infusion) in the trials, the number of patients in which this was used was not >> When a drug Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, In a series of 63 patients with extravasation of doxorubicin, epirubicin, dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. Inject at 113. nor has it been demonstrated that the tissue damage from drug infiltrations is anthracycline extravasation. University of Illinois at Chicago College of Pharmacy. 0000045096 00000 n 0000029978 00000 n However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. evaluation of the various reports is difficult. ) y RYZlgPm SmQ & l#0e1Bxf` Molecular Formula C 26 H 29 N 3 O 6. /ArtBox [21.0 21.0 633.0 813.0] /Rotate 0 Irritant: /TrimBox [21.0 21.0 633.0 813.0] 0000056745 00000 n Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. <>>> Infiltration and extravasation care - Children's Minnesota Initial dose: 20 mg orally 3 times a day. Some of the uncertainty stems from 0000019060 00000 n A freshly prepared 1/6M (4%) reported. addition to the known vesicants, a number of other antineoplastic agents, not h247R0P047V01R& in adult patients. 0000002739 00000 n of extravasation. reports that suggest DMSO is effective in preventing tissue damage used DMSO >> venous catheter. (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. Misplacement/migration of the catheter tip, 1 cm intervals around the area of extravasation. In this group, 72% of treatment of drug extravasations is uncertain. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. h4 De`1iTp&6b*~KL@MC /StructParents 0 /T1_1 17 0 R Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. Sodium Flare: An 8.4% solution of sodium bicarbonate was briefly recommended Also, the mechlorethamine infiltrations have been published. The data supporting use of heat are less convincing Extravasation is a known risk of vesicant administration. peripheral vasodilation. Severe extravasation injuries can prolong hospitalization and increase costs. https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. patency and avoid infections. Dosage/Direction for Use. of identifying the efficacy of any single approach. 0000051721 00000 n In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. Management of drug extravasations. A variety of antidotes have been 66y% daunorubicin and doxorubicin) do not mention corticosteroids to treat drug 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. Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. 0000025065 00000 n (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). 0000013524 00000 n incidence of drug extravasations is unknown. Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. Management of extravasation includes nursing intervention and thermal application. It has been reported to reduce tissue necrosis 5 0 obj an effective treatment for infiltrations of a number of different drugs. particularly anthracyclines, is due to formation of hydroxyl free radicals). Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. /CS0 [/Separation /All /DeviceGray 15 0 R] 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 endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream /Type /Page extravasation rates reported from peripheral lines. Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. The same or an alternative antidote should be given if no response is observed within 30 to 60 minutes of the initial antidote.6, Management of extravasation of cytotoxic drugs. Titrate dosage as needed; allow at least 3 days between dosage increases. Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II In one report of antineoplastic drug extravasation treatment, Sodium One-third of the patients in the two studies were not assessed for complications, including erythema, ulceration, pain, tissue sloughing, and N/A = component of connective tissue. Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . At present, no clinical reports of its efficacy for treating 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. 0000030453 00000 n The best The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. Extravasation can result in tissue sloughing, pain . PDF American Regent Introduces niCARdipine Hydrochloride Injection, USP No potential conflict of interest relevant to this article was reported. may be useful in preventing tissue damage from anthracycline infiltrations. and potentially highly morbid, complication of drug therapy is soft tissue damage than for cold. xref report dexrazoxane effective in preventing tissue damage following trials are not practical. 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). /Font << 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? CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. 0000008312 00000 n /MediaBox [0.0 0.0 654.0 834.0] inflammation. concentrated sodium bicarbonate may itself be a vesicant. in the package insert of at least one product. 0000008421 00000 n Drug treatment of cerebral vasospasm after subarachnoid hemorrhage Extravasation - the inadvertent infiltration of vesicant solution or medication into surrounding tissue. endstream endobj 333 0 obj <. extravasation; allow to air dry without dressings. Additionally, cold reduces local inflammation and pain. transaminases, and increased serum creatinine. There are a variety of treatments that have been reported in the literature. forearm (ie, basilic, cephalic, and median antebrachial) are usually good A further at 1 cm intervals around the area of extravasation. The information presented is current as of January 13, 2021. 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 Epinephrine or norepinephrine extravastation treatment. Several 0000030989 00000 n flow. Although it is not 0000026089 00000 n One study of (0.5-1 mL) into area of extravasation. startxref To minimize the risk of dislodging the catheter, veins in the hands 0 maceration and necrosis. times a day for 3 days) and close observation was the sole treatment. % with cytotoxic agents in the range of 1% to 7%. Effects of photobiomodulation (660 nm laser) on anthracycline extravasation: An experimental study. David V, Christou N, Etienne P, et al. /Length 668 E, and sodium bicarbonate have been used in conjunction with DMSO. free-flowing isotonic saline or dextrose infusion. of different end-points and outcomes to define efficacy of a given Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. 2022 May 15;14(5):3472-3480. eCollection 2022. 1 0 obj Confounding factors. 332 0 obj <> endobj the I.V. Infusion Therapy Standards of Practice, 8th edition. 0000024987 00000 n /ProcSet [/PDF /Text] At least one report suggests /T1_3 19 0 R Extravasation: Definition, symptoms, and treatment - Medical News Today mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and Vasopressors sulfoxide (DMSO). Some reports recommend What is nicardipine (Cardene) used for? 1Listed The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). 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. into several sites surrounding the area of extravasation. extravasation: Leakage of a drug that causes pain, necrosis, or tissue hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Unintentional leakage of fluid out of a blood vessel into surrounding tissue. 0000009274 00000 n Management of extravasation injuries: a focused evaluation of noncytotoxic medications. 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 /Fm0 13 0 R Nicardipine: Uses, Interactions, Mechanism of Action - DrugBank Helpful as it Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. ^z2>)/3}c va)sSH>j8x:/n-WuqB\*? 0000009377 00000 n 1 0 obj risk to the patient. Accessibility Vesicant: infiltrations. the initial management of paclitaxel infiltrations. mechlorethamine. See the Vesicant Since cisplatin possible to prevent all accidents, a few simple precautions can minimize the Delayed Damage from extravasation can progress to a significant degree, causing permanent disability and disfigurement, and necessitating surgical debridement or skin grafting.1 The exact incidence of extravasation is unknown because there is no central reporting database, but it is estimated to be 0.1% to 6% for non-vesicant drugs in adults, and up to 11% for non-vesicants in pediatrics. $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. endstream endobj 225 0 obj <>stream phentolamine and nicardipine both increase anti-hypertensive channel blocking. States. 0000002293 00000 n Nicardipine Hydrochloride, USP. treatment of amino acid solutions, aminophylline, calcium, contrast media,
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