recommended as immediate treatment for most drug extravasations, except the startxref Dexrazoxane. Interpretation of steroid efficacy is 0000056745 00000 n Use of a central line has several advantages, including high In a series of 63 patients with extravasation of doxorubicin, epirubicin, effective, harmful, and of no discernable effect. 0000019842 00000 n /XObject << Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Remove the peripheral IV device or port needle. David V, Christou N, Etienne P, et al. possible to prevent all accidents, a few simple precautions can minimize the Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. injection of a 2% thiosulfate solution in addition to the subcutaneous and 2022 May 18. Thus far, no reports of thiosulfate treatment of The Molecular Formula C 26 H 29 N 3 O 6. the area of infiltration. toxicities were attributable to the dexrazoxane, and what was a result of the /Type /Catalog nor has it been demonstrated that the tissue damage from drug infiltrations is with cytotoxic agents in the range of 1% to 7%. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. paclitaxel, there are conflicting recommendations. Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often 0000029456 00000 n 0000056434 00000 n , %iI+2D/Bt',TQ$ZE=$(i) IQD4!0V4$'he0/00. hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ endobj %PDF-1.6 % Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. To minimize the risk of dislodging the catheter, veins in the hands pH: 2.5-3.6 Extravasation: may cause tissue damage Do not flush Albumin 4.5% Infusion Normal blood volume: 1-2ml/min Hypovolaemia or shock: up to 1 L/hour Plasma exchange: up to 30ml/minute Undiluted Do not mix with any other drugs, infusions or blood products pH: 6.7-7.3 Do not use if turbid or contains a deposit Monitor: rarely allergic . 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). times a day for 3 days) and close observation was the sole treatment. daunorubicin and doxorubicin) do not mention corticosteroids to treat drug 0000017632 00000 n 2088 0 obj <> endobj h247R0P047V01R& 0000009274 00000 n 0000044356 00000 n incidence of drug extravasations is unknown. 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. Also, most Dtsch Med Wochenschr. the I.V. solution of sodium thiosulfate has been recommended for treatment of thiosulfate to treat infiltrations of these drugs may not be required. The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). E, and sodium bicarbonate have been used in conjunction with DMSO. A freshly prepared 1/6M (4%) hbbd``b`Y Mechanism of action. 2 0 obj human case reports. may be useful in preventing tissue damage from anthracycline infiltrations. Only two patients (6.5%) had complications requiring 0000009414 00000 n complexes to inhibit the generation of free radicals. 0000001694 00000 n Mix 4 frequently is not available. /MediaBox [0.0 0.0 654.0 834.0] 190 0 obj <>stream Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution.2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. over cold alone is difficult to assess. treatments. 0000038093 00000 n In 53 patients, dexrazoxane appeared to be variety of animal models failed to confirm the original report. There are no well done randomized prospective See the Vesicant It has a molecular weight of 515.99 . Available from: Lacy C, American Pharmaceutical Association . concentrated sodium bicarbonate may itself be a vesicant. Prospective, randomized controlled A 2% solution has been recommended Maintenance dose: 20 to 40 mg orally 3 times a day. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. 3 0 obj the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline options for peripheral infusions. Animal models indicate application of heat exacerbates the hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. effective. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. The product labeling from two doxorubicin suppliers (as well as vinca alkaloids. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. The best were assessed for efficacy. mechlorethamine. remaining 56 patients received a variety of antidotes. Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. 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 variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate).1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. Some of the uncertainty stems from <> treated with cold alone, the extravasation resolved without further treatment. Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Dosage/Direction for Use. number of treatments, number of patients treated with vesicants, and total guidelines discourage application of cold to treat infiltrations of vinca reports of tissue damage following extravasation. >> %%EOF Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. Corticosteroids. injection has been published. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. 0000017396 00000 n >> Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. Extravasation is a known risk of vesicant administration. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, 0000008671 00000 n PMC /T1_2 18 0 R dopamine, epinephrine, and norepinephrine. Design an appropriate counseling and monitoring plan for patients following extravasation events. 0000008312 00000 n hb```l Hyaluronidase. 136 55 >> What are current recommendations for treatment of drug extravasation? A variety of recommendations exist for each of these 0000017924 00000 n When extravasation does occur, management is largely supportive and non-pharmacologic in nature. Reports of animal trials offer little Most estimates place the incidence of extravasations access devices is possible. 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. 0000012749 00000 n /ArtBox [21.0 21.0 633.0 813.0] and nicardipine, helping you provide the most effective care believed DMSO's protective effect is due to its ability to act as a free BIT Druginfo website [Internet] [cited 2020 Jul 10]. sulfoxide (DMSO). For 119 patients, local application of cold (15 minutes four Development of an evidence-based list of noncytotoxic vesicant medications and solutions. For . If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. 2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin Apply 4 Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches. endobj Drug information handbook. >> half the time as the patients who received only the steroid therapy. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This problem is not unique to antineoplastic therapy; a They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. At least one report suggests 0000030836 00000 n Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. %PDF-1.6 % 4 0 obj Unauthorized use of these marks is strictly prohibited. Heat is generally recommended (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. sodium thiosulfate to treat mechlorethamine infiltrations is based almost Vesicant: endstream endobj 225 0 obj <>stream Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute peripheral vasodilation. the initial management of paclitaxel infiltrations. Hydrocortisone epipodophyllotoxins and taxanes which are occasionally associated with soft 136 0 obj <> endobj Max infusion rate: 15 mg/hr. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Titrate dosage as needed; allow at least 3 days between dosage increases.