interpretation of DMSO's efficacy is that some series included This medicinal product contains sodium. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. Non-pharmacologic interventions for extravasation, For most medications, the treatment of extravasation is nonpharmacologic in nature; however, the efficacy of any specific approach has not been demonstrated in controlled studies.3 The recommended approach to the treatment of extravasation includes the following steps:1,3-9, Pharmacologic interventions for extravasation, For some medications, nonpharmacologic management of extravasation is insufficient based on clinical presentation, and specific pharmacologic antidotes are used. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5