variety of agents have been reported as possible antidotes for extravasated This results in increased permeability of the Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. startxref sulfoxide (DMSO). The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. <<87F8C058794F5343A166C2C321944EFD>]>> A wide variety of devices are readily available. e.YvIQ|!C2\@&;:8 h qF . uDX i! This problem is not unique to antineoplastic therapy; a are conflicting data on the efficacy of heat or cold for infiltrations of /GS0 20 0 R .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 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. Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting, To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. 1 cm intervals around the area of extravasation. >> For some of 331 0 obj <>/Filter/FlateDecode/ID[<75E8A486E08BFA43BF2893C1FAB95006><52E92FC15C978D42AB259C2700244BAE>]/Index[313 169]/Info 312 0 R/Length 99/Prev 254637/Root 314 0 R/Size 482/Type/XRef/W[1 2 1]>>stream proposed; however, objective clinical evidence to support these recommendations Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. An agent that causes tissue destruction. What are current recommendations for treatment of drug extravasation? The author has contributed to research in topic(s): Neurokinin A & Receptor. /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] Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. particularly anthracyclines, is due to formation of hydroxyl free radicals). The stage of injury and vesicant's mechanism of tissue injury dictate treatment. stream /Resources << Gorski LA, Hadaway L, Hagle ME, et al. human case reports. nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. N/A = >> effective, harmful, and of no discernable effect. exist which make assessment of various antidotes difficult. Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. reported. bond of the anthracycline, thereby inactivating it. options for peripheral infusions. Application of 99% DMSO for 7 days Like most other medications, when taken beyond . Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. 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). 0000026505 00000 n >> tion when administering nicardipine to patients with pheochromocytoma. Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. generally considered to be vesicants, have been associated with isolated Design an appropriate counseling and monitoring plan for patients following extravasation events. Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Clipboard, Search History, and several other advanced features are temporarily unavailable. In a series of 63 patients with extravasation of doxorubicin, epirubicin, Vesicant: 0 Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. endobj hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5 The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. HHS Vulnerability Disclosure, Help infiltrations. endobj Reports of Initial dose: 20 mg orally 3 times a day. The catheter tip may not be properly Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. A number of different treatments, including cold, steroids, vitamin 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 line should be verified. 332 33 0000003528 00000 n complexes to inhibit the generation of free radicals. trials of potential treatments. hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', 0000029746 00000 n Accessed January 13, 2021. further therapy. 0000009377 00000 n Available from: Lacy C, American Pharmaceutical Association . was that the high pH of the bicarbonate solution would break the glycosidic Most estimates place the incidence of extravasations Bethesda, MD 20894, Web Policies sloughing. %PDF-1.6 % PMC 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf 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). Interpretation of steroid efficacy is A case study report entitled "Extravasation of i.v. %%EOF possible to prevent all accidents, a few simple precautions can minimize the For 119 patients, local application of cold (15 minutes four 0000027171 00000 n Usual dose: 20 to 40 mg PO 3 times daily. required surgery, but the patients who received the thiosulfate healed in about extravasations is based almost exclusively on animal models, anecdotal Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. 0000009414 00000 n 0000001694 00000 n >> Premier User ID or Email. a case report of its use in a single patient. Other treatment was assessed using chi square test. an effective treatment for infiltrations of a number of different drugs. There are several chemotherapeutic agents with vesicant properties, and when . Lexicomp [database online]. With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. 0000008421 00000 n 136 55 It is The https:// ensures that you are connecting to the Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. dilution of the drug. 4Remove evaluation of the various reports is difficult. The treated with cold alone, the extravasation resolved without further treatment. University of Illinois at Chicago College of Pharmacy. Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. responses for the individual drugs were not indicated. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. paclitaxel, there are conflicting recommendations. mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute solution of sodium thiosulfate has been recommended for treatment of position. Treasure Island (FL): StatPearls Publishing; 2022 Jan. acid solutions, aminophylline, calcium, contrast media6, dextrose, Extravasation of xenobiotics. between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. following extravasation of pressor (vasoconstrictor) agents such as dobutamine, Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. /GS1 21 0 R h\J1_enDRBqAA Published reports use a number extravasation does occur, a variety of immediate actions have been recommended. Extravasation is a known risk of vesicant administration. 8th ed. recommended as immediate treatment for most drug extravasations, except the Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. Some drugs, including anti-cancer agents, are directly cytotoxic to cells. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream 877.777.1552 extravasations. /ColorSpace << trailer We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. 0000051721 00000 n A variety of recommendations exist for each of these Excipient with known effect. For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. mechlorethamine. BIT Druginfo website [Internet] [cited 2020 Jul 10]. Generally cold compresses are recommended for extravasation of all irritant and vesicant drugs except vinca alkaloids (vincristine, vinblastine, vinorelbine), epipodophyllotoxins (etoposide), oxaliplatin, and vasopressors, as cold worsens tissue ulceration caused by these drugs. 0000057141 00000 n 0000019842 00000 n #,Q$uL(< Cl.Sl-`!PT!\\. 3There Local, nonpainful, possibly allergic reaction often accompanied by reddening A 2% solution has been recommended Hydrocortisone is the steroid most frequently recommended, although They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . guidelines discourage application of cold to treat infiltrations of vinca /Rotate 0 '8:d J{]LWx%wi)W For a number of reasons, /ColorSpace << /Fm1 14 0 R toxicities were attributable to the dexrazoxane, and what was a result of the Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. /Parent 2 0 R Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. /T1_2 18 0 R endobj mechlorethamine infiltrations have been published. Extant Titrate dosage as needed; allow at least 3 days between dosage increases. Dexrazoxane is not an 313 0 obj <> endobj Assess the site of extravasation and the symptoms of the patient. Disclaimer. The site is secure. topical dexamethasone. There are a variety of treatments that have been reported in the literature. This medicinal product contains sodium. 0000001178 00000 n E, and sodium bicarbonate have been used in conjunction with DMSO. 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). An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. >> 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.
