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CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. reports, and small, uncontrolled studies. 0
the initial management of paclitaxel infiltrations. Common clinical uses for nicardipine are: Treatment of stable angina. 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. the suppliers of daunorubicin, idarubicin, and liposome-encapsulated
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. /Rotate 0 Dexrazoxane was required to start within 6 hours of the drug
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<. component of connective tissue. Published reports use a number
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E, and sodium bicarbonate have been used in conjunction with DMSO. The data supporting use of heat are less convincing
0000051048 00000 n
Vesicants include several chemotherapy drugs. Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. extravasation treatment.26 Consequently, current man-agement recommendations are based for the most part on anecdotal experience.2,27-29 However, all current guidelines recommend the following steps at the first sign of infiltration or extravasation: (1) stop administra-tion of IV fluids immediately; (2) disconnect the IV tub- dilution of the drug. Excipient with known effect. endstream
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<. between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and
0000030176 00000 n
mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and
/Contents 23 0 R 0000029001 00000 n
Extravasation of noncytotoxic drugs. endstream
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Federal government websites often end in .gov or .mil. (0.5-1 mL) into area of extravasation. vesicant extravasations. It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. believed DMSO's protective effect is due to its ability to act as a free
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clinical series included infiltrations in 75 patients, but only 31 of the
line should be verified. endobj /XObject << 533 0 obj
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FOIA number of treatments, number of patients treated with vesicants, and total
For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. 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. hb```l Nicardipine is in a class of medications called calcium channel blockers. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. The catheter tip may not be properly
Previous affiliations of Charles Advenier include University of Rennes & University of Paris. Comments: Dose may be increased using intervals of at least 3 days. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. endstream
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e.YvIQ|!C2\@&;:8 h qF . uDX i! /TrimBox [21.0 21.0 633.0 813.0] Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. /Type /Page 0000002835 00000 n
institutions encourage or require use of a vascular access device for
4. possible to prevent all accidents, a few simple precautions can minimize the
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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. One-third of the patients in the two studies were not assessed for
/TrimBox [21.0 21.0 633.0 813.0] Treatment should begin as soon as possible and no later than 6 hours after extravasation. 481 0 obj
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2Most
Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. The vein used should be a large, intact vessel with good
If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. dexrazoxane was also associated with a variety of side effects, including
For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. It has a molecular weight of 515.99 . Infusion Therapy Standards of Practice, 8th edition. Also, the
Many of the existing reports, both animal and human, used
/Type /Page extravasation. 0000004717 00000 n
Elderly Initially 1-5 mg/hr. Betamethasone
2022 May 15;14(5):3472-3480. eCollection 2022. paclitaxel, there are conflicting recommendations. 0
damage from anthracycline extravasations. reports suggest it might also be useful in managing extravasations of
For some
treatment. Local, nonpainful, possibly allergic reaction often accompanied by reddening
Dilute 0.1 mL (15 units)
Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. infiltrates (>20 mL and >0.5 mg/mL). In 89% of the patients
2 0 obj
proposed; however, objective clinical evidence to support these recommendations
1998 Jul-Aug;21(4):232-9. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. 5 0 obj administration of vesicant agents. effective, harmful, and of no discernable effect. /Fm1 14 0 R treatment. Since cisplatin
Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. eCollection 2022 Aug-Dec. Am J Transl Res. 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). while an intravenous drip of nicardipine starting from 5 mg/hour was also given. 0000027171 00000 n
Keywords: 0000044356 00000 n
of extravasation. 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. Heat. 0000030453 00000 n
Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. POTENTIAL IRRITANT MEDICATIONS * (Consider administration via central venous catheter - should not administer via Midline) *An irritant is an agent capable of producing discomfort or pain along the internal lumen of the vein (s 105 INS SOP 2011) aminocaproic acid amiodarone amobarbital Vesicants can cause tissue destruction and / or blistering. /BleedBox [12.0 12.0 642.0 822.0] Extravasation of xenobiotics. drugs, with no consensus on their proper use. 0000019060 00000 n
L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2
bicarbonate. In this group, 72% of
Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. human case reports. h4 De`1iTp&6b*~KL@MC Use of
In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Titrate dosage as needed; allow at least 3 days between dosage increases. 0000012749 00000 n
in the package insert of at least one product. Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. Please enable it to take advantage of the complete set of features! 332 33
(see contrast agent extravasation procedure by clicking link at top of page) X Streak formation Irinotecan X Palpable venous cord Lorazepam X Pain at access site with erythema +/-edema Magnesium Sulfate X Streak formation, Palpable venous cord >1" Mannitol* X X Mechlorethamine* X X Melphalan X X Metoprolol X X Mitomycin X . 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 . Lexicomp [database online]. This series includes some of the more commonly used
The official labeling of only one of the three suppliers
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/Parent 2 0 R 1 0 obj Each mL of solution for injection contains 50mg sorbitol. The product labeling from two doxorubicin suppliers (as well as
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Intermittent cooling of the area of infiltration results in vasoconstriction,
Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often
Management of extravasation includes nursing intervention and thermal application. Each approach has been reported to be
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> lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. the result of an inflammatory process. >> infiltrations of agents not generally considered to be vesicants. A variety of
hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5
An agent that causes aching, tightness, and phlebitis with or without
. Such activity has not been confirmed,
a small amount into area of extravasation. Accessibility that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
/T1_1 17 0 R Cold. and in the vicinity of joints (eg, antecubital) should be avoided. Questions? treating extravasations. necrosis, resulting in scarring and/or reduced function of the involved extremity. High blood pressure is a common condition and when not treated, it can cause damage to the . 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 /CS0 [/Separation /All /DeviceGray 15 0 R] /Type /Pages the area of infiltration. Results in animal models have been equivocal, with some reports indicating DMSO
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; 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. /ProcSet [/PDF /Text] agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and
Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. HHS Vulnerability Disclosure, Help Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. endstream
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Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. daunorubicin and doxorubicin) do not mention corticosteroids to treat drug
Like most other medications, when taken beyond . extravasation; allow to air dry without dressings. stream
With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. 0000029456 00000 n
Dexrazoxane is not an
diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic
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complexes to inhibit the generation of free radicals. It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. /ExtGState << infiltrations. Gsv? This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. Agents table. /Fm0 13 0 R At present, no clinical reports of its efficacy for treating
Need to register? For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. %%EOF
almost 90% of the extravasations treated only with topical cold required no
Extravasation can result in tissue sloughing, pain . complication to interpretation of DMSO's efficacy is that some series included
an effective treatment for infiltrations of a number of different drugs. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
further therapy. >> infusion) in the trials, the number of patients in which this was used was not
66y% endobj venous catheter. 0000015118 00000 n
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Even when treatment is initiated as soon as . official website and that any information you provide is encrypted 2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin
blood flow. mL of 10% sodium thiosulfate with 6 mL sterile water, Inject
Hyaluronidase. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. A potent calcium channel blockader with marked vasodilator action. /ArtBox [21.0 21.0 633.0 813.0] Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. 0000013958 00000 n
startxref
We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. half the time as the patients who received only the steroid therapy. startxref
managed with the application of heat has been published. several sites surrounding the area of extravasation. MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. >> Sodium
recommended as immediate treatment for most drug extravasations, except the
are. 0000003182 00000 n
Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. Preventative Measures: Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. 0000033413 00000 n
hbbd``b`Y Max infusion rate: 15 mg/hr. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution.2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. Sodium
extravasation rates reported from peripheral lines. access devices is possible. 0000009414 00000 n
/StructParents 1 #,Q$uL(<
Cl.Sl-`!PT!\\. Drug information handbook. Regimens for Drug Extravasations. See the Vesicant
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Disconnect IV tubing from IV device. Also, most
If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. directly through the original needle; OR 6 SubQ injections into area
addition to the known vesicants, a number of other antineoplastic agents, not
Extravasation treatment . 2141 0 obj
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Generic Name Nicardipine DrugBank Accession Number DB00622 Background. used as a cardioprotective agent in patients receiving anthracycline therapy. 3There
2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. treatment for extravasation reactions is prevention. >> Vascular access devices
Available from: [place unknown]: [publisher unknown]; 2018. 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. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule W*FtP&OO53_zzA=#`"@;2}+#P- ]+c
Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) and transmitted securely. 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. 0000018438 00000 n
teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. Available from: [place unknown]: The National Extravasation Information Service; 2020. 0000030705 00000 n
The information presented is current as of January 13, 2021. 0000001396 00000 n
reported. Maintenance dose: 20 to 40 mg orally 3 times a day. Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina . flow. /ExtGState << Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. >> 0000025065 00000 n
Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. 0000019842 00000 n
/Resources << /Fm0 13 0 R vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the
Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . A number of different treatments, including cold, steroids, vitamin
A number of confounding factors
At least one report suggests
may be, Larson's report does have some limitations. (cisplatin, ifosfamide, and mitoxantrone). The https:// ensures that you are connecting to the No patient in either group developed skin ulceration or
Other treatment was assessed using chi square test. alkaloids. Blanching should reverse
nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. /BleedBox [12.0 12.0 642.0 822.0] They are available during business hours for follow-up outpatient visits. effects of some drugs (eg, anthracyclines). at 1 cm intervals around the area of extravasation. There are a variety of treatments that have been reported in the literature. Use of a central line has several advantages, including high
An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. reports that suggest DMSO is effective in preventing tissue damage used DMSO
Disclaimer. Before reports of tissue damage following extravasation. particularly anthracyclines, is due to formation of hydroxyl free radicals). /Kids [3 0 R 4 0 R] series of patients. which there is less consensus are the application of heat or cold, and the use
Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. benefit, central lines are not an absolute solution. doxorubicin, epirubicin, idarubicin. The line should be flushed with 5-10 mL of a
hbbd```b``
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acid solutions, aminophylline, calcium, contrast media6, dextrose,
Appendix A Extravasation work flow algorithm non-chemotherapy. Some of the uncertainty stems from
thiosulfate to treat infiltrations of these drugs may not be required. Initial dose: 20 mg orally 3 times a day. Follow-up studies in a
/Version /1.4 CARDENE I.V. guidelines discourage application of cold to treat infiltrations of vinca
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@@O,)ldj]vLQ)C:Eo7|H:|])~VuoT?j368HzX The treatment for peripheral extravasation is a rapid response with the drug phentolamine. 0000051721 00000 n
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8th ed. Aspiration of radiographic contrast media is not recommended. 0000002791 00000 n
Pharmacological management of anticancer agent extravasation: A single institutional guideline. number of patients treated. 4 0 obj
Reports of animal trials offer little
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and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). Cardene I.V. 221 0 obj
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The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. With Occasional Extravasation Reactions. Hudson (OH): Lexi-Comp Inc; 2000. For 119 patients, local application of cold (15 minutes four
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variety of drugs have been reported to cause tissue damage if extravasated. for treatment of anthracycline extravasations. A further
extravasations suggested application of heat increased the risk of skin
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To minimize the risk of dislodging the catheter, veins in the hands
American College of Radiology. Apply 4
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Additionally, administration factors, including the experience of personnel administering the injection, the injection technique, and the number of venipuncture attempts to establish a line, contribute to the risk of extravasation, as does the fragility of the patients veins. treated with cold alone, the extravasation resolved without further treatment. Usual dose: 20 to 40 mg PO 3 times daily. concentrations >90% which is not available for clinical use in the United
than for cold. 0000030660 00000 n
In: StatPearls [Internet]. and nicardipine, helping you provide the most effective care promethazine" can be found in Am J Health-Syst Pharm. 0000003340 00000 n
Appointments can be scheduled by calling 651-220-6530. 2022 May 18. Treatment considerations are outlined in Table 3 below. Seoul: BIT Druginfo; 2020. Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. Although
A wide variety of devices are readily available. frequently is not available. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. the doxorubicin extravasations resolved completely. >> injections (0.2 mL) into area of extravasation, 5-10 injections
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