Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and recommendations made by professional oncology organizations are useful resources in this process. 3. The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. A similar sized bag for the back flushing, such as a 25 mL bag of 0.9% saline is used for both adults and pediatric patients. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. 2. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. J Intraven Nurs. doi: 10.4081/pr.2012.e28. This site needs JavaScript to work properly. endobj Handbook of Injectable Drugs 17th Edition. The following information is a compilation from the various resources listed below.[1][2][3][4][5][6][7][8]. In some regimens, enough data support sequencing of agents, but in others, data are lacking. Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. All rights reserved. Chemical phlebitis may be caused by drugs that irritate the vasculature, usually because of extremes of pH or osmolarity.3Infusates with an osmolarity over 600 mOsm/L are associated with symptoms when extravasation occurs, and those over 800 mOsm/L are usually recommended to be given via a CVAD.9 Infusates with a pH between below 5.5 or above 8.5 can cause tissue damage, with alkaline agents generally producing worse toxicity than acidic agents. Please enable it to take advantage of the complete set of features! No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. Paclitaxel, nanoparticle albumin-bound (Abraxane), Chemotherapy extravasation injury (UpToDate), ONS (Oncology Nursing Society) chemotherapy extravasation FAQs, Beatson West of Scotland Cancer Centre Chemotherapy extravasation guideline, West Suffolk Hospitals extravasation guideline,, About - A Hematology Oncology Wiki. 3. An official website of the United States government. ACR Committee on Drugs and Contrast Media. These . TheAmerican Society of Clinical Oncology (ASCO)and ONS are conducting an ongoing collaborative project to use a rigorous, consensus-based process to develop standards for the safe administration of chemotherapy. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Extravasation of antineoplastic agents: prevention and treatments. Pediatr Rep. 2012 Aug 1;4(3):e28. 5200 Butler Pike Clipboard, Search History, and several other advanced features are temporarily unavailable. endstream endobj startxref Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Nafcillin. Reference: 1. Of the utmost importance is that the administration setup ensures chemotherapy is given safely and allows for prompt nursing intervention in the event of an adverse reaction or infiltration. The https:// ensures that you are connecting to the European Oncology Nursing Society extravasation guidelines. Unauthorized use of these marks is strictly prohibited. *Follow guidelines and treat like a vesicant. 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET FOIA Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. The vinCRIStine is infused via gravity through the peripheral line. Reviewed electronically by nursing reference committee. Overview, prevention and management of chemotherapy extravasation. Bethesda, MD 20894, Web Policies Bookshelf 3/26/2014 5. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and recommendations made by professional oncology organizations are useful resources in this process. <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>> Monitor for extravasation according to hospital policy. official website and that any information you provide is encrypted This section focuses on drug administration, including cycle definition (which contains the cycle length, number of cycles, and other schedule-related information), dosing, frequency, and routes of administration. 3/10/2014, 7. Nurgat Z, Smythe MP, Aljedai A. The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. 2. What are other facilities doing to avoid excessive drug loss in the tubing? 3/26/2014, 4. The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. Cold (different suggestions for anthracyclines depending on reference): (off-label, based on general management strategies for anthracyclines), Cold - 15 to 20 minutes at a time for at least four times per day for 24 hours, Irritant or neutral, depending on reference, Cold - Every 8 hours for 3 days; if using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate, Vesicant/Irritant (depending on reference). Epub 2014 Jul 3. J Oncol Pharm Pract. Avoid continuous vesicants or irritants (chemotherapy, vasopressors) . Midline catheters differ from other VADs with regard to their insertion and termination sites.1,3Midline catheters are inserted peripherally into the antecubital fossa or upper arm via the basilic, cephalic, or brachial vein, and extend from 8 to 20 cm centrally, where the catheter tip terminates at or below the axillary vein. J Oncol Pharm Pract. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) This information is intended as an educational piece and should not be used as the sole source for clinical decision making. In addition, whenever an extravasation occurs or is suspected, vesicant administration must immediately cease, and the appropriate antidote or treatment needs to be promptly administered. Pittsburg, PA: Oncology Nursing Society; 2014. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . In 2021 the Infusion Nurses Society (INS) updated their 2016 guidelines and recommended consideration of midline catheters when the anticipated duration of therapy was 5 to 14 days with a preference for peripheral catheters for shorter durations of therapy and CVCs when longer durations of therapy are required.6 A recent study supports use of midline catheters for prolonged courses of therapy up to 14 days, but there remains limited data for use of midline catheters beyond 2 weeks.7 Currently, the CDC recommends consideration of midline catheters when the duration of IV therapy is likely to exceed 6 days.1,8, Considerations for drugs administered via midline catheter 3. Apply cold pack intermittently for 15 minutes at a time, four times per day for 3 days, Apply cold pack 15 to 20 minutes at a time for at least four times per day for 24 hours. This website is using a security service to protect itself from online attacks. Do not pinch the IV administration tubing because this can cause the vein to rupture. Gorski LA, Hadaway L, Hagle ME, et al. References: 1. What do you recommend? Nurses, Chemotherapy, and Pregnancy: What Do We Know? Unauthorized use of these marks is strictly prohibited. Conclusion Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. The Hospira Brand of vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial package insert2 states: 866-257-4ONS (866-257-4667). Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. Would you like email updates of new search results? For example, many cytotoxic agents (ie, chemotherapy) are considered vesicants and should not be administered via midline catheters according to INS standards.10,11Additionally, in 2017, the INS assigned a Vesicant Task Force to publish a list of noncytotoxic vesicant medications and solutions.11The Table below, while not exhaustive, details drugs from this list, as well as drugs that have extremes of pH or osmolarity that have been associated with vascular injury or extravasation.8,9, One drug that has generated controversy regarding its appropriateness for administration via midline catheter is vancomycin. Polovich M, Olsen M, LeFebvre KB, eds. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. PMC Most importantly, organizations must weigh the risk of possible extravasation versus certain death from the accidental administration of vinCRIStine by the intrathecal route when making decisions about changing practice. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. Assessment of the risk of extravasation with the introduction of vincristine mini-bags to eliminate inadvertent intrathecal administration. 0 Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Apply ice to the area for 15 to 20 minutes each hour for 4 hours. Unable to load your collection due to an error, Unable to load your delegates due to an error. Advocating for the Provision of Alternate Responsibilities for Nurses Who Are Pregnant, Breastfeeding, or Trying to Conceive, Medical surveillance programs are recommended to detect changes in the health status of those working with hazardous drugs. When assessing a chemotherapy extravasation, it is important to understand the classification of the chemotherapeutic agent in terms of its potential to cause cellular damage if extravasated. eCollection 2012 Jul 31. stream Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. 125 Enterprise Drive A subsequent 2013 revision Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. eCollection 2012 Jul 31. Accessibility The action you just performed triggered the security solution. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. HHS Vulnerability Disclosure, Help Because this termination site is distal to those of CVCs and peripherally inserted central catheters (PICCs), midline catheters are not considered to dwell in the central circulation.1Whereas the central termination site of CVCs and PICCs provide the ability to administer a wider range of infusates (eg, vesicants), this is not recommended with VADs terminating distal to the central circulation. 2 0 obj Courtney Krueger, PharmD, BCPS official website and that any information you provide is encrypted %PDF-1.6 % 2088 0 obj <> endobj endstream endobj 2089 0 obj <. Disclaimer. National Library of Medicine 2006;12(2):113-8. Gilbar PJ, Carrington CV. % Version number changed to v.5. Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. Oncologist. National Library of Medicine 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; PMC Eur J Oncol Nurs. The venous access should not be removed immediately, since it can be used to attempt aspirating extravasated fluid and for administration of an antidote, if clinically appropriate. Antidotes to vesicant chemotherapy extravasations. 125 Enterprise Drive Developing extravasation protocols and monitoring outcomes. Vesicant extravasation: myths and realities. Clinical Associate Professor, Drug Information Specialist, Updated by: Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Additionally, the risk of cytotoxicity is reduced by intermittent compared with continuous infusion, as well as by dilution of vancomycin to concentrations of 2 to 5 mg/mL. Except as expressly stated on this site or as otherwise permitted by applicable law, no content on this site may be used or reproduced without the permission of the copyright holder. Another option is to aspirate with a syringe via the lowest Y-site and clamp off fluid from the minibag. Gilbar PJ, Carrington CV. Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. The https:// ensures that you are connecting to the Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. An official website of the United States government. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. If not clearly defined in the literature. Minor updates to administration and patient education. Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta-analysis [published online ahead of print, 2020 Dec 29]. When the institution implements the use of minibags to administer vinCRIStine, the following nursing guidelines should be followed to further reduce the risk of harm from extravasation. Depending on treatment complexity, ONS's Chemotherapy and Biotherapy Guidelines and Recommendations for Practice state that chemotherapy agents being administered by infusion "may be connected directly to the IV catheter or to a line of compatible maintenance solution." Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. 2012;18(suppl):16-7. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment information, and advocated for patient care, all in an effort to improve the quality of life and outcomes for patients with cancer and their families. Lastly, they recommend avoidance of midline catheters in patients with a history of thrombosis, hypercoagulability, venous stasis, or with a need to preserve vein integrity, such as in patients with end-stage renal disease. All rights reserved. Venous irritation (chemical phlebitis) that occurs with drug administration into a vein that remains intact (eg, vinorelbine and epirubicin), and other cutaneous complications of chemotherapy are discussed elsewhere. Rev. Polovich M, Olsen M, LeFebvre KB, eds. 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. 1,2 Recognize that when a vinca alkaloid is prepared in a minibag, it is likely more dilute than in a syringe, and thus the impact of tissue injury is even less if extravasation should occur. Intermountain Medical Center . Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital References: 1. Although relevant guidelines and policy statements existed (e.g., OSHA'sControlling Occupational Exposure to Hazardous Drugs, Chapter 2: Safe Handling of Chemotherapy Drugs, the ONSChemotherapy and Biotherapy Guidelines and Recommendations for Practice, ASCO'sCriteria for Facilities and Personnel for the Administration of Parenteral Systemic Antineoplastic Therapy), specific requirements to promote patient safety had not been well-defined by key stakeholders. If an antidote is not going to be used, the venous access can be removed after aspiration of the extravasated fluid has been attempted. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. 1990 Mar;4(1):41-60. doi: 10.1016/0268-960x(90)90015-k. Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. eCollection 2018 Apr. Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. Updated July 2017. European Oncology Nursing Society extravasation guidelines.
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