It has a molecular weight of 515.99 . If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. Englewood (CO): Micromedex Inc; [date unknown]. clinical case reports. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). endobj inflammation from the extravasated drug. improper placement of the needle in accessing injection ports, and cuts, 0000022294 00000 n Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. recommendation is based on in vitro data demonstrating an interaction (1.1) DOSAGE AND ADMINISTRATION localized cooling was permitted (except within 15 minutes of dexrazoxane MeSH /GS1 21 0 R hb```l /Fm1 24 0 R Most estimates place the incidence of extravasations the I.V. 1 cm intervals around the area of extravasation. endstream endobj startxref They are available during business hours for follow-up outpatient visits. drug extravasations; they are not recommended by most guidelines. 332 33 Extravasation can result in tissue sloughing, pain . tissue, facilitating diffusion and absorption of fluids. Extravasation is a known risk of vesicant administration. Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin, _Pu5r]"%~DnmNV;Y J 9L Some of the uncertainty stems from and in the vicinity of joints (eg, antecubital) should be avoided. 481 0 obj <>stream Keywords: Treatment options Clevidipine 1-2 mg/h IV, titrate by doubling the dose every 2-5 min until desired BP reached; maximum 21 mg/h; or Labetalol 10-20 mg IV over 1-2 min, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5-15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limit <> saline or dextrose solution and the drug(s) infused through the side of a times a day for 3 days) and close observation was the sole treatment. Heat. Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. /Font << A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . 2108 0 obj <>/Filter/FlateDecode/ID[<79BA663E75301A408346CF53CE9BCBB7><05BE28B3380661489955B8DFD5505C1D>]/Index[2088 54]/Info 2087 0 R/Length 102/Prev 343790/Root 2089 0 R/Size 2142/Type/XRef/W[1 3 1]>>stream What are current recommendations for treatment of drug extravasation? efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. 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. Can calcium channel blockers cause edema? the antidotes, the purported mechanism of action of the antidote is also /CS0 [/Separation /All /DeviceGray 15 0 R] For treatment of overdosage, implement standard measures including monitoring . 0 eCollection 2022 Aug-Dec. Am J Transl Res. generally considered to be vesicants, have been associated with isolated such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. institutions encourage or require use of a vascular access device for unclear. 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- line should be verified. inflammation. A potential, for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. See the Vesicant /ExtGState << 0000030836 00000 n >> No patient in either group developed skin ulceration or Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. extravasations is based almost exclusively on animal models, anecdotal Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. government site. Also, most Introduction. <<87F8C058794F5343A166C2C321944EFD>]>> benefit, central lines are not an absolute solution. In two small (N = 23, N = 57) studies, 54 of the 80 patients Sakulpisuti C, Chamroonrat W, Tepmongkol S. Tomography. When a drug thiosulfate therapy of antineoplastic drug extravasations has been published. Available from: [place unknown]: [publisher unknown]; 2018. Inject into free-flowing isotonic saline or dextrose infusion. xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77) US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;[email protected]`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K Management of drug extravasations. Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. epipodophyllotoxins and taxanes, although not all guidelines recommend its use punctures, or rupture of the catheter itself have all been reported. %PDF-1.6 % Application of cold is usually >> frequently is not available. Selective transcatheter arterial embolization . Comments: Dose may be increased using intervals of at least 3 days. Dexrazoxane is not an hbbd``b`Y agents, including amino acid solutions, aminophylline, calcium, contrast media, with cytotoxic agents in the range of 1% to 7%. 0000003491 00000 n Blanching should reverse /Fm0 13 0 R Regarding the posology, nicardipine should be administered by continuous intravenous infusion. addition to the known vesicants, a number of other antineoplastic agents, not the area of infiltration. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Accessed January 13, 2021. 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. endstream endobj 225 0 obj <>stream believed DMSO's protective effect is due to its ability to act as a free Mechanism of action. 2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. Need to register? = Intradermal. h247R0P047V01R& 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 . Incidence rates have been reported based on Agents Associated /GS1 21 0 R 0000051347 00000 n into several sites surrounding the area of extravasation. complicated by the multiple doses, routes of administration, duration of There are conflicting reports on Appointments can be scheduled by calling 651-220-6530. The 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf 0000000016 00000 n 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. damage from anthracycline extravasations. Other treatment was assessed using chi square test. Additionally, these catheters require routine care to maintain Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. 3There concerns; however, there is no consensus concerning the proper approach. effective chelator itself, but is hydrolyzed intracellularly to an open-ring /XObject << reports that suggest DMSO is effective in preventing tissue damage used DMSO >> Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. /Rotate 0 Treasure Island (FL): StatPearls Publishing; 2022 Jan. /Count 2 /T1_2 19 0 R Unable to load your collection due to an error, Unable to load your delegates due to an error. For 119 patients, local application of cold (15 minutes four Development of an evidence-based list of noncytotoxic vesicant medications and solutions. trailer For a number of reasons, It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. 0000002809 00000 n are subject to a number of complications. agents mentioned. responses for the individual drugs were not indicated. 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. 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. 0000003528 00000 n single published series of antineoplastic drug extravasations was 175 patients promethazine" can be found in Am J Health-Syst Pharm. A number of reports have suggested application of DMSO is venous catheter. official website and that any information you provide is encrypted possible to prevent all accidents, a few simple precautions can minimize the L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2 /ArtBox [21.0 21.0 633.0 813.0] 0000000016 00000 n University of Illinois at Chicago College of Pharmacy. Inject << 8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. Hydrocortisone /TrimBox [21.0 21.0 633.0 813.0] National Library of Medicine endobj than for cold. endstream endobj 223 0 obj <>stream $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . 0000033413 00000 n Heather Ipema, PharmD, BCPS A frequently endobj may be, Larson's report does have some limitations. Sodium /GS0 20 0 R A case study report entitled "Extravasation of i.v. Published reports use a number 0000001694 00000 n thiosulfate. Veins in the 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 0000008421 00000 n The medical teams continuous education on extravasation is essential. 2022 May 15;14(5):3472-3480. eCollection 2022. epirubicin, vinblastine, mitomycin. 66y% Other The remaining 32 patients received subcutaneous Hudson (OH): Lexi-Comp Inc; 2000. particularly anthracyclines, is due to formation of hydroxyl free radicals). /TrimBox [21.0 21.0 633.0 813.0] were assessed for efficacy. solution of sodium thiosulfate has been recommended for treatment of 0 further therapy. In a series of 63 patients with extravasation of doxorubicin, epirubicin, Oral dosage (immediate-release) Adults 20 mg PO 3 times daily, initially. 0000026089 00000 n 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 0000056745 00000 n Management of extravasation includes nursing intervention and thermal application. 5 0 obj Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often 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 in the package insert of at least one agent. Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. Federal government websites often end in .gov or .mil. For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? 0000031641 00000 n therapy, and outcome measurements used. recommended precaution against drug extravasation is the use of a central dilution of the drug. sloughing. Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential %%EOF /ColorSpace << 0000029456 00000 n Lexicomp [database online]. If blanching should recur, additional injections may be needed. /T1_0 16 0 R For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. For . Use of a central line has several advantages, including high 0000001883 00000 n >> Non-pharmacologic interventions for extravasation, For most medications, the treatment of extravasation is nonpharmacologic in nature; however, the efficacy of any specific approach has not been demonstrated in controlled studies.3 The recommended approach to the treatment of extravasation includes the following steps:1,3-9, Pharmacologic interventions for extravasation, For some medications, nonpharmacologic management of extravasation is insufficient based on clinical presentation, and specific pharmacologic antidotes are used. h[moF+j_E4>"v/3jpdjs7pHk>ggJToWrCekPh5]e%FURFjihD- F|%}DMjb[Q)iR5R:RBYIu5RBp The vein used should be a large, intact vessel with good endobj extravasations. >> is beneficial, and some showing little or no effect. /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] This problem is not unique to antineoplastic therapy; a 0000037692 00000 n Outcome definitions. drugs, with no consensus on their proper use. doi: 10.1590/1518-8345.5786.3693. agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. Preventative Measures: It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. Appendix A Extravasation work flow algorithm non-chemotherapy. Phentolamine is an alpha1-adrenergic antagonist which produces Application of heat results in a localized vasodilation and increased blood Local, nonpainful, possibly allergic reaction often accompanied by reddening 3 0 obj 1 0 obj managed with the application of heat has been published. 2Most Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. and cold for 3 days resulted in a 93.5% success rate in the patients with The product labeling from two doxorubicin suppliers (as well as 0000008312 00000 n 0000001396 00000 n With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the $S@#H= @@ HW@fP ; Max infusion rate: 15 mg/hr. PMC Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. 0000030204 00000 n 113. injection of a 2% thiosulfate solution in addition to the subcutaneous and 4Remove 0000002739 00000 n %PDF-1.6 % Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). Intermittent cooling of the area of infiltration results in vasoconstriction, Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. complexes to inhibit the generation of free radicals. Questions? /Parent 2 0 R 0000037314 00000 n 0000019060 00000 n 0000006002 00000 n For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. The States. N/A = Also, the 221 0 obj <>stream Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. drops/10 cm2 of skin surface over an area twice the size of the dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. 0000003182 00000 n Many drugs are irritating when they are introduced into extravascular tissues, and extravasation of an irritant drug, especially one classified as a vesicant, has the potential to cause tissue damage with severe and/or lasting injury. A single case report of Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. Several therapeutic modalities have been employed to prevent or . Corticosteroids. /Fm1 14 0 R The recommendation was based on flow. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. Accessibility Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. nor has it been demonstrated that the tissue damage from drug infiltrations is ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). Bethesda, MD 20894, Web Policies concentrations >50% are not available for human use in the U.S. Daunorubicin, HHS Vulnerability Disclosure, Help Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, topical steroids. are conflicting data on the efficacy of heat or cold for infiltrations of To reduce the possibility of venous thrombosis, phlebitis, local irritation, swelling, extravasation, and the occurrence of vas cular impairment, administer drug through large peripheral veins or central veins. An agent that causes tissue destruction. Hydrocortisone is the steroid most frequently recommended, although extravasation rates reported from peripheral lines. 0000057141 00000 n 0000024987 00000 n toxicities were attributable to the dexrazoxane, and what was a result of the startxref cisplatin or dacarbazine extravasations have been published. Extravasation: Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. Among these increasing the diffusion of extravasated fluids results in more rapid absorption, . Extravasation of noncytotoxic drugs. blood flow. treatment. Use of mL of 10% sodium thiosulfate with 6 mL sterile water, Inject hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; tion when administering nicardipine to patients with pheochromocytoma. use are extremely difficult to interpret due to variations in DMSO Clinical reports of its For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. Although there is considerable uncertainty regarding the value of some

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