Antidotes to vesicant chemotherapy extravasations. Polovich M, Olsen M, LeFebvre KB, eds. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. Lu H, Yang Q, Yang L, et al. Answer:Yes, the product is stable in a minibag. Rev. The following information is a compilation from the various resources listed below.[1][2][3][4][5][6][7][8]. 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. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 2. Reviewed electronically by nursing reference committee. Gilbar PJ. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. eCollection 2012 Jul 31. Question:Wouldnt the administration of vinCRIStine IV push using a syringe be much shorter in duration and with less chance of extravasation than administration using a minibag? Additionally, patient mobility is greater with midline catheters because of the location of their insertion site.2 Lastly, compared with drug administration via peripheral IV catheter, the risk of phlebitis may be reduced with administration via midline catheter because of its termination in an area with a higher rate of blood flow.2The rates of CRBSI have also been reported to be lower with midline versus peripheral catheters (0 to 0.2 versus 0.5 per 1,000 catheter days).1, Overall, the properties of midline catheters may make them preferable for specific durations of therapy. References: 1. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. 3/26/2014, 4. %%EOF Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. Pittsburg, PA: Oncology Nursing Society; 2014. Answer:According to a publication by the Oncology Nursing Society, 1 the easiest way to check for a blood return is to use gravity by lowering the minibag below the IV site. Bookshelf Seo H, Altshuler D, Dubrovskaya Y, et al. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. The ASCO/ONS Chemotherapy Administration Safety Standards are intended to reduce the risk of error when providing adult patients with chemotherapy, and to provide a framework for best practices in cancer care. Preventing and managing vesicant chemotherapy extravasations 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. 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 Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. Cloudflare Ray ID: 7c0b26d1e9b36bd5 Manage conservatively; shield exposed tissues from light. Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. The site is secure. Also, dilution of the vinca alkaloid likely reduces the impact of any extravasation that might occur. Avoid the "blame game.". Gorski LA, Stranz M, Cook LS, et al. x][8~Gi"K6$Yd cG_")X=@zdbXb"f]FyMQrt2i[Fl')o:{pO^}~[~9>aP,p"yKxb}t+~{x:?OA9?tvK:0+M*7y wg|[]okN(6cw1gQX$|6x5Q^Xn{~(8klFaL8?k|9}YjO"?}M8OC?}T-Qezi^D1@olKSw8E[D7:z,eQ,rY!'HT|9,}O$. For every 1 mg of mechlorethamine suspected to have extravasated, inject 2 mL of the 1/6 molar sodium thiosulfate solution subcutaneously into the extravasation site using a 25 gauge or smaller needle. All rights reserved. A subsequent 2013 revision 139.59.111.99 Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. Intravascular catheter-related infection (BSI). 1998 Jul-Aug;21(4):232-9. 2141 0 obj <>stream 866-257-4ONS (866-257-4667). 4 0 obj Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. Sodium Chloride. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Listed below are a few non-chemo agents: Vancomycin. Rev. Abstract. FOIA Oncology Nursing Society releases updated guidelines on - Healio However, the INS Task Force identified limited literature describing extravasation of vancomycin. Management of Chemotherapy Extravasations - U.S. Pharmacist ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. European Oncology Nursing Society extravasation guidelines. Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. An official website of the United States government. References: 1. www.hospira.com/Images/434047_32-91799_1.pdf, http://opp.sagepub.com/content/early/2014/01/13/1078155213517729, Medication Safety Officers Society (MSOS). 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. Vesicants and irritants with vesicant . % 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. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Midline catheters have properties unique from those of peripheral and central VADs. Plast Reconstr Surg Glob Open. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. Rev. <> %PDF-1.7 (K k0|hzv 6gN5UzVa+91C+yTOOcV^t^IjpiOROeutcI9GOqs'."XA*c2@GfK!rKP;{4?|h=,G _wyNdfSc#A]LHq#@Gtn[YWk%1o*Bbyk'82h6~IOvvi2`6 Heat - 15 to 20 minutes at a time for at least four times per day for 24 to 48 hours. Always double check information at the primary references linked below. Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. Treatment of cutaneous injuries of neonates induced by drug extravasation with hyaluronidase and hirudoid. Polovich M, Olsen M, LeFebvre KB, eds. 2022 Dec 2;12:1021488. doi: 10.3389/fonc.2022.1021488. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. Gilbar PJ, Carrington CV. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. endobj Furthermore, in vitro evidence suggested that vancomycin-associated endothelial damage is caused by factors other than pH. Preparation for flexible plastic container VinCRIStine sulfate injection, USP when diluted with 0.9% sodium chloride injection in concentrations from 0.0015 mg/mL to 0.08 mg/mL is stable for up to 24 hours when protected from light or 8 hours under normal light at 25C. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. Potassium Chloride. In contrast, the Chemotherapy and Biotherapy Guidelines and Recommendations for Practice recommended against infusing vesicant agents peripherally for more than 30-60 min, but they also fail to categorize specifically chemotherapeutic agents as vesicants or irritants [Polovich et al. official website and that any information you provide is encrypted Nurses, Chemotherapy, and Pregnancy: What Do We Know? MeSH Vesicant chemotherapy extravasation antidotes and treatments Infusion therapy standards of practice. (PDF) Chemotherapy administration standards and guidelines: The %PDF-1.6 % 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. The main consideration in determining whether a drug is appropriate for administration via midline catheter is its propensity for causing phlebitis.2Phlebitis is inflammation of a vein caused by damage to the tunica intima, which may be accompanied by erythema, swelling, pain, heat, and a palpable cord if thrombosis is present. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, selecting an appropriate administration site for peripheral vesicant administration, and checking for a blood return prior to and during vesicant administration. The https:// ensures that you are connecting to the Pittsburg, PA: Oncology Nursing Society; 2014. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. The practice of monitoring the administration of vinCRIStine and other vinca alkaloids in a minibag to avoid extravasation via a peripheral IV is essentially the same as if it was administered IV push. Accessibility Would you like email updates of new search results? 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. MeSH 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. Current ASCO/ONS standards address the safety of all routes of chemotherapy administration to adult patients in the outpatient and inpatient settings. Version number changed to v.5. 4. Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. The .gov means its official. Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Extravasation injury from chemotherapy and other non - UpToDate Disclaimer. endobj Copyright 2023 Oncology Nursing Society. This site needs JavaScript to work properly. 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. www.hospira.com/Images/434047_32-91799_1.pdf Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. 2. 8}-Fb}" "R5xPQ%Flm^%/jV HHS Vulnerability Disclosure, Help No formal recommendation, but depending on clinical condition could consider extrapolating from management of other vinca alkaloids: Apply cold pack initially for 30 to 60 minutes, then repeat every 15 minutes on day 1 only. Hospira. 125 Enterprise Drive One randomized controlled trial found that the incidence of total complications, phlebitis, and thrombosis did not significantly differ when vancomycin was administered for less than 6 days via midline catheter versus PICC.3,14. Bethesda, MD 20894, Web Policies European Oncology Nursing Society extravasation guidelines. 09/04/2019. 3/10/2014, 6. Overview, prevention and management of chemotherapy extravasation. American Society of Clinical Oncology (ASCO), Personal Protective Equipment for Use with Hazardous Drugs.