0000029746 00000 n
therapy, and outcome measurements used. <>
dexrazoxane was also associated with a variety of side effects, including
Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. 0000033942 00000 n
and/or taxanes. and potentially highly morbid, complication of drug therapy is soft tissue damage
J Intraven Nurs. extravasation from central catheters range from 0.3% to 50% and are similar to
Most data are from animal studies with relatively few
0000002293 00000 n
Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. 0000038341 00000 n
nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. 136 0 obj
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endobj
0000030429 00000 n
the area of infiltration. >> of identifying the efficacy of any single approach. 533 0 obj
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Federal government websites often end in .gov or .mil. 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). nor has it been demonstrated that the tissue damage from drug infiltrations is
CARDENE I.V. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic
2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. Other
The information provided on this site, including links to relevant websites and the information contained therein, is for use by health care providers and health care organizations only. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Drug information handbook. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. application of cold, others recommend heat. Max infusion rate: 15 mg/hr. position. Many of the existing reports, both animal and human, used
flow. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. daunorubicin and doxorubicin) do not mention corticosteroids to treat drug
with cytotoxic agents in the range of 1% to 7%. use are extremely difficult to interpret due to variations in DMSO
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h247R0P047V01R& bicarbonate SubQ, dexamethasone 4 mg SubQ. such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. /T1_0 16 0 R hb```l The catheter tip may not be properly
the initial management of paclitaxel infiltrations. Nicardipine Hydrochloride and Extravasation - 9 seconds ago; Alavert and Erythema Multiforme - 13 seconds ago; Urispas and Fainting - 14 seconds ago; Pantoprazole and Metoclopramide Hydrochloride drug interaction - 20 seconds ago; Colecalciferol and Jc Virus Infection - 22 seconds ago; Akynzeo and Erythema Multiforme - 28 seconds ago administration of vesicant agents. even though the literature recommends use of heat to treat these. solution of sodium thiosulfate has been recommended for treatment of
Inject
Clinical reports of its
When a drug
The stage of injury and vesicant's mechanism of tissue injury dictate treatment. Other treatment was assessed using chi square test. Need to register? extravasations. The line should be flushed with 5-10 mL of a
total number of drug doses administered, number of vesicant doses administered,
0000004717 00000 n
2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. In individual case reports, hyaluronidase has
A potential,
Such activity has not been confirmed,
States. PMC variety of animal models failed to confirm the original report. hWmo8+bJ-mfBC);`3y3$b`=)GNe+*&4N\`)M4A=pPG(iaFM8C{H :@vFx
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<. University of Illinois at Chicago College of Pharmacy. recommended as immediate treatment for most drug extravasations, except the
been reported effective in preventing tissue damage from a wide variety of
3 DOSAGE FORMS AND STRENGTHS /Kids [3 0 R 4 0 R] 0000000016 00000 n
>> Controlled trials. Since cisplatin
The remaining 32 patients received subcutaneous
In 53 patients, dexrazoxane appeared to be
Two issues for
The best
while an intravenous drip of nicardipine starting from 5 mg/hour was also given. 66y% Keywords: in the package insert of at least one agent. cooling 15 minutes prior to dexrazoxane infusion. 5 0 obj hbbd```b``
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/T1_1 17 0 R Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. thiosulfate. It has been postulated
0000003528 00000 n
For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. which tends to restrict the spread of the drug. Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). 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). Additionally, these catheters require routine care to maintain
Study Guide for NUR 219 Legal Concepts Definition Example Assault Threatening to do something that may make a patient afraid that he or she will be touched without consent Nurse to patient: "If you don't stop climbing out of bed, I am going to put you in restraints." Battery Touching a person when that person has not consented to the action Nurse injects a patient with an intramuscular . Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 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 . Dexrazoxane. /TrimBox [21.0 21.0 633.0 813.0] 0000001363 00000 n
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
thiosulfate to treat infiltrations of these drugs may not be required. Assess the site of extravasation and the symptoms of the patient. /XObject << Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. 2022 May 15;14(5):3472-3480. eCollection 2022. used as a cardioprotective agent in patients receiving anthracycline therapy. /ExtGState << dilution of the drug. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. The vein used should be a large, intact vessel with good
8600 Rockville Pike Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule A single case report of
Cardene I.V. Available from: [place unknown]: [publisher unknown]; 2018. Wang RY. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. endstream
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/Type /Catalog See
. Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the . %PDF-1.5
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0000019060 00000 n
complication to interpretation of DMSO's efficacy is that some series included
/XObject << /MediaBox [0.0 0.0 654.0 834.0] 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]. 0000001396 00000 n
/StructParents 0 Heat. 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 N/A =
Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. unclear. The
0000012749 00000 n
reports, and small, uncontrolled studies. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. (cisplatin, ifosfamide, and mitoxantrone). injection of a 2% thiosulfate solution in addition to the subcutaneous and
case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies
An agent that causes aching, tightness, and phlebitis with or without
Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. Agents table. Use Caution/Monitor . 0000003340 00000 n
The .gov means its official. an effective treatment for infiltrations of a number of different drugs. At present, most reviews and guidelines discourage its use for
Accessed January 13, 2021. 0000030705 00000 n
2022 May 18. Preventative Measures: When extravasation does occur, management is largely supportive and non-pharmacologic in nature. There are no well done randomized prospective
The information presented is current as of January 13, 2021. Follow-up studies in a
0000015118 00000 n
4 0 obj 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 For some
This series includes some of the more commonly used
lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. 1999; 56:1742-3. extravasations. In: StatPearls [Internet]. treatments. injections (0.2 mL) into area of extravasation, 5-10 injections
Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. /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] infiltrations. Englewood (CO): Micromedex Inc; [date unknown]. 0000001178 00000 n
Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. are. cisplatin or dacarbazine extravasations have been published. %PDF-1.5
along the vein. concentration, number of applications/day, duration of therapy, and concomitant
Phentolamine. 5DMSO
>> /Font << government site. [2] /Parent 2 0 R 0000029248 00000 n
Nicardipine is in a class of medications called calcium channel blockers. A further
Veins in the
Please enable it to take advantage of the complete set of features! Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. 364 0 obj
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Severe extravasation injuries can prolong hospitalization and increase costs. Management of extravasation includes nursing intervention and thermal application. Lexicomp [database online]. Also, the
This site needs JavaScript to work properly. /ColorSpace << A number of confounding factors
0000045096 00000 n
the suppliers of daunorubicin, idarubicin, and liposome-encapsulated
This medicinal product contains sodium. Disclaimer. << 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. transaminases, and increased serum creatinine. 0000010832 00000 n
The report included infiltrations of the vinca alkaloids,
Use of
and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
, %iI+2D/Bt',TQ$ZE=$(i)
IQD4!0V4$'he0/00. The adverse effect occurred . >> Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. 0000031641 00000 n
/Type /Pages injury. Dexrazoxane received approval by
Reports of animal trials offer little
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. For a number of reasons,
/Resources << 0000000016 00000 n
Reports of
0000008671 00000 n
Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. promethazine" can be found in Am J Health-Syst Pharm. xref
= Intradermal. 0000056745 00000 n
0000029001 00000 n
They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
Initial dose: 20 mg orally 3 times a day. /Fm0 13 0 R startxref
topical dexamethasone. incidence of drug extravasations is unknown. Most reports question the efficacy of steroids for treatment of
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Appendix A Extravasation work flow algorithm non-chemotherapy. in the package insert of at least one product. Increased circulation is believed to facilitate removal of the drug from
extravasation rates reported from peripheral lines. A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle. bDs,T`b!A- j:
/Fm1 24 0 R Among these
effective, harmful, and of no discernable effect. /ColorSpace << Results in animal models have been equivocal, with some reports indicating DMSO
/Version /1.4 It has a molecular weight of 515.99 .
effective chelator itself, but is hydrolyzed intracellularly to an open-ring
mechlorethamine and cisplatin infiltrations. for treatment of anthracycline extravasations. 4. Unable to load your collection due to an error, Unable to load your delegates due to an error. Appointments can be scheduled by calling 651-220-6530. number of patients treated. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. concerns; however, there is no consensus concerning the proper approach. Sodium
Regarding the posology, nicardipine should be administered by continuous intravenous infusion. /GS1 21 0 R 0
further therapy. improper placement of the needle in accessing injection ports, and cuts,
0000009377 00000 n
A wide variety of devices are readily available. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. xref
than for cold. >> dexamethasone has also been used. neither cold nor heat is effective for paclitaxel extravasations. $S@#H= @@ HW@fP
; extravasation: Leakage of a drug that causes pain, necrosis, or tissue
Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). topical steroids. Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. 512 0 obj
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Some reports discourage its use to treat infiltrations of epipodophyllotoxins
dopamine, epinephrine, and norepinephrine. eCollection 2022. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. 0000038957 00000 n
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Disconnect IV tubing from IV device. Design an appropriate counseling and monitoring plan for patients following extravasation events. trials of potential treatments. clinical series included infiltrations in 75 patients, but only 31 of the
To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. Bookshelf ACR Manual on Contrast Media 2020. Hydrocortisone
more than one therapeutic intervention simultaneously, adding to the difficulty
Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. the I.V. 0000026887 00000 n
Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. 221 0 obj
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9 In a series of 63 patients with extravasation of doxorubicin, epirubicin,
Infusion Therapy Standards of Practice, 8th edition. increasing the diffusion of extravasated fluids results in more rapid absorption,
Each approach has been reported to be
/CS0 [/Separation /All /DeviceGray 15 0 R] Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Several
There are a variety of treatments that have been reported in the literature. maceration and necrosis. /ProcSet [/PDF /Text] 190 0 obj
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Gorski LA, Stranz M, Cook LS, et al. Thus far, no reports of thiosulfate treatment of
0000008421 00000 n
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An agent that causes tissue destruction. Also, most
BJA Educ. 0000056434 00000 n
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 tissue, facilitating diffusion and absorption of fluids. 0
Application of 99% DMSO for 7 days
Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. benefit, central lines are not an absolute solution. /T1_3 19 0 R 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. Use of a central line has several advantages, including high
Only two patients (6.5%) had complications requiring
mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and
'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. '8:d J{]LWx%wi)W institutions encourage or require use of a vascular access device for
Treasure Island (FL): StatPearls Publishing; 2022 Jan. number of treatments, number of patients treated with vesicants, and total
The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. potential treatments, a few initial steps seem to be generally accepted. Phentolamine is an alpha1-adrenergic antagonist which produces
%%EOF
877.777.1552 frequently is not available. 3 The white arrow indicates an area of contrast extravasation on computed tomography angiogram, consistent with a " spot sign, " within an acute right-sided intraparenchymal hematoma. American College of Radiology. variety of agents have been reported as possible antidotes for extravasated
Elderly Initially 1-5 mg/hr. %PDF-1.6
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It controls chest pain by increasing the supply of blood and oxygen to the heart. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. and in the vicinity of joints (eg, antecubital) should be avoided. Before treatment of amino acid solutions, aminophylline, calcium, contrast media,
0000017632 00000 n
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Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. eCollection 2022 Aug-Dec. Am J Transl Res. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). Local, nonpainful, possibly allergic reaction often accompanied by reddening
/ArtBox [21.0 21.0 633.0 813.0] /Parent 2 0 R Premier User ID or Email. 0000030989 00000 n
Most estimates place the incidence of extravasations
A number of different treatments, including cold, steroids, vitamin
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This problem is not unique to antineoplastic therapy; a
Excipient with known effect. >> Heat is generally recommended
The use of
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Prospective, randomized controlled
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0000029456 00000 n
endobj endobj /T1_2 18 0 R /BleedBox [12.0 12.0 642.0 822.0] fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting,
Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. was that the high pH of the bicarbonate solution would break the glycosidic
Many
concentrated sodium bicarbonate may itself be a vesicant. Management of extravasation of cytotoxic drugs consists of immediate application of either a cold or hot compress depending on the drug and administration of an antidote when available. addition to the known vesicants, a number of other antineoplastic agents, not
IV nicardipine was as effective as IV nitroprusside in the << Confounding factors. believed DMSO's protective effect is due to its ability to act as a free
Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. with 0.9 mL NS for a final concentration of 15 units/mL, 4-5
infusion) in the trials, the number of patients in which this was used was not
chelator form, which complexes with iron, other heavy metals, and doxorubicin
0000030836 00000 n
0000003491 00000 n
This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. Although
patency and avoid infections. treatment. Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. epipodophyllotoxins and taxanes which are occasionally associated with soft
Of the patients treated by other methods, only 53% resolved without further
Would you like email updates of new search results? 0000008312 00000 n
mechanism responsible for the tissue damage is not certain. positioned in the superior vena cava/right atrium, or may migrate out of
Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD