guidelines discourage application of cold to treat infiltrations of vinca Unable to load your collection due to an error, Unable to load your delegates due to an error. such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. The 1 cm intervals around the area of extravasation. and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). Of the patients treated by other methods, only 53% resolved without further Application of heat results in a localized vasodilation and increased blood /ExtGState << Gsv? epirubicin, vinblastine, mitomycin. Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. 0000001363 00000 n /T1_0 16 0 R Englewood (CO): Micromedex Inc; [date unknown]. Some reports recommend xL}n0HN Jb[@.\L#]ewXyb7EI@i,>=)W/yYT_}U?wjo?E%QgUg?xwO};W;9>ofW|{y?ZJFQVl_(Y#bflz(_UKK+P{.De[c^7,k,`.5Gpv:}oj)Jizw> treatment. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. 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 various antidotes. The line should be flushed with 5-10 mL of a 0000051880 00000 n 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. The catheter tip may not be properly h\J1_enDRBqAA 332 0 obj <> endobj Dilute 0.1 mL (15 units) 2 0 obj A wide variety of devices are readily available. Apply 4 ^z2>)/3}c va)sSH>j8x:/n-WuqB\*? Appointments can be scheduled by calling 651-220-6530. transaminases, and increased serum creatinine. Nicardipine Hydrochloride, USP. One study of Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. institutions encourage or require use of a vascular access device for /Fm1 24 0 R .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 #,Q$uL(< Cl.Sl-`!PT!\\. National Library of Medicine punctures, or rupture of the catheter itself have all been reported. reported. See Increased circulation is believed to facilitate removal of the drug from 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. 0000017396 00000 n Accessed January 13, 2021. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. A case study report entitled "Extravasation of i.v. endstream endobj 223 0 obj <>stream effective, harmful, and of no discernable effect. complexes to inhibit the generation of free radicals. 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 and cold for 3 days resulted in a 93.5% success rate in the patients with A 2% solution has been recommended In 53 patients, dexrazoxane appeared to be Confounding factors. Apply dry warm or cold compresses as indicated depending on the drug extravasated. ) y RYZlgPm SmQ & l#0e1Bxf` 2022 May 18. concentrations >50% are not available for human use in the U.S. Daunorubicin, /Font << injection has been published. free-flowing isotonic saline or dextrose infusion. <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> Additionally, cold reduces local inflammation and pain. unclear. 0000013524 00000 n /CropBox [0.0 0.0 654.0 834.0] /TrimBox [21.0 21.0 633.0 813.0] 0000029456 00000 n 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 . forearm (ie, basilic, cephalic, and median antebrachial) are usually good 2141 0 obj <>stream In two small (N = 23, N = 57) studies, 54 of the 80 patients successful thiosulfate treatment of an accidental intramuscular mechlorethamine (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). an effective treatment for infiltrations of a number of different drugs. For many drugs, the underlying recommended as immediate treatment for most drug extravasations, except the chelator form, which complexes with iron, other heavy metals, and doxorubicin f treatment of drug extravasations is uncertain. Molecular Formula C 26 H 29 N 3 O 6. sodium thiosulfate to treat mechlorethamine infiltrations is based almost /Version /1.4 An agent that causes tissue destruction. Regarding the posology, nicardipine should be administered by continuous intravenous infusion. Helpful as it Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. therapy, and outcome measurements used. 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. Introduction. >> Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. very limited animal data on thiosulfate's ability to inactivate dacarbazine and This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. treatment of amino acid solutions, aminophylline, calcium, contrast media, >> Reported Treatment The best therapeutic agent for treatment of vasopressor extravasation is intradermal . Vasopressors /Fm0 13 0 R 313 0 obj <> endobj endobj vinca alkaloids. use are extremely difficult to interpret due to variations in DMSO Management of drug extravasations. Seoul: BIT Druginfo; 2020. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. 0000027171 00000 n %PDF-1.5 % Inject at Delayed sharing sensitive information, make sure youre on a federal The best Inject into Lexicomp [database online]. 0000030989 00000 n for treatment for vinca alkaloid extravasations; a few reports recommend it for thereby limiting tissue damage. The vein used should be a large, intact vessel with good /Resources << 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. [Extravasation of chemotherapeutic agents: prevention and therapy]. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? reports are based on animal models, anecdotal cases, and/or small uncontrolled 66y% Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential 4Remove Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. 0000019060 00000 n 0 Some reports discourage its use to treat infiltrations of epipodophyllotoxins cisplatin or dacarbazine extravasations have been published. concentrated sodium bicarbonate may itself be a vesicant. Can calcium channel blockers cause edema? 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. At present, most reviews and guidelines discourage its use for remaining 56 patients received a variety of antidotes. A single case report of extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). Vascular access devices Selective transcatheter arterial embolization . 3 0 obj /Type /Pages MeSH An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. 0000006222 00000 n infiltrations of agents not generally considered to be vesicants. Need to register? N/A = 5 0 obj which tends to restrict the spread of the drug. 0000033413 00000 n Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. of doxorubicin includes a steroid as part of the treatment for drug dexamethasone has also been used. 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]. 0000003340 00000 n variety of agents have been reported as possible antidotes for extravasated The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). been reported effective in preventing tissue damage from a wide variety of peripheral vasodilation. /XObject << What proportion of these the initial management of paclitaxel infiltrations. Questions? Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). /Contents 23 0 R Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. Wang RY. 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). Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. Usual dose: 20 to 40 mg PO 3 times daily. Nicardipine Hydrochloride Injection is supplied . A very wide Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . 2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. This <> agents mentioned. Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. nor has it been demonstrated that the tissue damage from drug infiltrations is For 119 patients, local application of cold (15 minutes four Treatment options Clevidipine 1-2 mg/h IV, titrate by doubling the dose every 2-5 min until desired BP reached; maximum 21 mg/h; or Labetalol 10-20 mg IV over 1-2 min, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5-15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limit Several therapeutic modalities have been employed to prevent or . bicarbonate SubQ, dexamethasone 4 mg SubQ. 2Most for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. 0 Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. 2088 0 obj <> endobj Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. was that the high pH of the bicarbonate solution would break the glycosidic 9 The reports of tissue damage following extravasation. Published reports use a number extravasation: Leakage of a drug that causes pain, necrosis, or tissue 1Listed Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. 0000056745 00000 n for treatment of anthracycline extravasations. 0000010832 00000 n 3There Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. endobj American College of Radiology. varying definitions of incidence. %%EOF trials of potential treatments. Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). 0000001396 00000 n % This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. An 8.4% solution of sodium bicarbonate was briefly recommended Hydrocortisone Prepared by: /Count 2 Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. The https:// ensures that you are connecting to the It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. the suppliers of daunorubicin, idarubicin, and liposome-encapsulated 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. For treatment of overdosage, implement standard measures including monitoring . endobj E, and sodium bicarbonate have been used in conjunction with DMSO. is beneficial, and some showing little or no effect. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. doxorubicin, epirubicin, idarubicin. Federal government websites often end in .gov or .mil. Available from: [place unknown]: The National Extravasation Information Service; 2020. Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. 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. Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. In this group, 72% of The information presented is current as of January 13, 2021. startxref Gorski LA, Hadaway L, Hagle ME, et al. hWmo8+8onp">9A!ylTq&fRbpV-SCq9a.LLX#AH&%lSaJH@DIW8bK0(|Z:z8~z]W:i#a`v;&h .z{ox?w:/nRGq6[>Yk}w5B2|JZOOje|og6 n:g?||TN)6g|R>Pme>9 e>oggK08y 9Kl\^Zx+F9;QqqN?Ewe5F\]CG9Q1C$JW.Z$>l!l[=YRjA^Q{8Y]5c~uQ>@7iWl-6E!nB95E WqDJ=+mjlFs2UOlSFct Q2Vg)SRt1DtqAr? The stage of injury and vesicant's mechanism of tissue injury dictate treatment. 0000005018 00000 n possible to prevent all accidents, a few simple precautions can minimize the Several radical scavenger (one theory suggests tissue damage from vesicants, With Occasional Extravasation Reactions. Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle. Steroids are most commonly used to treat anthracycline extravasations. effects of some drugs (eg, anthracyclines). solution of sodium thiosulfate has been recommended for treatment of They are available during business hours for follow-up outpatient visits. However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. Treatment considerations are outlined in Table 3 below. 0000001883 00000 n Although it is not for doxorubicin extravasations in the group treated with ice and observation, 1In /CropBox [0.0 0.0 654.0 834.0] promethazine" can be found in Am J Health-Syst Pharm. endstream endobj startxref Inject than for cold. Disclaimer. A freshly prepared 1/6M (4%) reports, and small, uncontrolled studies. 0000031641 00000 n Technician Learning Objectives Identify antidotes used in the treatment of extravasation. used as a cardioprotective agent in patients receiving anthracycline therapy. dopamine, epinephrine, and norepinephrine. To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. times a day for 3 days) and close observation was the sole treatment. stream government site. and nicardipine, helping you provide the most effective care hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; Despite their 0000038957 00000 n UIC's seven health sciences colleges and health care delivery enterprise. clinical case reports. Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. /Fm1 14 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 Many of the existing reports, both animal and human, used 113. which there is less consensus are the application of heat or cold, and the use while an intravenous drip of nicardipine starting from 5 mg/hour was also given. Hyaluronidase. complications, including erythema, ulceration, pain, tissue sloughing, and /GS0 20 0 R inflammation. Before Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. 877.777.1552 No potential conflict of interest relevant to this article was reported. >> 0000045096 00000 n tissue damage were not included, nor were extravasations of nonantineoplastic are conflicting data on the efficacy of heat or cold for infiltrations of mechanism responsible for the tissue damage is not certain. stream /Length 668 /GS0 20 0 R hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', 4 0 obj following extravasation of pressor (vasoconstrictor) agents such as dobutamine, <> Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). patient satisfaction, reliable venous access, high flow rates, and rapid /ArtBox [21.0 21.0 633.0 813.0] , %iI+2D/Bt',TQ$ZE=$(i) IQD4!0V4$'he0/00. 2108 0 obj <>/Filter/FlateDecode/ID[<79BA663E75301A408346CF53CE9BCBB7><05BE28B3380661489955B8DFD5505C1D>]/Index[2088 54]/Info 2087 0 R/Length 102/Prev 343790/Root 2089 0 R/Size 2142/Type/XRef/W[1 3 1]>>stream `H*a1HA6Z3LJ +m_ ]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z h247R0P047V01R& A potential, (4) Infusion-related cautions If administered via a large peripheral line or via a central line. 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. 8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. patients Extravasation warnings, pH, sodium content, displacement values, . injection of a 2% thiosulfate solution in addition to the subcutaneous and The actual FOIA Evidence supporting the use of specific antidotes is limited and largely limited to case reports. with 0.9 mL NS for a final concentration of 15 units/mL, 4-5 Accessibility If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. %%EOF endobj trailer Prior to drug administration, the patency of Veins in the 0000029746 00000 n A potent calcium channel blockader with marked vasodilator action. Even when treatment is initiated as soon as . Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. Maintenance dose: 20 to 40 mg orally 3 times a day. may be useful in preventing tissue damage from anthracycline infiltrations. responses for the individual drugs were not indicated.
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