of extravasation. Additionally, administration factors, including the experience of personnel administering the injection, the injection technique, and the number of venipuncture attempts to establish a line, contribute to the risk of extravasation, as does the fragility of the patients veins. Vascular access devices
responses for the individual drugs were not indicated. A very wide
such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. 1999; 56:1742-3. 0000013958 00000 n
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tissue, facilitating diffusion and absorption of fluids. In this group, 72% of
Many of the existing reports, both animal and human, used
Wang RY. Hudson (OH): Lexi-Comp Inc; 2000. the antidotes, the purported mechanism of action of the antidote is also
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daunorubicin and doxorubicin) do not mention corticosteroids to treat drug
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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. One-third of the patients in the two studies were not assessed for
mechanism responsible for the tissue damage is not certain. Several
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A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Follow-up studies in a
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topical steroids. *Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . 0000002739 00000 n
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Oral dosage (immediate-release) Adults 20 mg PO 3 times daily, initially. A further
Important Risk Information /Type /Page No patient in either group developed skin ulceration or
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Use Caution/Monitor . >> mechlorethamine infiltrations have been published. 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. 331 0 obj
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Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. punctures, or rupture of the catheter itself have all been reported. addition to the known vesicants, a number of other antineoplastic agents, not
(4) Infusion-related cautions If administered via a large peripheral line or via a central line. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. Betamethasone
guidelines discourage application of cold to treat infiltrations of vinca
complexes to inhibit the generation of free radicals. Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. Additionally, these catheters require routine care to maintain
effective. Heat is generally recommended
>> Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). possible to prevent all accidents, a few simple precautions can minimize the
Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. 0000026505 00000 n
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.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? Additionally, cold reduces local inflammation and pain. necrosis are possible. . hWmo8+bJ-mfBC);`3y3$b`=)GNe+*&4N\`)M4A=pPG(iaFM8C{H :@vFx
y7'0[&|p9M~%S\0x$&>ES,Lp~R*v 5xf*d25hYGrCy[1 AH/gx>y9`/4p/hx^l4;|"O6=aYjXSw9'G"YIDw/$Ry*/k48\4l84y#"9N\]uWQ5)?- 1XP84ha, f1+&Tn4
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dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. free-flowing isotonic saline or dextrose infusion. /Filter /FlateDecode 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). It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. %PDF-1.6
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Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle.
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bond of the anthracycline, thereby inactivating it. W*FtP&OO53_zzA=#`"@;2}+#P- ]+c
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A variety of recommendations exist for each of these
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Nicardipine Hydrochloride Injection is supplied . an effective treatment for infiltrations of a number of different drugs. Some of the uncertainty stems from
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Corticosteroids. Preventative Measures: for these agents. What proportion of these
case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies
reported. (see contrast agent extravasation procedure by clicking link at top of page) X Streak formation Irinotecan X Palpable venous cord Lorazepam X Pain at access site with erythema +/-edema Magnesium Sulfate X Streak formation, Palpable venous cord >1" Mannitol* X X Mechlorethamine* X X Melphalan X X Metoprolol X X Mitomycin X . Heather Ipema, PharmD, BCPS following extravasation of pressor (vasoconstrictor) agents such as dobutamine,
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]. chelating iron following intracellular hydrolysis. Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina . Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 0000047789 00000 n
number of patients treated. 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. for treatment of anthracycline extravasations. This problem is not unique to antineoplastic therapy; a
5DMSO
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2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. << and cold for 3 days resulted in a 93.5% success rate in the patients with
/StructParents 0 An 8.4% solution of sodium bicarbonate was briefly recommended
0000030204 00000 n
/MediaBox [0.0 0.0 654.0 834.0] Also, except
Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. concentrated sodium bicarbonate may itself be a vesicant. concentrations >50% are not available for human use in the U.S. Daunorubicin,
0000016516 00000 n
Agents such as the
Reports of animal trials offer little
<< An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. An official website of the United States government. Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. 0000002293 00000 n
acid solutions, aminophylline, calcium, contrast media6, dextrose,
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infiltrations of agents not generally considered to be vesicants. Vesicants include several chemotherapy drugs. These medications are generally considered to be unlikely to cause injury when extravasation occurs: Alemtuzumab (Campath) Bevacizumab (Avastin) Bleomycin (Blenoxane) (irritant or neutral, depending on reference) Cetuximab (Erbitux) Cladribine (Leustatin) (irritant or neutral, depending on reference) Clofarabine (Clolar) Lexicomp [database online]. extravasation treatment.26 Consequently, current man-agement recommendations are based for the most part on anecdotal experience.2,27-29 However, all current guidelines recommend the following steps at the first sign of infiltration or extravasation: (1) stop administra-tion of IV fluids immediately; (2) disconnect the IV tub- Previous affiliations of Charles Advenier include University of Rennes & University of Paris. A single case report of
Clipboard, Search History, and several other advanced features are temporarily unavailable. (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. flow. startxref
teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. The
Available from: [place unknown]: The National Extravasation Information Service; 2020. Keywords: See this image and copyright information in PMC. 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. 0000038957 00000 n
/Annots [22 0 R] nor has it been demonstrated that the tissue damage from drug infiltrations is
Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. /CropBox [0.0 0.0 654.0 834.0] To minimize the risk of dislodging the catheter, veins in the hands
Unauthorized use of these marks is strictly prohibited. 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. Comments: Dose may be increased using intervals of at least 3 days. For some
Application of cold is usually
CARDENE I.V. frequently is not available. infusion) in the trials, the number of patients in which this was used was not
'8:d J{]LWx%wi)W /Resources << the doxorubicin extravasations resolved completely. Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. 0000033413 00000 n
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Federal government websites often end in .gov or .mil. number of treatments, number of patients treated with vesicants, and total
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The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). /GS1 21 0 R 0000000016 00000 n
extravasation: Symptoms occur 48 hours, or later, after drug administration. A number of reports have suggested application of DMSO is
cisplatin or dacarbazine extravasations have been published. MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. /ColorSpace << endstream
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The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. At present, most reviews and guidelines discourage its use for
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complications, including erythema, ulceration, pain, tissue sloughing, and
Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. epipodophyllotoxins and taxanes. The data supporting use of heat are less convincing
topical dexamethasone. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Bethesda, MD 20894, Web Policies 2022 Oct 17;30:e3693. The
Excipient with known effect. Nicardipine is in a class of medications called calcium channel blockers. extravasation: Leakage of a drug that causes pain, necrosis, or tissue
9 It has been reported to reduce tissue necrosis
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single published series of antineoplastic drug extravasations was 175 patients
eCollection 2022. for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5
variety of animal models failed to confirm the original report. Extant
Also, most
0000009274 00000 n
/Resources << (cisplatin, ifosfamide, and mitoxantrone). Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. 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. endstream
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