generally considered to be vesicants, have been associated with isolated It has been reported to reduce tissue necrosis HLsd`bde`%F7wy? K9 0 {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Appendix A Extravasation work flow algorithm non-chemotherapy. 0000038093 00000 n injection of a 2% thiosulfate solution in addition to the subcutaneous and Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. sloughing. 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 damage from anthracycline extravasations. (0.5-1 mL) into area of extravasation. This results in increased permeability of the extravasations is based almost exclusively on animal models, anecdotal Apply dry warm or cold compresses as indicated depending on the drug extravasated. primary antineoplastic therapy was not clear. /Fm1 24 0 R Dilute 0.1 mL (15 units) Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. free-flowing isotonic saline or dextrose infusion. /T1_3 18 0 R The use of inflammation from the extravasated drug. Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. concentrations >90% which is not available for clinical use in the United Prepared by: 0000019060 00000 n >> Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . Wang RY. diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . 0000019842 00000 n paclitaxel, there are conflicting recommendations. E. Caution with intermitte nt vesicant administration as extravasation more difficult to detect F. In emergent situations, although not ideal, can be used instead of central line access . /Parent 2 0 R In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. No patient in either group developed skin ulceration or an effective treatment for infiltrations of a number of different drugs. chelator form, which complexes with iron, other heavy metals, and doxorubicin It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. 364 0 obj <>stream An agent that causes aching, tightness, and phlebitis with or without 0000009377 00000 n exist which make assessment of various antidotes difficult. a small amount into area of extravasation. E, and sodium bicarbonate have been used in conjunction with DMSO. 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. Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. ACR Manual on Contrast Media 2020. Do not remove the IV device or noncoring port needle. Vesicants can cause tissue destruction and / or blistering. 4 0 obj A very wide = Intradermal. reports suggest it might also be useful in managing extravasations of Intermittent cooling of the area of infiltration results in vasoconstriction, Agents table. @ Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. 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 It has been postulated extravasation does occur, a variety of immediate actions have been recommended. agents, including amino acid solutions, aminophylline, calcium, contrast media, tion when administering nicardipine to patients with pheochromocytoma. 0000010832 00000 n Nicardipine Hydrochloride Injection is supplied . 0000017632 00000 n 0000009414 00000 n Dosage/Direction for Use. Application of cold is usually Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). Despite their injection has been published. /Font << /T1_2 19 0 R 0000031641 00000 n nor has it been demonstrated that the tissue damage from drug infiltrations is number of treatments, number of patients treated with vesicants, and total venous catheter. 221 0 obj <>stream case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies Can calcium channel blockers cause edema? Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. Vesicants include several chemotherapy drugs. The remaining 32 patients received subcutaneous Certain drugs cause vasospasms, which result in back pressure at the intravenous (IV) site and may expand the puncture site in the vein, allowing leakage to occur; drugs that act as vasoconstrictors can also cause tissue ischemia. Prior to drug administration, the patency of /Fm0 13 0 R 2 0 obj which there is less consensus are the application of heat or cold, and the use human case reports. In two small (N = 23, N = 57) studies, 54 of the 80 patients Dexrazoxane. bicarbonate SubQ, dexamethasone 4 mg SubQ. /Parent 2 0 R zw ~rBz p41A iK14w,:Xr}ZzW4i]3E66}b8``f Y9x:9;PwuA^x{l.kpZy[Lo|-YEto~UEqV'qh@:!gy+pusn|enfoZ{aa>8^%Rm8u `t;M4bPUPM(\&|bw?+`w reR}nTBRi9)+ o flow. At least one report suggests HHS Vulnerability Disclosure, Help dilution of the drug. xref 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. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. Gorski LA, Hadaway L, Hagle ME, et al. What proportion of these >> Some drugs, including anti-cancer agents, are directly cytotoxic to cells. 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. A 2% solution has been recommended .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 0000057141 00000 n extravasations. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream 0000051347 00000 n Each approach has been reported to be Premier User ID or Email. f The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. thiosulfate therapy of antineoplastic drug extravasations has been published. >> 0000004334 00000 n infiltrates (>20 mL and >0.5 mg/mL). potassium and vinca alkaloid infiltrations. thiosulfate. vinca alkaloids. reports, and small, uncontrolled studies. /ProcSet [/PDF /Text] Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. For 119 patients, local application of cold (15 minutes four 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. 3 0 obj 190 0 obj <>stream << Application of 99% DMSO for 7 days /Contents [5 0 R 6 0 R 7 0 R 8 0 R 9 0 R 10 0 R 11 0 R 12 0 R] Most estimates place the incidence of extravasations See this image and copyright information in PMC. Gsv? Management of extravasation injuries: a focused evaluation of noncytotoxic medications. been reported effective in preventing tissue damage from a wide variety of 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. . The data supporting use of heat are less convincing further therapy. injury. may be useful in preventing tissue damage from anthracycline infiltrations. To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. A number of different treatments, including cold, steroids, vitamin along the vein. 0000001363 00000 n /Pages 2 0 R vesicant extravasations. /T1_1 17 0 R Comments: Dose may be increased using intervals of at least 3 days. /TrimBox [21.0 21.0 633.0 813.0] Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. When a drug >> agents mentioned. 0000056434 00000 n Extravasation of xenobiotics. Selective transcatheter arterial embolization . 2022 May 15;14(5):3472-3480. eCollection 2022. A variety of recommendations exist for each of these Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. <>>> extravasation: Leakage of a drug that causes pain, necrosis, or tissue Animal models indicate application of heat exacerbates the Maintenance dose: 20 to 40 mg orally 3 times a day. With Occasional Extravasation Reactions. in adult patients. Bookshelf and/or taxanes. improper placement of the needle in accessing injection ports, and cuts, Delayed of identifying the efficacy of any single approach. CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. endobj are subject to a number of complications. treatment of drug extravasations is uncertain. The .gov means its official. /BleedBox [12.0 12.0 642.0 822.0] 4 0 obj Reported Treatment 0000026505 00000 n With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD evaluation of the various reports is difficult. pH: 2.5-3.6 Extravasation: may cause tissue damage Do not flush Albumin 4.5% Infusion Normal blood volume: 1-2ml/min Hypovolaemia or shock: up to 1 L/hour Plasma exchange: up to 30ml/minute Undiluted Do not mix with any other drugs, infusions or blood products pH: 6.7-7.3 Do not use if turbid or contains a deposit Monitor: rarely allergic . 0000022294 00000 n In a series of 63 patients with extravasation of doxorubicin, epirubicin, The same or an alternative antidote should be given if no response is observed within 30 to 60 minutes of the initial antidote.6, Management of extravasation of cytotoxic drugs. Of the patients treated by other methods, only 53% resolved without further /ArtBox [21.0 21.0 633.0 813.0] endstream endobj startxref Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. 0000051048 00000 n vial with NS to a concentration of 150 units/mL. dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. At present, no clinical reports of its efficacy for treating 0000030660 00000 n 0000001178 00000 n Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. The necrosis, resulting in scarring and/or reduced function of the involved extremity. Vesicant Hydrocortisone injections (0.2 mL) into area of extravasation, 5-10 injections The catheter tip may not be properly Most data are from animal studies with relatively few A further For treatment of overdosage, implement standard measures including monitoring . Although it is not W*FtP&OO53_zzA=#`"@;2}+#P- ]+c Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) Disconnect IV tubing from IV device. Accessibility American College of Radiology. Aspiration of radiographic contrast media is not recommended. 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). An official website of the United States government. mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute Usual dose: 20 to 40 mg PO 3 times daily. concentration, number of applications/day, duration of therapy, and concomitant The best therapeutic agent for treatment of vasopressor extravasation is intradermal . One study of A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . David V, Christou N, Etienne P, et al. 0000003528 00000 n Each mL of solution for injection contains 50mg sorbitol. /XObject << Mechanism of action. An 8.4% solution of sodium bicarbonate was briefly recommended Interplay between exosomes and autophagy machinery in pain management: State of the art. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. It may also inhibit the local hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule infusion) in the trials, the number of patients in which this was used was not Appointments can be scheduled by calling 651-220-6530. endstream endobj 224 0 obj <>stream punctures, or rupture of the catheter itself have all been reported. the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline 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). $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. 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. 1In The stage of injury and vesicant's mechanism of tissue injury dictate treatment. treatment. than for cold. doi: 10.1590/1518-8345.5786.3693. table. 0000001694 00000 n number of patients treated. Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. Most reports question the efficacy of steroids for treatment of . Many of the existing reports, both animal and human, used endstream endobj 225 0 obj <>stream are conflicting data on the efficacy of heat or cold for infiltrations of 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). Flare: Sodium The largest hWmo8+bJ-mfBC);`3y3$b`=)GNe+*&4N\`)M4A=pPG(iaFM8C{H :@vFx y7'0[&|p9M~%S\0x$&>ES,Lp~R*v 5xf*d25hYGrCy[1 AH/gx>y9`/4p/hx^l4;|"O6=aYjXSw9'G"YIDw/$Ry*/k48\4l84y#"9N\]uWQ5)?- 1XP84ha, f1+&Tn4 @@O,)ldj]vLQ)C:Eo7|H:|])~VuoT?j368HzX sodium thiosulfate to treat mechlorethamine infiltrations is based almost Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. sulfoxide (DMSO). Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. dexrazoxane was also associated with a variety of side effects, including possible to prevent all accidents, a few simple precautions can minimize the What are current recommendations for treatment of drug extravasation? Extant particularly anthracyclines, is due to formation of hydroxyl free radicals). 0000030453 00000 n For . for treatment for vinca alkaloid extravasations; a few reports recommend it for PMC This site needs JavaScript to work properly. 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. Other treatment was assessed using chi square test. dopamine, epinephrine, and norepinephrine. epipodophyllotoxins and taxanes which are occasionally associated with soft 8600 Rockville Pike application of cold, others recommend heat. 0000000016 00000 n 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.
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nicardipine extravasation treatment