8600 Rockville Pike Seo H, Altshuler D, Dubrovskaya Y, et al. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. References: 1. $on8+i5BqlA/K>I,ELi{z292%4ImIK=EYG[tlX5l6XjVYU>WyAfb;%a@ These . stream If not clearly defined in the literature. Midline catheters have properties unique from those of peripheral and central VADs. HHS Vulnerability Disclosure, Help 125 Enterprise Drive Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . The safety of midline catheters for intravenous therapy at a large academic medical center. There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. Polovich M, Olsen M, LeFebvre KB, eds. Eur J Oncol Nurs. Conclusion To discuss the information in this article with other oncology nurses, visit the ONS Communities. Paclitaxel, nanoparticle albumin-bound (Abraxane), Chemotherapy extravasation injury (UpToDate), ONS (Oncology Nursing Society) chemotherapy extravasation FAQs, Beatson West of Scotland Cancer Centre Chemotherapy extravasation guideline, West Suffolk Hospitals extravasation guideline, https://hemonc.org/w/index.php?title=Vesicant_%26_irritant_chemotherapy&oldid=68542, About HemOnc.org - A Hematology Oncology Wiki. Federal government websites often end in .gov or .mil. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. 2014;(Epub ahead of print). The site is secure. References: 1. Answer:According to a publication by the Oncology Nursing Society, 1 the easiest way to check for a blood return is to use gravity by lowering the minibag below the IV site. 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. If chemical phlebitis occurs, consideration should be given to the need for alternative vascular access, an alternative medication, a slower infusion rate, or further dilution of the medication.6. Trissel LA. Chemical phlebitis may be caused by drugs that irritate the vasculature, usually because of extremes of pH or osmolarity.3Infusates with an osmolarity over 600 mOsm/L are associated with symptoms when extravasation occurs, and those over 800 mOsm/L are usually recommended to be given via a CVAD.9 Infusates with a pH between below 5.5 or above 8.5 can cause tissue damage, with alkaline agents generally producing worse toxicity than acidic agents. For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. Nafcillin. Remove cold pack at least 15 minutes before dexrazoxane therapy. Copyright 2023 Oncology Nursing Society. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. Because this termination site is distal to those of CVCs and peripherally inserted central catheters (PICCs), midline catheters are not considered to dwell in the central circulation.1Whereas the central termination site of CVCs and PICCs provide the ability to administer a wider range of infusates (eg, vesicants), this is not recommended with VADs terminating distal to the central circulation. 8}-Fb}" "R5xPQ%Flm^%/jV 2008 Sep;12(4):357-61. Cold (different suggestions for anthracyclines depending on reference): (off-label, based on general management strategies for anthracyclines), Cold - 15 to 20 minutes at a time for at least four times per day for 24 hours, Irritant or neutral, depending on reference, Cold - Every 8 hours for 3 days; if using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate, Vesicant/Irritant (depending on reference). Polovich M, Olsen M, LeFebvre KB, eds. Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. 3/10/2014, 7. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. However, the INS Task Force identified limited literature describing extravasation of vancomycin. Accidental administration of vincristine in pediatric patients. 3 0 obj Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Vesicant Chemotherapy Extravasation Antidotes and Treatments 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Prepared by: 2014 Aug;24(4):352-8. Flare reaction: A skin reaction to a medication which is an allergic response. 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 The procedure includes connecting the bag of saline to a long straight infusion set. Find the answers to questions regarding symptoms, side effects, and more. References: 1. sharing sensitive information, make sure youre on a federal The information presented is current as of August 2, 2021. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Question:Wouldnt the administration of vinCRIStine IV push using a syringe be much shorter in duration and with less chance of extravasation than administration using a minibag? Tubing features can present another challenge when considering how to best administer chemotherapy agents. Managing Extravasation During Chemotherapy Administration Accessed August 2, 2021. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Two important safety features are important here. Midline catheters represent a unique vascular access device (VAD) for patients requiring intravenous (IV) administration of drugs or other infusates.1,2After their introduction in the 1950s, hypersensitivity and phlebitis reactions to the manufacturing materials led to a temporary decline in the use of midline catheters through the 1990s; however, a redesign of these products in recent years has led to their renewed adoption. General recommendations for midline administration: A. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. Intermountain Medical Center . The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. Preparation for flexible plastic container VinCRIStine sulfate injection, USP when diluted with 0.9% sodium chloride injection in concentrations from 0.0015 mg/mL to 0.08 mg/mL is stable for up to 24 hours when protected from light or 8 hours under normal light at 25C. Updated January 2021. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. 3/26/2014 5. %%EOF The main consideration in determining whether a drug is appropriate for administration via midline catheter is its propensity for causing phlebitis.2Phlebitis is inflammation of a vein caused by damage to the tunica intima, which may be accompanied by erythema, swelling, pain, heat, and a palpable cord if thrombosis is present. Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. Package insert for vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial. Monitor for extravasation according to hospital policy. Unauthorized use of these marks is strictly prohibited. Except as expressly stated on this site or as otherwise permitted by applicable law, no content on this site may be used or reproduced without the permission of the copyright holder. 125 Enterprise Drive {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 J Oncol Pharm Pract. 2016 Feb 10; 7(1): 8797. Most importantly, organizations must weigh the risk of possible extravasation versus certain death from the accidental administration of vinCRIStine by the intrathecal route when making decisions about changing practice. Clinical exam may reveal warmth, erythema, or tenderness. Ryan Rodriguez, PharmD, BCPS Eur J Oncol Nurs. 1990 Mar;4(1):41-60. doi: 10.1016/0268-960x(90)90015-k. Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. 1. Clin J Oncol Nurs. The Oncology Nursing Society4 recommends administering IV vinCRIStine and other vinca alkaloids via a minibag to prevent errors with intrathecal chemotherapy administration. Updated July 2017. 1 0 obj Extravasation of noncytotoxic drugs. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Apply ice to the area for 15 to 20 minutes each hour for 4 hours. Depending on treatment complexity, ONS's Chemotherapy and Biotherapy Guidelines and Recommendations for Practice state that chemotherapy agents being administered by infusion "may be connected directly to the IV catheter or to a line of compatible maintenance solution." Facebook - National Cancer Institute All rights reserved. Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. 2023 Institute for Safe Medication Practices. doi: 10.1097/GOX.0000000000001743. Once the infusion is complete, the short set is dropped to backfill the line with saline and then the remaining drug is infused. Patients often seek explanations for why their extravasations occurred. In December 2008, ASCO and ONS held a workshop to develop a consensus regarding standards for the safe administration of chemotherapy to adult patients in the outpatient setting. (K k0|hzv 6gN5UzVa+91C+yTOOcV^t^IjpiOROeutcI9GOqs'."XA*c2@GfK!rKP;{4?|h=,G _wyNdfSc#A]LHq#@Gtn[YWk%1o*Bbyk'82h6~IOvvi2`6 In general--aside from the exceptions listed below--keeping the extravasation cold is preferable to cause vasoconstriction, to prevent spread of the medication, and to decrease inflammation/pain. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. The vinCRIStine is infused via gravity through the peripheral line. This site needs JavaScript to work properly. Lastly, they recommend avoidance of midline catheters in patients with a history of thrombosis, hypercoagulability, venous stasis, or with a need to preserve vein integrity, such as in patients with end-stage renal disease. Nonetheless, a review of literature of known vesicants and drugs reported to cause vascular injury or extravasation indicates some drugs that may present higher risk when administered via midline catheter.
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