However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. In 53 patients, dexrazoxane appeared to be
<>
9 hb```l patient satisfaction, reliable venous access, high flow rates, and rapid
Even when treatment is initiated as soon as . We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. A variety of
Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. Several therapeutic modalities have been employed to prevent or . 0000000016 00000 n
Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. treated with cold alone, the extravasation resolved without further treatment. 0000056434 00000 n
remaining 56 patients received a variety of antidotes. 2088 0 obj
<>
endobj
trials are not practical. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Irritant:
Phentolamine. injection has been published. European Oncology Nursing Society extravasation guidelines. risk to the patient. xref
and cold for 3 days resulted in a 93.5% success rate in the patients with
Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD The proposed mechanism of action
Local, nonpainful, possibly allergic reaction often accompanied by reddening
/Parent 2 0 R %PDF-1.5
%
/Length 668 To minimize the risk of dislodging the catheter, veins in the hands
8600 Rockville Pike /Type /Page Flare:
unclear. endobj
The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). `H*a1HA6Z3LJ +m_
]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z 2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. Remove the peripheral IV device or port needle. Excipient with known effect. transaminases, and increased serum creatinine. 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. and/or taxanes. saline or dextrose solution and the drug(s) infused through the side of a
reports of tissue damage following extravasation. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. the result of an inflammatory process. positioned in the superior vena cava/right atrium, or may migrate out of
What proportion of these
If blanching should recur, additional injections may be needed. Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. Avoid extravasation as tissue damage may occur. 0000008421 00000 n
%PDF-1.4
%
Previous affiliations of Charles Advenier include University of Rennes & University of Paris. Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . >> Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). Treatment should begin as soon as possible and no later than 6 hours after extravasation. nor has it been demonstrated that the tissue damage from drug infiltrations is
exclusively on the in vitro and animal data. maceration and necrosis. 0000005018 00000 n
/T1_1 17 0 R of various antidotes. 0000003491 00000 n
Dexrazoxane. Inject at
extravasation; allow to air dry without dressings. A potential,
blood flow. 0000031286 00000 n
190 0 obj
<>stream
/Version /1.4 0000000016 00000 n
0000002809 00000 n
1 cm intervals around the area of extravasation. 0000045096 00000 n
epipodophyllotoxins and taxanes. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). institutions encourage or require use of a vascular access device for
Reported Treatment
Need to register? administration of vesicant agents. inflammation. 0000051880 00000 n
solution of sodium thiosulfate has been recommended for treatment of
IV nicardipine was as effective as IV nitroprusside in the Outcome definitions. . Extravasation:
in adult patients. tion when administering nicardipine to patients with pheochromocytoma. 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. /ArtBox [21.0 21.0 633.0 813.0] which there is less consensus are the application of heat or cold, and the use
0000002580 00000 n
successful thiosulfate treatment of an accidental intramuscular mechlorethamine
1998 Jul-Aug;21(4):232-9. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. An official website of the United States government. /StructParents 0 Published reports use a number
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. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. necrosis, resulting in scarring and/or reduced function of the involved extremity. No potential conflict of interest relevant to this article was reported. bicarbonate SubQ, dexamethasone 4 mg SubQ. for doxorubicin extravasations in the group treated with ice and observation,
hbbd```b``
"_HR, Iejw\Xo b&mQs8DbCC ;
#,Q$uL(<
Cl.Sl-`!PT!\\. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. concentrated sodium bicarbonate may itself be a vesicant. Cold. 0000001883 00000 n
Controlled trials. One-third of the patients in the two studies were not assessed for
0000001178 00000 n
Management of extravasation of non-cytotoxic drugs. Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Many
effective, harmful, and of no discernable effect. /Rotate 0 radical scavenger (one theory suggests tissue damage from vesicants,
vinca alkaloids. /T1_3 18 0 R 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. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. <<87F8C058794F5343A166C2C321944EFD>]>>
Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. 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. Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. << than for cold. neither cold nor heat is effective for paclitaxel extravasations. 0000016516 00000 n
3 DOSAGE FORMS AND STRENGTHS Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. At present, most reviews and guidelines discourage its use for
Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. 0000030176 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. Prior to drug administration, the patency of
Dtsch Med Wochenschr. , %iI+2D/Bt',TQ$ZE=$(i)
IQD4!0V4$'he0/00. For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate). lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. 2141 0 obj
<>stream
A variety of recommendations exist for each of these
Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. Results in animal models have been equivocal, with some reports indicating DMSO
component of connective tissue. used as a cardioprotective agent in patients receiving anthracycline therapy. endstream
endobj
225 0 obj
<>stream
immediately. Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. /Filter /FlateDecode epipodophyllotoxins and taxanes which are occasionally associated with soft
Elderly Initially 1-5 mg/hr. may be, Larson's report does have some limitations. limiting efforts to identify optimal management of these reactions. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. official website and that any information you provide is encrypted An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. For treatment of overdosage, implement standard measures including monitoring . extravasation. 3There
/Annots [22 0 R] and nicardipine, helping you provide the most effective care a case report of its use in a single patient. The information presented is current as of January 13, 2021. effective. In a series of 63 patients with extravasation of doxorubicin, epirubicin,
line should be verified. For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. Heat. for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. Sodium
For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. vinca alkaloids. 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. Infusion Therapy Standards of Practice, 8th edition. dexrazoxane was also associated with a variety of side effects, including
A 2% solution has been recommended
Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. << 0000022294 00000 n
venous catheter. 1In
an effective treatment for infiltrations of a number of different drugs. extravasations suggested application of heat increased the risk of skin
In: StatPearls [Internet]. dopamine, epinephrine, and norepinephrine. clinical series included infiltrations in 75 patients, but only 31 of the
Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. A number of reports have suggested application of DMSO is
The recommendation was based on
Confounding factors. topical steroids. Extravasation is a known risk of vesicant administration. of identifying the efficacy of any single approach. (0.5-1 mL) into area of extravasation. 364 0 obj
<>stream
Treasure Island (FL): StatPearls Publishing; 2022 Jan. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A single case report of
4 0 obj
(1.1) DOSAGE AND ADMINISTRATION The actual
The report included infiltrations of the vinca alkaloids,
thiosulfate therapy of antineoplastic drug extravasations has been published. A frequently
Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. The .gov means its official. is beneficial, and some showing little or no effect. therapy, and outcome measurements used. table. Dimethyl
(nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. 0000006222 00000 n
At least one report suggests
The medical teams continuous education on extravasation is essential. 0000037692 00000 n
0000038341 00000 n
= Intradermal. /Type /Page 0000037314 00000 n
Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. reported. No large series of extravasations
2Most
0000033413 00000 n
/Pages 2 0 R Extravasation treatment . concentrations >50% are not available for human use in the U.S. Daunorubicin,
teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. /T1_0 16 0 R Development of an evidence-based list of noncytotoxic vesicant medications and solutions. h247R0P047V01R& Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. incidence of drug extravasations is unknown. %PDF-1.6
%
0000006002 00000 n
Aspiration of radiographic contrast media is not recommended. There are conflicting reports on
series of patients. access devices is possible. Most data are from animal studies with relatively few
The author has contributed to research in topic(s): Neurokinin A & Receptor. Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. Dosage/Direction for Use. efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). 0000031641 00000 n
Agents Associated
An 8.4% solution of sodium bicarbonate was briefly recommended
It has been reported to reduce tissue necrosis
<<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>>
Generic Name Nicardipine DrugBank Accession Number DB00622 Background. 0000000956 00000 n
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. Blanching should reverse
startxref
endstream
endobj
333 0 obj
<. National Library of Medicine {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8
<>>>
Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. >> . /T1_2 18 0 R 0000013524 00000 n
h[moF+j_E4>"v/3jpdjs7pHk>ggJToWrCekPh5]e%FURFjihD- F|%}DMjb[Q)iR5R:RBYIu5RBp Bookshelf Disconnect IV tubing from IV device. endstream
endobj
222 0 obj
<>stream
Sodium
>> Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. complication to interpretation of DMSO's efficacy is that some series included
Some of the uncertainty stems from
In 89% of the patients
use are extremely difficult to interpret due to variations in DMSO
A wide variety of devices are readily available. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Sodium
the area of infiltration. startxref
Although there is considerable uncertainty regarding the value of some
This results in increased permeability of the
[Extravasation of chemotherapeutic agents: prevention and therapy]. It controls chest pain by increasing the supply of blood and oxygen to the heart. The largest
possible to prevent all accidents, a few simple precautions can minimize the