= Intradermal. 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 . The site is secure. Evidence supporting the use of specific antidotes is limited and largely limited to case reports. bicarbonate. Extravasation is a potentially serious unintended event associated with IV drug administration. >> Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. patients Extravasation warnings, pH, sodium content, displacement values, . Guidelines for the management of extravasation - PubMed A very wide
exist which make assessment of various antidotes difficult. What proportion of these
nor has it been demonstrated that the tissue damage from drug infiltrations is
>> Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. No patient in either group developed skin ulceration or
Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. To minimize the risk of dislodging the catheter, veins in the hands
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It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. improper placement of the needle in accessing injection ports, and cuts,
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primary antineoplastic therapy was not clear. States. cisplatin or dacarbazine extravasations have been published. topical dexamethasone. 0000029456 00000 n
/CropBox [0.0 0.0 654.0 834.0] Pharmacological management of anticancer agent extravasation: A single institutional guideline. Dexrazoxane received approval by
diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic
Confounding factors. tissue, facilitating diffusion and absorption of fluids. dexrazoxane was also associated with a variety of side effects, including
is beneficial, and some showing little or no effect. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. 4 0 obj
Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. 0000033413 00000 n
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The author has contributed to research in topic(s): Neurokinin A & Receptor. Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. 0000009414 00000 n
A potent calcium channel blockader with marked vasodilator action. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. This site needs JavaScript to work properly. For some
Nicarson Dosage & Drug Information | MIMS Philippines There are a variety of treatments that have been reported in the literature. Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. Hudson (OH): Lexi-Comp Inc; 2000. /ColorSpace << hbbd```b``
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The product labeling from two doxorubicin suppliers (as well as
which tends to restrict the spread of the drug. 0000038341 00000 n
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Premier User ID or Email - Sign In mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and
chelator form, which complexes with iron, other heavy metals, and doxorubicin
/ProcSet [/PDF /Text] Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. Remove the peripheral IV device or port needle. 0000009056 00000 n
Other treatment was assessed using chi square test. An 8.4% solution of sodium bicarbonate was briefly recommended
Sodium
A 2% solution has been recommended
Comments: Dose may be increased using intervals of at least 3 days. solution of sodium thiosulfate has been recommended for treatment of
>> PDF Irritants and Vesicants Guide to Intravenous Administration via Midline Extravasation can result in tissue sloughing, pain . Other
Alteplase/levetiracetam/nicardipine | SpringerLink 8th ed. reports that suggest DMSO is effective in preventing tissue damage used DMSO
0000031807 00000 n
injection of a 2% thiosulfate solution in addition to the subcutaneous and
It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. /Type /Page treated with cold alone, the extravasation resolved without further treatment. Accessed January 13, 2021. drops/10 cm2 of skin surface over an area twice the size of the
[2] 4. 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. Steroids are most commonly used to treat anthracycline extravasations. A further
Titrate dosage as needed; allow at least 3 days between dosage increases. 0000006002 00000 n
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h\J1_enDRBqAA immediately. It is postulated that
than for cold. paclitaxel, there are conflicting recommendations. sharing sensitive information, make sure youre on a federal tion when administering nicardipine to patients with pheochromocytoma. endobj Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule 0000029978 00000 n
treatment of amino acid solutions, aminophylline, calcium, contrast media,
Premier User ID or Email. Also, except
number of patients treated. 66y% Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. promethazine" can be found in Am J Health-Syst Pharm. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. /XObject << that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
a small amount into area of extravasation. vial with NS to a concentration of 150 units/mL. of extravasation. @
%%EOF
(0.5-1 mL) into area of extravasation. /MediaBox [0.0 0.0 654.0 834.0] /T1_0 16 0 R stream
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MeSH /Type /Pages Although
Drug Vesicant vs Irritant PIV Midline Central line Comments . Wang RY. Gorski LA, Hadaway L, Hagle ME, et al. Nicardipine Hydrochloride Injection is supplied . PMC This series includes some of the more commonly used
variety of animal models failed to confirm the original report. 0000001178 00000 n
treatment. 5 0 obj Although there is considerable uncertainty regarding the value of some
Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. trials are not practical. 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
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Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. report dexrazoxane effective in preventing tissue damage following
dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin,
Local, nonpainful, possibly allergic reaction often accompanied by reddening
Several
0
0000018438 00000 n
When a drug
#,Q$uL(<
Cl.Sl-`!PT!\\. https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. 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). The use of
extravasation: Leakage of a drug that causes pain, necrosis, or tissue
N/A =
additional information, being plagued by many of the limitations of the
necrosis, resulting in scarring and/or reduced function of the involved extremity. endobj CARDENE I.V. 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. 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? No large series of extravasations
A number of confounding factors
of different end-points and outcomes to define efficacy of a given
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. treating extravasations. A case study report entitled "Extravasation of i.v. mechlorethamine infiltrations have been published. 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- Inject
Some of the uncertainty stems from
>> Application of heat results in a localized vasodilation and increased blood
line should be verified. Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. This problem is not unique to antineoplastic therapy; a
Keywords: human case reports. Animal models indicate application of heat exacerbates the
0000019598 00000 n
( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). required surgery, but the patients who received the thiosulfate healed in about
are subject to a number of complications. are. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. HCl. Effects of photobiomodulation (660 nm laser) on anthracycline extravasation: An experimental study. 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. Treatment should begin as soon as possible and no later than 6 hours after extravasation. Effect modifiers modalities like nitrate which require continuous were controlled through stratification of age, gender, hemodynamic monitoring and dose adjustment and type of APE and effect of these on outcome variable NIPPV which is costly and technically difficult to use. Hikma launches Nicardipine Hydrochloride premixed injection in ready to following extravasation of pressor (vasoconstrictor) agents such as dobutamine,
Misplacement/migration of the catheter tip,
Nicardipine: MedlinePlus Drug Information /T1_2 18 0 R Avoid extravasation as tissue damage may occur. the area of infiltration. doi: 10.1590/1518-8345.5786.3693. 0
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<. dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. 2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin
0000037692 00000 n
8600 Rockville Pike /ExtGState << 1 cm intervals around the area of extravasation. Inject into
What are current recommendations for treatment of drug extravasation Contrast injections were performed at 2-5-mg intervals to assess effective response (a 60% increase in arterial diameter of the most severely decreased in caliber vessel compared with the very first angiographic run). 0000005018 00000 n
Unable to load your collection due to an error, Unable to load your delegates due to an error. Information concerning treatment of
complicated by the multiple doses, routes of administration, duration of
The purpose of these practice guidelines is to offer and share strategies for preventing extravasation and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled experts at intravenous (IV) injection. a case report of its use in a single patient. Assess the site of extravasation and the symptoms of the patient. 0000031286 00000 n
%%EOF
0000004717 00000 n
lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. single published series of antineoplastic drug extravasations was 175 patients
Vesicants include several chemotherapy drugs. The best
0000025065 00000 n
damage from anthracycline extravasations. for these agents. 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. A number of reports have suggested application of DMSO is
PDF Injection: 200 mL nicardipine (0.2 mg/mL) in sodium chloride (0.8%) in Would you like email updates of new search results? Kidney infection (pyelonephritis) and Infant skin characteristics A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Regitine, OraVerse (phentolamine) dosing, indications, interactions epirubicin, vinblastine, mitomycin. Medications | Management of Extravasation of Non - UW Health Several therapeutic modalities have been employed to prevent or . sodium thiosulfate to treat mechlorethamine infiltrations is based almost
/BleedBox [12.0 12.0 642.0 822.0] f <>>>
and in the vicinity of joints (eg, antecubital) should be avoided. 0000030989 00000 n
and/or taxanes. Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
0000017396 00000 n
effective chelator itself, but is hydrolyzed intracellularly to an open-ring
, %iI+2D/Bt',TQ$ZE=$(i)
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113. The largest
mechlorethamine and cisplatin infiltrations. 0000003804 00000 n
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0000002739 00000 n
See this image and copyright information in PMC. Some reports discourage its use to treat infiltrations of epipodophyllotoxins
Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. 0000045096 00000 n
Additionally, cold reduces local inflammation and pain. /ExtGState << Not applicable; NS = Not specified; I.V. 0000019842 00000 n
Nicardipine: Package Insert / Prescribing Information - Drugs.com 0000056745 00000 n
PDF Indications and Usage Dosage and Administration 0000044356 00000 n
Results in animal models have been equivocal, with some reports indicating DMSO
remaining 56 patients received a variety of antidotes. peripheral vasodilation. /Rotate 0 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. Of the patients treated by other methods, only 53% resolved without further
0000030660 00000 n
Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. for treatment of anthracycline extravasations. 1 0 obj The data supporting use of heat are less convincing
for doxorubicin extravasations in the group treated with ice and observation,
2022 May 15;14(5):3472-3480. eCollection 2022. toxicities were attributable to the dexrazoxane, and what was a result of the
They are available during business hours for follow-up outpatient visits. Important Risk Information (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. >> Nicardipine - an overview | ScienceDirect Topics Available from: [place unknown]: The National Extravasation Information Service; 2020. Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. 2 0 obj
Infusion Therapy Standards of Practice, 8th edition. Drug information handbook. 0000051048 00000 n
0000030429 00000 n
evaluation of the various reports is difficult. limiting efforts to identify optimal management of these reactions. In a series of 63 patients with extravasation of doxorubicin, epirubicin,
extravasations suggested application of heat increased the risk of skin
/CS0 [/Separation /All /DeviceGray 15 0 R] inflammation from the extravasated drug. Seoul: BIT Druginfo; 2020. Clipboard, Search History, and several other advanced features are temporarily unavailable. complications, including erythema, ulceration, pain, tissue sloughing, and
<< infiltrations. epipodophyllotoxins and taxanes, although not all guidelines recommend its use
0000001694 00000 n
Lexicomp [database online]. /GS1 21 0 R 0
treatment. The official labeling of only one of the three suppliers
agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and
MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. are conflicting data on the efficacy of heat or cold for infiltrations of
David V, Christou N, Etienne P, et al. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Follow-up studies in a
an effective treatment for infiltrations of a number of different drugs. 2022 Oct 17;30:e3693. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. 0000026887 00000 n
Although it is not
Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. series of patients. Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. 0000044739 00000 n
saline or dextrose solution and the drug(s) infused through the side of a
1999; 56:1742-3. PDF Intravenous Nicardipine - EMCrit Project Epinephrine or norepinephrine extravastation treatment. Regimens for Drug Extravasations. The vein used should be a large, intact vessel with good
Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. endstream
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European Oncology Nursing Society extravasation guidelines. were assessed for efficacy. Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). '8:d J{]LWx%wi)W Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate). Nicardipine is in a class of medications called calcium channel blockers. Metoprolol Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Medication Thermal Therapy Antidote Dose Treatment Nitroglycerin Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Norepinephrine Heat Nitroglycerin 2% paste n/a Apply thin layer to area of extravasation q 6 hr x 24 hr >> Helpful as it
Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. %PDF-1.5
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