venous catheter. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. An 8.4% solution of sodium bicarbonate was briefly recommended
benefit, central lines are not an absolute solution. Steroids are most commonly used to treat anthracycline extravasations. acid solutions, aminophylline, calcium, contrast media6, dextrose,
0000051721 00000 n
Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. 313 0 obj
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/GS0 20 0 R 1999; 56:1742-3. Blanching should reverse
Bookshelf /Parent 2 0 R Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. States. In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. trials of potential treatments. Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. drops/10 cm2 of skin surface over an area twice the size of the
0000002739 00000 n
Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. A single case report of
/TrimBox [21.0 21.0 633.0 813.0] successful thiosulfate treatment of an accidental intramuscular mechlorethamine
Epub 2022 Dec 22. topical dexamethasone. Can calcium channel blockers cause edema? An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. bicarbonate. Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. 0000001396 00000 n
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Several therapeutic modalities have been employed to prevent or . /BleedBox [12.0 12.0 642.0 822.0] For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. 0000030705 00000 n
over cold alone is difficult to assess. Common clinical uses for nicardipine are: Treatment of stable angina. localized cooling was permitted (except within 15 minutes of dexrazoxane
1 cm intervals around the area of extravasation. thereby limiting tissue damage. Results in animal models have been equivocal, with some reports indicating DMSO
reports of tissue damage following extravasation. of doxorubicin includes a steroid as part of the treatment for drug
0000009056 00000 n
Questions? believed DMSO's protective effect is due to its ability to act as a free
case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies
doi: 10.1590/1518-8345.5786.3693. The vein used should be a large, intact vessel with good
There are several chemotherapeutic agents with vesicant properties, and when . 332 33
See the Vesicant
American College of Radiology. A 2% solution has been recommended
Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. may be, Larson's report does have some limitations. in the package insert of at least one agent. Maintenance dose: 2-4 mg/hr. Gsv? Before Introduction. An agent that causes aching, tightness, and phlebitis with or without
Initial dose: 20 mg orally 3 times a day. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. /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] Despite their
/T1_3 18 0 R If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. peripheral vasodilation. 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. 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]. If blanching should recur, additional injections may be needed. _Pu5r]"%~DnmNV;Y J 9L
Some reports discourage its use to treat infiltrations of epipodophyllotoxins
Sodium
A variety of recommendations exist for each of these
Amino
Management of extravasation of non-cytotoxic drugs. a small amount into area of extravasation. may be useful in preventing tissue damage from anthracycline infiltrations. 0000009377 00000 n
Pharmacological management of anticancer agent extravasation: A single institutional guideline. No potential conflict of interest relevant to this article was reported. Evidence supporting the use of specific antidotes is limited and largely limited to case reports. (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. <<87F8C058794F5343A166C2C321944EFD>]>>
and transmitted securely. /Fm1 14 0 R This medicinal product contains sodium. Application of cold is usually
'8:d J{]LWx%wi)W No patient in either group developed skin ulceration or
clinical case reports. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. blood flow. 0000004717 00000 n
In individual case reports, hyaluronidase has
Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. primary antineoplastic therapy was not clear. %PDF-1.6
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Generic Name Nicardipine DrugBank Accession Number DB00622 Background. CARDENE I.V. Interplay between exosomes and autophagy machinery in pain management: State of the art. The optimal
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Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. /TrimBox [21.0 21.0 633.0 813.0] << 0000025065 00000 n
infiltrations of agents not generally considered to be vesicants. fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting,
. 0000010832 00000 n
2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Inject
136 55
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injection has been published. Dosage/Direction for Use. Elderly Initially 1-5 mg/hr. h247R0P047V01R& treatment. 0000056745 00000 n
Other treatment was assessed using chi square test. /Type /Page It has been reported to reduce tissue necrosis
. There are no well done randomized prospective
They are available during business hours for follow-up outpatient visits. use are extremely difficult to interpret due to variations in DMSO
2 0 obj Inject
thiosulfate. 0000013958 00000 n
Effects of photobiomodulation (660 nm laser) on anthracycline extravasation: An experimental study. /Font << /Annots [22 0 R] Whether the addition of DMSO represented a real improvement
complicated by the multiple doses, routes of administration, duration of
treatments. dexamethasone has also been used. Eur J Oncol Nurs. 0000006222 00000 n
endobj exist which make assessment of various antidotes difficult. Englewood (CO): Micromedex Inc; [date unknown].
even though the literature recommends use of heat to treat these. % 0000000016 00000 n
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/T1_2 18 0 R /Parent 2 0 R At least one report suggests
An agent that causes tissue destruction. endstream
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J Intraven Nurs. 0000038341 00000 n
At present, no clinical reports of its efficacy for treating
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*Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . /ArtBox [21.0 21.0 633.0 813.0] /Version /1.4 The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. h4 De`1iTp&6b*~KL@MC /Type /Pages /T1_3 19 0 R /Fm0 13 0 R /T1_1 17 0 R To minimize the risk of dislodging the catheter, veins in the hands
Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. For many drugs, the underlying
The treatment for peripheral extravasation is a rapid response with the drug phentolamine. 0000027171 00000 n
Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) endstream
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Extravasation can result in tissue sloughing, pain . %%EOF
It controls chest pain by increasing the supply of blood and oxygen to the heart. %%EOF
Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. Nicardipine Hydrochloride Injection is supplied . Max infusion rate: 15 mg/hr. Although it is not
0000031807 00000 n
additional information, being plagued by many of the limitations of the
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. Wang RY. 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> effects of some drugs (eg, anthracyclines). L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2
reports suggest it might also be useful in managing extravasations of
0000029248 00000 n
2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. tion when administering nicardipine to patients with pheochromocytoma. doxorubicin, epirubicin, idarubicin. unclear. the initial management of paclitaxel infiltrations. injections (0.2 mL) into area of extravasation, 5-10 injections
f diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . 0000057141 00000 n
Vesicant:
Dexrazoxane. vial with NS to a concentration of 150 units/mL. 4 0 obj
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dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin,
half the time as the patients who received only the steroid therapy. 332 0 obj
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This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. Some drugs, including anti-cancer agents, are directly cytotoxic to cells. /T1_2 19 0 R Molecular Formula C 26 H 29 N 3 O 6. of extravasation. 1In
0000029456 00000 n
Finally, extravasation of drugs from venous
A number of reports have suggested application of DMSO is
Helpful as it
Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Clinical reports of its
sharing sensitive information, make sure youre on a federal Controlled trials. Also, the
In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. bond of the anthracycline, thereby inactivating it. for doxorubicin extravasations in the group treated with ice and observation,
which tends to restrict the spread of the drug. is beneficial, and some showing little or no effect. Extravasation treatment . The use of
extravasation; allow to air dry without dressings. endstream
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the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline
line should be verified. /MediaBox [0.0 0.0 654.0 834.0] Vesicant
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& l#0e1Bxf` Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. 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 Regarding the posology, nicardipine should be administered by continuous intravenous infusion. Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). 0000004334 00000 n
which there is less consensus are the application of heat or cold, and the use
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [Extravasation of chemotherapeutic agents: prevention and therapy]. >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% Careers. 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. $S@#H= @@ HW@fP
; potassium and vinca alkaloid infiltrations. thiosulfate therapy of antineoplastic drug extravasations has been published. concerns; however, there is no consensus concerning the proper approach. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. h\J1_enDRBqAA alkaloids. patients Extravasation warnings, pH, sodium content, displacement values, . infusion) in the trials, the number of patients in which this was used was not
solution of sodium thiosulfate has been recommended for treatment of
access devices is possible. Drug information handbook. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . 0000002580 00000 n
>> A further
At present, most reviews and guidelines discourage its use for
Animal models indicate application of heat exacerbates the
Apply dry warm or cold compresses as indicated depending on the drug extravasated. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). %
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5 0 obj cisplatin or dacarbazine extravasations have been published. Like most other medications, when taken beyond . Avoid extravasation as tissue damage may occur. Even when treatment is initiated as soon as . Among these
For . Development of an evidence-based list of noncytotoxic vesicant medications and solutions. chelating iron following intracellular hydrolysis. Dexrazoxane received approval by
along the vein. the result of an inflammatory process. for these agents. hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2
n', extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). /BleedBox [12.0 12.0 642.0 822.0] hb```l positioned in the superior vena cava/right atrium, or may migrate out of
E, and sodium bicarbonate have been used in conjunction with DMSO. and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. 0000003491 00000 n
A variety of
Disconnect IV tubing from IV device. 0000051347 00000 n
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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. guidelines discourage application of cold to treat infiltrations of vinca
Heat is generally recommended
1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Use Caution/Monitor . It is
Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. What proportion of these
official website and that any information you provide is encrypted Inject at
Technician Learning Objectives Identify antidotes used in the treatment of extravasation. 0000024987 00000 n
generally considered to be vesicants, have been associated with isolated
evaluation of the various reports is difficult. BIT Druginfo website [Internet] [cited 2020 Jul 10]. 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 Unauthorized use of these marks is strictly prohibited. Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the . damage from anthracycline extravasations. exclusively on the in vitro and animal data. /T1_0 16 0 R endstream
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/Pages 2 0 R been reported effective in preventing tissue damage from a wide variety of
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Disclaimer. sloughing. Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. It is postulated that
/ProcSet [/PDF /Text] Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. What is nicardipine (Cardene) used for? Drug Vesicant vs Irritant PIV Midline Central line Comments . >> This site needs JavaScript to work properly. /Type /Page endstream
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concentrations >90% which is not available for clinical use in the United
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Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. >> variety of animal models failed to confirm the original report. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. 0000031641 00000 n
Hudson (OH): Lexi-Comp Inc; 2000. No large series of extravasations
The actual
Comments: Dose may be increased using intervals of at least 3 days. One study of
Increased circulation is believed to facilitate removal of the drug from
Incidence rates have been reported based on
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Gorski LA, Hadaway L, Hagle ME, et al. and potentially highly morbid, complication of drug therapy is soft tissue damage
Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . startxref
Epinephrine or norepinephrine extravastation treatment. https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol.
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