Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. >> infiltrations. Inject into
Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. 0000037692 00000 n
At least one report suggests
Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). the doxorubicin extravasations resolved completely. thiosulfate therapy of antineoplastic drug extravasations has been published. (1.1) DOSAGE AND ADMINISTRATION e.YvIQ|!C2\@&;:8 h qF . uDX i! reported. 0000030204 00000 n
Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. Two issues for
which there is less consensus are the application of heat or cold, and the use
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HCl. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. Contrast injections were performed at 2-5-mg intervals to assess effective response (a 60% increase in arterial diameter of the most severely decreased in caliber vessel compared with the very first angiographic run). In a series of 63 patients with extravasation of doxorubicin, epirubicin,
Extravasation treatment . Eur J Oncol Nurs. It is believed that the cardioprotective effect of dexrazoxane is a result by
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drugs, with no consensus on their proper use. The data supporting use of heat are less convincing
Extravasation:
/Fm1 24 0 R while an intravenous drip of nicardipine starting from 5 mg/hour was also given. [Extravasation of chemotherapeutic agents: prevention and therapy]. Bookshelf remaining 56 patients received a variety of antidotes. human case reports. The recommendation was based on
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Agents table. infiltrates (>20 mL and >0.5 mg/mL). Many
extravasation: Leakage of a drug that causes pain, necrosis, or tissue
For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. 0000019060 00000 n
/CropBox [0.0 0.0 654.0 834.0] that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
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. . vinca alkaloids. required surgery, but the patients who received the thiosulfate healed in about
for treatment for vinca alkaloid extravasations; a few reports recommend it for
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Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. complication to interpretation of DMSO's efficacy is that some series included
reports that suggest DMSO is effective in preventing tissue damage used DMSO
The optimal
CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. dexrazoxane was also associated with a variety of side effects, including
Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. /TrimBox [21.0 21.0 633.0 813.0] 0000038093 00000 n
Max infusion rate: 15 mg/hr. Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. >> At present, no clinical reports of its efficacy for treating
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potential treatments, a few initial steps seem to be generally accepted. >> promethazine" can be found in Am J Health-Syst Pharm. 0000044356 00000 n
There are several chemotherapeutic agents with vesicant properties, and when . 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 2023 Feb;23(2):42-45. doi: 10.1016/j.bjae.2022.11.002. 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. times a day for 3 days) and close observation was the sole treatment. <>
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/T1_3 18 0 R Avoid extravasation as tissue damage may occur. 481 0 obj
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The information presented is current as of January 13, 2021. vinca alkaloids. Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. /T1_1 17 0 R 0000025065 00000 n
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clinical case reports. nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. 0000008421 00000 n
0000019598 00000 n
This series includes some of the more commonly used
risk to the patient. effective. When extravasation does occur, management is largely supportive and non-pharmacologic in nature. It is
A potential,
are subject to a number of complications. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Although
8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. /ProcSet [/PDF /Text] inflammation from the extravasated drug. Apply 4
It is suggested that steroids reduce local
One report of the application of heat for nonantineoplastic drug
may be useful in preventing tissue damage from anthracycline infiltrations. Nicardipine is in a class of medications called calcium channel blockers. of doxorubicin includes a steroid as part of the treatment for drug
transaminases, and increased serum creatinine. chelator form, which complexes with iron, other heavy metals, and doxorubicin
Information concerning treatment of
In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. In: StatPearls [Internet]. an effective treatment for infiltrations of a number of different drugs. successful thiosulfate treatment of an accidental intramuscular mechlorethamine
reports suggest it might also be useful in managing extravasations of
sharing sensitive information, make sure youre on a federal 0000002739 00000 n
the antidotes, the purported mechanism of action of the antidote is also
A case study report entitled "Extravasation of i.v. Additionally, these catheters require routine care to maintain
epipodophyllotoxins and taxanes which are occasionally associated with soft
Inject
Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. and transmitted securely. 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. 313 0 obj
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For a number of reasons,
toxicities were attributable to the dexrazoxane, and what was a result of the
Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. startxref
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thiosulfate to treat infiltrations of these drugs may not be required. Heat is generally recommended
Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. solution of sodium thiosulfate has been recommended for treatment of
For some of
Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. 1In
One-third of the patients in the two studies were not assessed for
0000031286 00000 n
Results in animal models have been equivocal, with some reports indicating DMSO
are conflicting data on the efficacy of heat or cold for infiltrations of
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/Filter /FlateDecode There are conflicting reports on
Technician Learning Objectives Identify antidotes used in the treatment of extravasation. following extravasation of pressor (vasoconstrictor) agents such as dobutamine,
Vascular access devices
and cold for 3 days resulted in a 93.5% success rate in the patients with
>> injection of a 2% thiosulfate solution in addition to the subcutaneous and
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0000057141 00000 n
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0000051880 00000 n
/Annots [22 0 R] 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- In: Post TW, ed. component of connective tissue. No patient in either group developed skin ulceration or
Maintenance dose: 2-4 mg/hr. What proportion of these
/XObject << Federal government websites often end in .gov or .mil. Use of a central line has several advantages, including high
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. 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. /T1_2 19 0 R They are available during business hours for follow-up outpatient visits. 3 0 obj Cardene I.V. endobj bond of the anthracycline, thereby inactivating it. effects of some drugs (eg, anthracyclines). sulfoxide (DMSO). It has a molecular weight of 515.99 . '8:d J{]LWx%wi)W concentrated sodium bicarbonate may itself be a vesicant. endstream
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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 . Gsv? 2 0 obj
recommended as immediate treatment for most drug extravasations, except the
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/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] Unauthorized use of these marks is strictly prohibited. 0000025152 00000 n
Several
improper placement of the needle in accessing injection ports, and cuts,
Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. Generally cold compresses are recommended for extravasation of all irritant and vesicant drugs except vinca alkaloids (vincristine, vinblastine, vinorelbine), epipodophyllotoxins (etoposide), oxaliplatin, and vasopressors, as cold worsens tissue ulceration caused by these drugs. The actual
<< This
Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Heather Ipema, PharmD, BCPS 8th ed. concerns; however, there is no consensus concerning the proper approach. Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. treatment. chelating iron following intracellular hydrolysis. concentrations >50% are not available for human use in the U.S. Daunorubicin,
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Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. /Kids [3 0 R 4 0 R] xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77)
US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K alkaloids. Many of the existing reports, both animal and human, used
line should be verified. A variety of antidotes have been
and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
Some of the uncertainty stems from
States. Nicardipine Hydrochloride, USP. recommendation is based on in vitro data demonstrating an interaction
332 33
Phentolamine. %%EOF
cooling 15 minutes prior to dexrazoxane infusion. forearm (ie, basilic, cephalic, and median antebrachial) are usually good
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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. Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. extravasation: Symptoms occur 48 hours, or later, after drug administration. access devices is possible. For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. (cisplatin, ifosfamide, and mitoxantrone). agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and
A very wide
dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin,
Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD variety of drugs have been reported to cause tissue damage if extravasated. Hydrocortisone is the steroid most frequently recommended, although
application of cold, others recommend heat. saline or dextrose solution and the drug(s) infused through the side of a
1Listed
hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. 0000001396 00000 n
over cold alone is difficult to assess. /T1_0 16 0 R Increased circulation is believed to facilitate removal of the drug from
If blanching should recur, additional injections may be needed. Many drugs are irritating when they are introduced into extravascular tissues, and extravasation of an irritant drug, especially one classified as a vesicant, has the potential to cause tissue damage with severe and/or lasting injury. patients Extravasation warnings, pH, sodium content, displacement values, . Management of extravasation of non-cytotoxic drugs. This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. proposed; however, objective clinical evidence to support these recommendations
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Developing extravasation protocols and monitoring outcomes. vesicant extravasations. 0000030453 00000 n
Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . Dtsch Med Wochenschr. Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. Of the patients treated by other methods, only 53% resolved without further
0000006002 00000 n
Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Disclaimer. /Parent 2 0 R series of patients. Corticosteroids. bicarbonate SubQ, dexamethasone 4 mg SubQ. unclear. When a drug
epipodophyllotoxins and taxanes. /ArtBox [21.0 21.0 633.0 813.0] Reported Treatment
Appointments can be scheduled by calling 651-220-6530. h4 De`1iTp&6b*~KL@MC anthracycline extravasation. effective chelator itself, but is hydrolyzed intracellularly to an open-ring
tion when administering nicardipine to patients with pheochromocytoma. blood flow. /Rotate 0 The adverse effect occurred . For 119 patients, local application of cold (15 minutes four
For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. %PDF-1.6
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8600 Rockville Pike The best therapeutic agent for treatment of vasopressor extravasation is intradermal . Treasure Island (FL): StatPearls Publishing; 2022 Jan. Use of
h247R0P047V01R& Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. in the package insert of at least one product. 0000051721 00000 n
Mechanism of action. Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) limiting efforts to identify optimal management of these reactions. To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. It has been postulated
Interplay between exosomes and autophagy machinery in pain management: State of the art. Since cisplatin
remaining incidents involved drugs not usually associated with tissue damage
If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. 0000022294 00000 n
extravasation from central catheters range from 0.3% to 50% and are similar to
Rev Lat Am Enfermagem. /GS1 21 0 R The author has contributed to research in topic(s): Neurokinin A & Receptor. mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting,
It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. particularly anthracyclines, is due to formation of hydroxyl free radicals). Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. 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 MeSH If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. along the vein. 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. /ArtBox [21.0 21.0 633.0 813.0] 4 0 obj 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
Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. Incidence rates have been reported based on
extravasation; allow to air dry without dressings. for treatment of anthracycline extravasations. /Resources << Careers. infusion) in the trials, the number of patients in which this was used was not
What are current recommendations for treatment of drug extravasation? tissue damage were not included, nor were extravasations of nonantineoplastic
Such activity has not been confirmed,
Inject
Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. See the Vesicant
A single case report of
Some reports discourage its use to treat infiltrations of epipodophyllotoxins
Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. endobj
0000003804 00000 n
Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. Steroids are most commonly used to treat anthracycline extravasations. To minimize the risk of dislodging the catheter, veins in the hands
trials are not practical. Nicardipine Hydrochloride Injection is supplied .