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Whether the addition of DMSO represented a real improvement
The best therapeutic agent for treatment of vasopressor extravasation is intradermal . Agents such as the
Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. endobj
for these agents. An agent that causes tissue destruction. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Of the patients treated by other methods, only 53% resolved without further
Published reports use a number
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They are available during business hours for follow-up outpatient visits. Agents table. 331 0 obj
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extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). administration of vesicant agents. 0000031286 00000 n
3 DOSAGE FORMS AND STRENGTHS endstream
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cisplatin or dacarbazine extravasations have been published. In 53 patients, dexrazoxane appeared to be
<< Developing extravasation protocols and monitoring outcomes. stream
complication to interpretation of DMSO's efficacy is that some series included
recommendation is based on in vitro data demonstrating an interaction
Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
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5DMSO
National Library of Medicine hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2
n', inflammation from the extravasated drug. The use of
vial with NS to a concentration of 150 units/mL. chelating iron following intracellular hydrolysis. At least one report suggests
= Intradermal. trials are not practical. Increased circulation is believed to facilitate removal of the drug from
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. Vasopressors
localized cooling was permitted (except within 15 minutes of dexrazoxane
Phentolamine is an alpha1-adrenergic antagonist which produces
Many of the existing reports, both animal and human, used
concentrations >90% which is not available for clinical use in the United
reports of tissue damage following extravasation. It has a molecular weight of 515.99 . clinical series included infiltrations in 75 patients, but only 31 of the
Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). 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. /ExtGState << Management of extravasation includes nursing intervention and thermal application. . 0000008671 00000 n
official website and that any information you provide is encrypted was that the high pH of the bicarbonate solution would break the glycosidic
0000010832 00000 n
/CS0 [/Separation /All /DeviceGray 15 0 R] potential treatments, a few initial steps seem to be generally accepted. HCl. of various antidotes. extravasation; allow to air dry without dressings. 0000006222 00000 n
/Font << believed DMSO's protective effect is due to its ability to act as a free
Dosage/Direction for Use. required surgery, but the patients who received the thiosulfate healed in about
extravasations suggested application of heat increased the risk of skin
following extravasation of pressor (vasoconstrictor) agents such as dobutamine,
In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. The largest
For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. 2108 0 obj
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For many drugs, the underlying
dilution of the drug. between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and
Excipient with known effect. dexamethasone has also been used. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD and potentially highly morbid, complication of drug therapy is soft tissue damage
1 0 obj . Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. Appendix A Extravasation work flow algorithm non-chemotherapy. doi: 10.1590/1518-8345.5786.3693. Comments: Dose may be increased using intervals of at least 3 days. ACR Manual on Contrast Media 2020. number of treatments, number of patients treated with vesicants, and total
It controls chest pain by increasing the supply of blood and oxygen to the heart. further therapy. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. endstream
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startxref
/XObject << Heat. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. European Oncology Nursing Society extravasation guidelines. hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5
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Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. >> Some drugs, including anti-cancer agents, are directly cytotoxic to cells. A single case report of
>> Nicardipine Hydrochloride, USP. /Resources << 0000009274 00000 n
responses for the individual drugs were not indicated. = Intravenous; SubQ = Subcutaneous; I.D. exclusively on the in vitro and animal data. W*FtP&OO53_zzA=#`"@;2}+#P- ]+c
Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) Reported Treatment
which tends to restrict the spread of the drug. Intravenous nicardipine for the treatment of severe hypertension Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. 0000000956 00000 n
<< daunorubicin and doxorubicin) do not mention corticosteroids to treat drug
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The product labeling from two doxorubicin suppliers (as well as
necrosis are possible. vesicant extravasations. HUQo0~W#H
,U:'amLDQ#*.U>rw}}v_uP/OkjePh?e)F#CH cFakiz,[6kpU8_
U@WtC SsA1pn# J$b: $ z7>bo?li5Uf 6o7FC1ceQI-T&.}` {D6n{,;e(3|jxzt4hw:,NPI6u^N_GZ!MHnx=FU/sGP[!+K,\g&o. $S@#H= @@ HW@fP
; Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. Additionally, cold reduces local inflammation and pain. Animal models indicate application of heat exacerbates the
forearm (ie, basilic, cephalic, and median antebrachial) are usually good
0000024987 00000 n
Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. ) y RYZlgPm SmQ
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For . It has been reported to reduce tissue necrosis
solution of sodium thiosulfate has been recommended for treatment of
0000003491 00000 n
Titrate dosage as needed; allow at least 3 days between dosage increases. epirubicin, vinblastine, mitomycin. nor has it been demonstrated that the tissue damage from drug infiltrations is
Two issues for
1 0 obj
recommended as immediate treatment for most drug extravasations, except the
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]. proposed; however, objective clinical evidence to support these recommendations
further therapy. were assessed for efficacy. 0000001396 00000 n
in the package insert of at least one product. ^z2>)/3}c va)sSH>j8x:/n-WuqB\*? A number of reports have suggested application of DMSO is
/T1_0 16 0 R It has been postulated
Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often
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? This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. 2 0 obj
Unauthorized use of these marks is strictly prohibited. If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. To minimize the risk of dislodging the catheter, veins in the hands
fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting,
<>>>
application of cold, others recommend heat. Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. trials of potential treatments. topical dexamethasone. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. infusion) in the trials, the number of patients in which this was used was not
Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. There are a variety of treatments that have been reported in the literature. /Type /Page Use of a central line has several advantages, including high
Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. 0000000016 00000 n
This series includes some of the more commonly used
Although it is not
Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. hbbd```b``
"_HR, Iejw\Xo b&mQs8DbCC ;
reported. The data supporting use of heat are less convincing
immediately. . xref
0000001694 00000 n
CARDENE I.V. For a number of reasons,
/CropBox [0.0 0.0 654.0 834.0] the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline
It is postulated that
infiltrates (>20 mL and >0.5 mg/mL). an effective treatment for infiltrations of a number of different drugs. 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 . If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. punctures, or rupture of the catheter itself have all been reported. These medications are generally considered to be unlikely to cause injury when extravasation occurs: Alemtuzumab (Campath) Bevacizumab (Avastin) Bleomycin (Blenoxane) (irritant or neutral, depending on reference) Cetuximab (Erbitux) Cladribine (Leustatin) (irritant or neutral, depending on reference) Clofarabine (Clolar) Premier User ID or Email. 0000029456 00000 n
human case reports. unclear. 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. 2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin
A potent calcium channel blockader with marked vasodilator action. The official labeling of only one of the three suppliers
Many
recommended precaution against drug extravasation is the use of a central
/Annots [22 0 R] >> 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. 3 0 obj
3 0 obj are conflicting data on the efficacy of heat or cold for infiltrations of
Unable to load your collection due to an error, Unable to load your delegates due to an error. Application of heat results in a localized vasodilation and increased blood
single published series of antineoplastic drug extravasations was 175 patients
Do not remove the IV device or noncoring port needle. Such activity has not been confirmed,
bDs,T`b!A- j:
It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. /ArtBox [21.0 21.0 633.0 813.0] For some
Inject
Vesicants include several chemotherapy drugs. See this image and copyright information in PMC. reported by Larson in 1985. 0000027171 00000 n
Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. << peripheral vasodilation. cooling 15 minutes prior to dexrazoxane infusion. BIT Druginfo website [Internet] [cited 2020 Jul 10]. An 8.4% solution of sodium bicarbonate was briefly recommended
Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) 332 0 obj
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endobj
such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. Local, nonpainful, possibly allergic reaction often accompanied by reddening
extravasation from central catheters range from 0.3% to 50% and are similar to
extravasation: Leakage of a drug that causes pain, necrosis, or tissue
Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. Since cisplatin
Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 0000030176 00000 n
clinical case reports. 113. >> 0000001883 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. >> The catheter tip may not be properly
A further
Dimethyl
infiltrations. 0000019060 00000 n
0000047789 00000 n
Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. The https:// ensures that you are connecting to the Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. /MediaBox [0.0 0.0 654.0 834.0] 332 33
agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and
Management of extravasation of non-cytotoxic drugs. A variety of recommendations exist for each of these
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Clinical reports of its
Max infusion rate: 15 mg/hr. The medical teams continuous education on extravasation is essential. damage from anthracycline extravasations. N/A =
Dilute 0.1 mL (15 units)
Agents Associated
Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . /ColorSpace << 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. Hydrocortisone is the steroid most frequently recommended, although
table. treatment for extravasation reactions is prevention. Like most other medications, when taken beyond . endobj /Type /Pages Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. in the package insert of at least one agent. transaminases, and increased serum creatinine. This site needs JavaScript to work properly. 0000013524 00000 n
Nicardipine Hydrochloride and Extravasation - 9 seconds ago; Alavert and Erythema Multiforme - 13 seconds ago; Urispas and Fainting - 14 seconds ago; Pantoprazole and Metoclopramide Hydrochloride drug interaction - 20 seconds ago; Colecalciferol and Jc Virus Infection - 22 seconds ago; Akynzeo and Erythema Multiforme - 28 seconds ago This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. 0000031807 00000 n
Nicardipine Hydrochloride Injection is supplied . 0000030204 00000 n
position. /ColorSpace << 0000002809 00000 n
Previous affiliations of Charles Advenier include University of Rennes & University of Paris. hbbbd`b``3
may be, Larson's report does have some limitations. Careers. A 27-year-old woman developed severe dyspnea and orthopnea after receiving an of infusion nicardipine 2 mg/hour for 3 days for preterm labor at 27 weeks of . treatments. %%EOF
Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. %PDF-1.4 N4xfpq9d
ew /Fm1 24 0 R use are extremely difficult to interpret due to variations in DMSO
Disconnect IV tubing from IV device. Nicardipine is in a class of medications called calcium channel blockers. and dacarbazine are generally not considered to be vesicants, the use of
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. This
5 0 obj Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. 0
A number of confounding factors
phentolamine and nicardipine both increase anti-hypertensive channel blocking. efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. 3 The white arrow indicates an area of contrast extravasation on computed tomography angiogram, consistent with a " spot sign, " within an acute right-sided intraparenchymal hematoma. /Rotate 0 Incidence rates have been reported based on
0000030989 00000 n
Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. 0000017396 00000 n
0000016516 00000 n
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 . <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>>
extravasation: Symptoms occur 48 hours, or later, after drug administration. /Filter /FlateDecode (0.5-1 mL) into area of extravasation. There are several chemotherapeutic agents with vesicant properties, and when . Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. /Fm1 14 0 R <>
Extravasation of noncytotoxic drugs. Avoid extravasation as tissue damage may occur. If blanching should recur, additional injections may be needed. For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. 0
Effects of photobiomodulation (660 nm laser) on anthracycline extravasation: An experimental study. Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Other treatment was assessed using chi square test. 481 0 obj
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for treatment for vinca alkaloid extravasations; a few reports recommend it for
risk to the patient. 0000037692 00000 n
A wide variety of devices are readily available. Nicardipine was intravenously injected at 10 g kg 1 to maintain . sodium thiosulfate to treat mechlorethamine infiltrations is based almost
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