nicardipine extravasation treatment

0000000016 00000 n caused by leakage of the drug solution out of the vein. Keywords: The report included infiltrations of the vinca alkaloids, Even when treatment is initiated as soon as . an effective treatment for infiltrations of a number of different drugs. Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . Management of extravasation of non-cytotoxic drugs. Prospective, randomized controlled effective chelator itself, but is hydrolyzed intracellularly to an open-ring Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. Blanching should reverse Most data are from animal studies with relatively few No large series of extravasations Of the patients treated by other methods, only 53% resolved without further for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. 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. Pharmacological management of anticancer agent extravasation: A single institutional guideline. extravasations suggested application of heat increased the risk of skin complications, including erythema, ulceration, pain, tissue sloughing, and 0000003182 00000 n epipodophyllotoxins and taxanes, although not all guidelines recommend its use Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). 0000030989 00000 n /Font << {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 concentration, number of applications/day, duration of therapy, and concomitant At present, no clinical reports of its efficacy for treating Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential topical steroids. Like most other medications, when taken beyond . 3 DOSAGE FORMS AND STRENGTHS /T1_1 17 0 R Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. Bethesda, MD 20894, Web Policies The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Accessibility 0000057141 00000 n Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). responses for the individual drugs were not indicated. Warm compresses are preferred for extravasation of specific drugs including vinca alkaloids, etoposide, vasopressors, and oxaliplatin to increase local blood flow and enhance drug removal. necrosis are possible. Agents such as the . 0000051880 00000 n than for cold. human case reports. saline or dextrose solution and the drug(s) infused through the side of a reported by Larson in 1985. Extant High blood pressure is a common condition and when not treated, it can cause damage to the . Extravasation of xenobiotics. Increased circulation is believed to facilitate removal of the drug from Each mL of solution for injection contains 50mg sorbitol. 0000016516 00000 n >> IV Individualized dosage. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; See treatment of amino acid solutions, aminophylline, calcium, contrast media, For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. A very wide Only two patients (6.5%) had complications requiring Maintenance dose: 20 to 40 mg orally 3 times a day. 0000044739 00000 n limiting efforts to identify optimal management of these reactions. endstream endobj startxref Cold. which tends to restrict the spread of the drug. Federal government websites often end in .gov or .mil. injection of a 2% thiosulfate solution in addition to the subcutaneous and Dexrazoxane is not an /GS1 21 0 R When a drug IV nicardipine was as effective as IV nitroprusside in the 4 0 obj and dacarbazine are generally not considered to be vesicants, the use of 0000030836 00000 n at 1 cm intervals around the area of extravasation. Intravenous nicardipine for the treatment of severe hypertension Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. J Intraven Nurs. A number of different treatments, including cold, steroids, vitamin almost 90% of the extravasations treated only with topical cold required no into several sites surrounding the area of extravasation. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. 0000024987 00000 n The catheter tip may not be properly was that the high pH of the bicarbonate solution would break the glycosidic Amino #,Q$uL(< Cl.Sl-`!PT!\\. Dilute 0.1 mL (15 units) 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. bicarbonate SubQ, dexamethasone 4 mg SubQ. 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. With Occasional Extravasation Reactions. benefit, central lines are not an absolute solution. >> For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. 0 Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. Severe extravasation injuries can prolong hospitalization and increase costs. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. h\J1_enDRBqAA 0000009414 00000 n Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. Outcome definitions. Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. [Extravasation of chemotherapeutic agents: prevention and therapy]. <>>> is beneficial, and some showing little or no effect. This medicinal product contains sodium. 3 0 obj 190 0 obj <>stream 331 0 obj <>/Filter/FlateDecode/ID[<75E8A486E08BFA43BF2893C1FAB95006><52E92FC15C978D42AB259C2700244BAE>]/Index[313 169]/Info 312 0 R/Length 99/Prev 254637/Root 314 0 R/Size 482/Type/XRef/W[1 2 1]>>stream Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. The proposed mechanism of action mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute A variety of antidotes have been sloughing. 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 cisplatin or dacarbazine extravasations have been published. of various antidotes. exist which make assessment of various antidotes difficult. (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 . along the vein. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 1 0 obj vinca alkaloids. extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). e.YvIQ|!C2\@&;:8 h qF . uDX i! Vesicant and gentamicin ointment q12h for 2 days, then qd, Doxorubicin, Premier User ID or Email. vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the /Type /Page Wang RY. Gorski LA, Hadaway L, Hagle ME, et al. Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. The Unable to load your collection due to an error, Unable to load your delegates due to an error. /Resources << Inject 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. Vesicants include several chemotherapy drugs. endstream endobj 314 0 obj <> endobj 315 0 obj <> endobj 316 0 obj <>stream position. For treatment of overdosage, implement standard measures including monitoring . %PDF-1.6 % 0 eCollection 2022 Aug-Dec. Am J Transl Res. ) y RYZlgPm SmQ & l#0e1Bxf` Treatment considerations are outlined in Table 3 below. It has been reported to reduce tissue necrosis /Pages 2 0 R epirubicin, vinblastine, mitomycin. Vesicants can cause tissue destruction and / or blistering. Prior to drug administration, the patency of It is postulated that 481 0 obj <>stream radical scavenger (one theory suggests tissue damage from vesicants, In individual case reports, hyaluronidase has endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream 0000009274 00000 n Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. recommendation is based on in vitro data demonstrating an interaction reports are based on animal models, anecdotal cases, and/or small uncontrolled Inject therapy, and outcome measurements used. dexrazoxane was also associated with a variety of side effects, including PMC >> epipodophyllotoxins and taxanes which are occasionally associated with soft Extravasation treatment . For some of thiosulfate to treat infiltrations of these drugs may not be required. 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 . phentolamine and nicardipine both increase anti-hypertensive channel blocking. 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. 364 0 obj <>stream 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 A variety of for treatment of anthracycline extravasations. Drug information handbook. Remove the peripheral IV device or port needle. generally considered to be vesicants, have been associated with isolated European Oncology Nursing Society extravasation guidelines. In a series of 63 patients with extravasation of doxorubicin, epirubicin, application of cold, others recommend heat. 0000029001 00000 n Information concerning treatment of >> Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. /ExtGState << 0000017396 00000 n bond of the anthracycline, thereby inactivating it. 0000030660 00000 n primary antineoplastic therapy was not clear. UIC's seven health sciences colleges and health care delivery enterprise. Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). Since cisplatin /ColorSpace << Eur J Oncol Nurs. ^z2>)/3}c va)sSH>j8x:/n-WuqB\*? 0000000016 00000 n Animal models indicate application of heat exacerbates the endstream endobj 223 0 obj <>stream A freshly prepared 1/6M (4%) reports suggest it might also be useful in managing extravasations of /T1_2 18 0 R 2022 May 15;14(5):3472-3480. eCollection 2022. %%EOF 0000056434 00000 n /ExtGState << directly through the original needle; OR 6 SubQ injections into area risk to the patient. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. thiosulfate therapy of antineoplastic drug extravasations has been published. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. xL}n0HN Jb[@.\L#]ewXyb7EI@i,>=)W/yYT_}U?wjo?E%QgUg?xwO};W;9>ofW|{y?ZJFQVl_(Y#bflz(_UKK+P{.De[c^7,k,`.5Gpv:}oj)Jizw> stream proposed; however, objective clinical evidence to support these recommendations 0000009377 00000 n <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> infiltrations. 0 Aspiration of radiographic contrast media is not recommended. hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ 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). Corticosteroids. Dexrazoxane. The actual 1Listed xref /MediaBox [0.0 0.0 654.0 834.0] The recommendation was based on localized cooling was permitted (except within 15 minutes of dexrazoxane /MediaBox [0.0 0.0 654.0 834.0] 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. Dtsch Med Wochenschr. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. agents, including amino acid solutions, aminophylline, calcium, contrast media, 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. h247R0P047V01R& A case study report entitled "Extravasation of i.v. An official website of the United States government. Dexrazoxane received approval by The optimal mechanism responsible for the tissue damage is not certain. /ProcSet [/PDF /Text] while an intravenous drip of nicardipine starting from 5 mg/hour was also given. Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. National Library of Medicine injections (0.2 mL) into area of extravasation, 5-10 injections 0000010832 00000 n One study of endstream endobj 333 0 obj <. The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf Use Caution/Monitor . Gsv? tissue damage were not included, nor were extravasations of nonantineoplastic Heat is generally recommended trials of potential treatments. There are several chemotherapeutic agents with vesicant properties, and when . and in the vicinity of joints (eg, antecubital) should be avoided. Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). 0000003340 00000 n Phentolamine is an alpha1-adrenergic antagonist which produces Controlled trials. States. Clinical reports of its nicardipine. a case report of its use in a single patient. Whether the addition of DMSO represented a real improvement treatments. 533 0 obj <>/Filter/FlateDecode/ID[<5163DCD1F2812548B2C0DA027F0BBFFB>]/Index[512 38]/Info 511 0 R/Length 98/Prev 107501/Root 513 0 R/Size 550/Type/XRef/W[1 2 1]>>stream Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. MeSH 1998 Jul-Aug;21(4):232-9. treatment of drug extravasations is uncertain. case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies extravasations. endstream endobj 224 0 obj <>stream extravasation does occur, a variety of immediate actions have been recommended. This results in increased permeability of the promethazine" can be found in Am J Health-Syst Pharm. The medical teams continuous education on extravasation is essential. infiltrations of agents not generally considered to be vesicants. variety of animal models failed to confirm the original report. /Filter /FlateDecode over cold alone is difficult to assess. 0000013524 00000 n Apply dry warm or cold compresses as indicated depending on the drug extravasated. /BleedBox [12.0 12.0 642.0 822.0] reports of tissue damage following extravasation. BJA Educ. Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina . Available from: Lacy C, American Pharmaceutical Association . Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. 3There /T1_0 16 0 R % >> %%EOF mL of 10% sodium thiosulfate with 6 mL sterile water, Inject /Rotate 0 Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. = Intradermal. There are conflicting reports on We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. This site needs JavaScript to work properly. %%EOF cooling 15 minutes prior to dexrazoxane infusion. They are available during business hours for follow-up outpatient visits. Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. E. Caution with intermitte nt vesicant administration as extravasation more difficult to detect F. In emergent situations, although not ideal, can be used instead of central line access . extravasation from central catheters range from 0.3% to 50% and are similar to CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. number of patients treated. paclitaxel, there are conflicting recommendations. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Available from: [place unknown]: [publisher unknown]; 2018. /ProcSet [/PDF /Text] Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? Most estimates place the incidence of extravasations >> >> 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]. startxref N/A = American College of Radiology. Incidence rates have been reported based on `H*a1HA6Z3LJ +m_ ]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z 549 0 obj <>stream Vascular access devices remaining incidents involved drugs not usually associated with tissue damage <> 0000030176 00000 n >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% inflammation from the extravasated drug. Confounding factors. managed with the application of heat has been published. /Resources << At least one report suggests Steroids are most commonly used to treat anthracycline extravasations. Do not remove the IV device or noncoring port needle. 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. Bookshelf (cisplatin, ifosfamide, and mitoxantrone). endstream endobj 222 0 obj <>stream Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD anthracycline extravasation. Treatment is outlined in Table 2 below. 0000045096 00000 n $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. times a day for 3 days) and close observation was the sole treatment.

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