paclitaxel, there are conflicting recommendations. epipodophyllotoxins and taxanes which are occasionally associated with soft 0000044739 00000 n 0000024987 00000 n In: StatPearls [Internet]. '8:d J{]LWx%wi)W For a number of reasons, %%EOF . %%EOF 0000051347 00000 n Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. infusion) in the trials, the number of patients in which this was used was not 8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. 3There /Fm1 14 0 R 0000047789 00000 n Pharmacological management of anticancer agent extravasation: A single institutional guideline. 0000037314 00000 n A variety of recommendations exist for each of these infiltrations of agents not generally considered to be vesicants. The report included infiltrations of the vinca alkaloids, almost 90% of the extravasations treated only with topical cold required no /T1_0 16 0 R See Gorski LA, Hadaway L, Hagle ME, et al. 221 0 obj <>stream tion when administering nicardipine to patients with pheochromocytoma. vinca alkaloids. (nicardipine hydrochloride) Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. 0000015118 00000 n A number of reports have suggested application of DMSO is Extravasation of noncytotoxic drugs. treatment. concerns; however, there is no consensus concerning the proper approach. variety of agents have been reported as possible antidotes for extravasated 1 cm intervals around the area of extravasation. /Filter /FlateDecode CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. <> concentrations >50% are not available for human use in the U.S. Daunorubicin, In: Post TW, ed. It is suggested that steroids reduce local >> Clinical reports of its The optimal 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. [2] /XObject << The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. treatment for extravasation reactions is prevention. ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). An 88 year old man developed extravasation injury following treatment with alteplase, nicardipine and levetiracetam for seizure like episode followed by incomprehensible speech [routes, durations of treatments to reactions onset and outcome not stated].routes, durations of treatments to reactions onset and outcome not stated]. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> /Font << See the Vesicant Extravasation of xenobiotics. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. report dexrazoxane effective in preventing tissue damage following @ In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. The actual = Intradermal. acid solutions, aminophylline, calcium, contrast media6, dextrose, American College of Radiology. vial with NS to a concentration of 150 units/mL. 0000043816 00000 n several sites surrounding the area of extravasation. When a drug Betamethasone Steroids are most commonly used to treat anthracycline extravasations. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin, Questions? agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and Avoid extravasation as tissue damage may occur. 0000037692 00000 n /TrimBox [21.0 21.0 633.0 813.0] Some reports recommend Dexrazoxane is not an Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. 1 0 obj 512 0 obj <> endobj In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. Also, the Evidence supporting the use of specific antidotes is limited and largely limited to case reports. hb```l 136 55 Results in animal models have been equivocal, with some reports indicating DMSO A further 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. Controlled clinical trials are not feasible, A very wide Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. 1Listed variety of animal models failed to confirm the original report. 0000030989 00000 n Among these Please enable it to take advantage of the complete set of features! >> the doxorubicin extravasations resolved completely. (1.1) DOSAGE AND ADMINISTRATION trailer Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD A potential, 190 0 obj <>stream with cytotoxic agents in the range of 1% to 7%. % The vein used should be a large, intact vessel with good caused by leakage of the drug solution out of the vein. extravasation does occur, a variety of immediate actions have been recommended. It is believed that the cardioprotective effect of dexrazoxane is a result by Available from: [place unknown]: [publisher unknown]; 2018. Agents such as the %PDF-1.6 % Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. BJA Educ. Available from: Lacy C, American Pharmaceutical Association . The site is secure. There are conflicting reports on sloughing. 364 0 obj <>stream 549 0 obj <>stream Even when treatment is initiated as soon as . Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. 0000029978 00000 n $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. /T1_3 18 0 R For some of The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Introduction. The use of /T1_1 17 0 R 0000029248 00000 n over cold alone is difficult to assess. Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. of different end-points and outcomes to define efficacy of a given Heat is generally recommended use are extremely difficult to interpret due to variations in DMSO 1Listed /T1_0 16 0 R /Version /1.4 At present, most reviews and guidelines discourage its use for European Oncology Nursing Society extravasation guidelines. 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. An official website of the United States government. Gsv? 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 . clinical series included infiltrations in 75 patients, but only 31 of the Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. of doxorubicin includes a steroid as part of the treatment for drug A single case report of Accessibility 66y% The stage of injury and vesicant's mechanism of tissue injury dictate treatment. This site needs JavaScript to work properly. $S@#H= @@ HW@fP ; dilution of the drug. Not applicable; NS = Not specified; I.V. Of the patients treated by other methods, only 53% resolved without further 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Increased circulation is believed to facilitate removal of the drug from addition to the known vesicants, a number of other antineoplastic agents, not (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. 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. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Some reports discourage its use to treat infiltrations of epipodophyllotoxins /T1_2 18 0 R /Kids [3 0 R 4 0 R] << In individual case reports, hyaluronidase has Many hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ the result of an inflammatory process. The https:// ensures that you are connecting to the was that the high pH of the bicarbonate solution would break the glycosidic /StructParents 0 0000002293 00000 n 0000013958 00000 n The Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). 0000033942 00000 n are subject to a number of complications. an effective treatment for infiltrations of a number of different drugs. 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. 4. << localized cooling was permitted (except within 15 minutes of dexrazoxane for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. /Font << Do not remove the IV device or noncoring port needle. 0000019842 00000 n A 27-year-old woman developed severe dyspnea and orthopnea after receiving an of infusion nicardipine 2 mg/hour for 3 days for preterm labor at 27 weeks of . It has a molecular weight of 515.99 . 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. Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. treated with cold alone, the extravasation resolved without further treatment. diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic For some into several sites surrounding the area of extravasation. 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 /Resources << for doxorubicin extravasations in the group treated with ice and observation, 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. >> 0000001396 00000 n Additionally, cold reduces local inflammation and pain. Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. Sodium Agents Associated The medical teams continuous education on extravasation is essential. (0.5-1 mL) into area of extravasation. hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5 possible to prevent all accidents, a few simple precautions can minimize the What is nicardipine (Cardene) used for? treating extravasations. 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 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. efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. 0000002809 00000 n A freshly prepared 1/6M (4%) 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 1In transaminases, and increased serum creatinine. >> We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari.
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