Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. 6. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. 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 This site needs JavaScript to work properly. 2013;1(1):9- 16. Management of the extravasation of anti-neoplastic agents. World J Clin Oncol. Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, selecting an appropriate administration site for peripheral vesicant administration, and checking for a blood return prior to and during vesicant administration. The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. Disclaimer. Reference Of the utmost importance is that the administration setup ensures chemotherapy is given safely and allows for prompt nursing intervention in the event of an adverse reaction or infiltration. For permissions, please contacthelp@ons.org. MeSH When assessing a chemotherapy extravasation, it is important to understand the classification of the chemotherapeutic agent in terms of its potential to cause cellular damage if extravasated. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. Eur J Oncol Nurs. Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. Reference: 1. Accessibility 4 0 obj If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. 2.13.2 Vesicant chemotherapy administered through a peripheral intravenous must be infused IV push as ordered or via a short-term gravity intravenous line. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) Before Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Pediatr Rep. 2012 Aug 1;4(3):e28. A study in Australia involving 68 cancer centers evaluated more than 44,000 doses of vinca alkaloids administered via syringe or minibag to adult and pediatric patients, found that the extravasation rates were similar and low0.03% with syringes and 0.04% with minibags.1 Preliminary data from another study conducted in children and adults found no cases of extravasation during administration via minibags.2 These data strongly support the safe use of minibags in adults and children.3 The risk of extravasation injury doesnt compare to the risk of severe neurological injury and near certain death resulting from the intrathecal administration of vinca alkaloids. 1995 Jan-Feb;22(1):57-67. Bethesda, MD 20894, Web Policies Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. Prepared by: The .gov means its official. The Oncology Nursing Society (ONS) is a professional association that represents 100,000 nurses and is the professional home to more than 35,000 members. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Answer:According to a publication by the Oncology Nursing Society, 1 the easiest way to check for a blood return is to use gravity by lowering the minibag below the IV site. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. Determinations regarding the administration of drugs via midline catheter should consider properties of each drug individually because no definitive guidance is available to list the appropriateness of all drugs. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. 2014;(Epub ahead of print). 2141 0 obj <>stream Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. J Intraven Nurs. and transmitted securely. Eur J Oncol Nurs. Answer:Some practitioners have expressed concern that administering diluted IV vinCRIStine via a minibag might increase the risk of extravasation and subsequent tissue injury. (An infusion pump is not recommended by the Oncology Nurses Society (ONS) to administer vinCRIStine in this situation1 .) Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. Hyaluronidase may be used in extreme scenarios such as large volume extravasation or severe irritation. TheAmerican Society of Clinical Oncology (ASCO)and ONS are conducting an ongoing collaborative project to use a rigorous, consensus-based process to develop standards for the safe administration of chemotherapy. UIC's seven health sciences colleges and health care delivery enterprise. Ryan Rodriguez, PharmD, BCPS 3. This website is using a security service to protect itself from online attacks. Updated January 2021. If an antidote is not going to be used, the venous access can be removed after aspiration of the extravasated fluid has been attempted. 2012;18(suppl):16-7. www.hospira.com/Images/434047_32-91799_1.pdf In contrast, the Chemotherapy and Biotherapy Guidelines and Recommendations for Practice recommended against infusing vesicant agents peripherally for more than 30-60 min, but they also fail to categorize specifically chemotherapeutic agents as vesicants or irritants [Polovich et al. Rev. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants. Some medications are more likely to have vesicant properties in high concentrations or large volumes. Central VADs may also be more appropriate in patients needing longer-term therapy.3 Although some evidence has supported lower thrombosis risk with midline catheters compared with CVCs,1 a recent systematic review of 12 studies in 40,871 patients found that risk of venous thromboembolism was significantly higher with a midline catheter compared with a PICC (3.97% versus 2.29%; relative risk, 1.53; 95% CI, 1.33 to 1.76; p<0.00001).4 However, evidence evaluating the risk of catheter-related bloodstream infections (CRBSI) continues to find similar or improved rates of infection with midline catheters compared with PICCs.5, Compared with midline catheters, peripheral IV catheters are inserted more distally and most often utilize veins of the dorsum of the hand for cannulation.1-3Peripheral IV catheters have high first-attempt failure rates (26% in adults, 54% in children) and often require recannulation in larger more proximal sites.1,2Therefore, midline catheters may reduce the need for recannulation and thereby afford a longer dwell time. The procedure includes connecting the bag of saline to a long straight infusion set. 3 0 obj Bookshelf Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. National Library of Medicine Lu H, Yang Q, Yang L, et al. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. Extravasation is a known risk of vesicant administration. 2. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. Flare reaction: A skin reaction to a medication which is an allergic response. Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . Manage conservatively; shield exposed tissues from light. Polovich M, Olsen M, LeFebvre KB, eds. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. Antidotes to vesicant chemotherapy extravasations. Federal government websites often end in .gov or .mil. Because this termination site is distal to those of CVCs and peripherally inserted central catheters (PICCs), midline catheters are not considered to dwell in the central circulation.1Whereas the central termination site of CVCs and PICCs provide the ability to administer a wider range of infusates (eg, vesicants), this is not recommended with VADs terminating distal to the central circulation. Vesicants and irritants with vesicant . Clipboard, Search History, and several other advanced features are temporarily unavailable. endobj The Oncology Nursing Society (ONS) is a professional association that represents 100,000 nurses and is the professional home to more than 35,000 members. % HHS Vulnerability Disclosure, Help Trissel LA. Answer: To prevent excessive drug loss, some organizations are utilizing a back flushing method to infuse the remaining volume of drug that may remain in the IV tubing. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. eCollection 2012 Jul 31. Vesicant extravasation: myths and realities. Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Reference: 1. 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . Except as expressly stated on this site or as otherwise permitted by applicable law, no content on this site may be used or reproduced without the permission of the copyright holder. References: 1. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. Overview, prevention and management of chemotherapy extravasation. In 2021 the Infusion Nurses Society (INS) updated their 2016 guidelines and recommended consideration of midline catheters when the anticipated duration of therapy was 5 to 14 days with a preference for peripheral catheters for shorter durations of therapy and CVCs when longer durations of therapy are required.6 A recent study supports use of midline catheters for prolonged courses of therapy up to 14 days, but there remains limited data for use of midline catheters beyond 2 weeks.7 Currently, the CDC recommends consideration of midline catheters when the duration of IV therapy is likely to exceed 6 days.1,8, Considerations for drugs administered via midline catheter doi: 10.4081/pr.2012.e28. Exfoliants:An agent that is capable of causing inflammation and skin shedding, but less likely to cause tissue damage. The 2021 INS guidelines recommend against the use of midline catheters for continuous administration of vesicant therapy, parenteral nutrition, or other infusates with "extremes" of pH or osmolarity. Cloudflare Ray ID: 7c0b26d1e9b36bd5 ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Answer:For those patients who do not have a PICC or central venous access device, a peripheral IV line can still be used to administer vinCRIStine in a minibag. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. J Oncol Pharm Pract. The vinCRIStine is infused via gravity through the peripheral line. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. eCollection 2012 Jul 31. The main consideration in determining whether a drug is appropriate for administration via midline catheter is its propensity for causing phlebitis.2Phlebitis is inflammation of a vein caused by damage to the tunica intima, which may be accompanied by erythema, swelling, pain, heat, and a palpable cord if thrombosis is present. All rights reserved. Dosing Guidelines for Drugs Used to Manage Extravasations: Dexrazoxane: 1000mg/m2 (maximum dose= 2000mg/day) by intravenous infusion on days 1 and 2, followed by 500mg/m2 (maximum dose = 1000mg/day) by intravenous infusion on day 3. Version number changed to v.5. Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. Unauthorized use of these marks is strictly prohibited. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings.

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