. Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. potassium and vinca alkaloid infiltrations. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. This results in increased permeability of the
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further therapy. 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. tissue damage were not included, nor were extravasations of nonantineoplastic
1Listed
Extravasation:
Vesicants can cause tissue destruction and / or blistering. Drug Vesicant vs Irritant PIV Midline Central line Comments . Several
It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. /TrimBox [21.0 21.0 633.0 813.0] 0000033413 00000 n
line should be verified. Clipboard, Search History, and several other advanced features are temporarily unavailable. Keywords: The medical teams continuous education on extravasation is essential. Hydrocortisone
2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. . /T1_2 19 0 R The adverse effect occurred . Despite their
Apply dry warm or cold compresses as indicated depending on the drug extravasated. Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. Inject
that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
Heather Ipema, PharmD, BCPS Dexrazoxane is not an
position. A 2% solution has been recommended
concentration, number of applications/day, duration of therapy, and concomitant
Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. institutions encourage or require use of a vascular access device for
which tends to restrict the spread of the drug. /Resources << h\J1_enDRBqAA 549 0 obj
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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 Results in animal models have been equivocal, with some reports indicating DMSO
0000003491 00000 n
and potentially highly morbid, complication of drug therapy is soft tissue damage
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Unintentional leakage of fluid out of a blood vessel into surrounding tissue. 113. component of connective tissue. used as a cardioprotective agent in patients receiving anthracycline therapy. Max infusion rate: 15 mg/hr. 0000002293 00000 n
and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). >> Gsv? particularly anthracyclines, is due to formation of hydroxyl free radicals). /MediaBox [0.0 0.0 654.0 834.0] Prior to drug administration, the patency of
Each mL of solution for injection contains 50mg sorbitol. /ArtBox [21.0 21.0 633.0 813.0] 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- Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. MeSH Developing extravasation protocols and monitoring outcomes. 8th ed. risk to the patient. %PDF-1.4 /CropBox [0.0 0.0 654.0 834.0] Selective transcatheter arterial embolization . There are conflicting reports on
They are available during business hours for follow-up outpatient visits. Management of extravasation includes nursing intervention and thermal application. effects of some drugs (eg, anthracyclines). Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). Each approach has been reported to be
/GS1 21 0 R 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. drugs, with no consensus on their proper use. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. 0000051721 00000 n
of different end-points and outcomes to define efficacy of a given
Careers. for these agents. xref
E, and sodium bicarbonate have been used in conjunction with DMSO. The information presented is current as of January 13, 2021. A variety of antidotes have been
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concentrations >50% are not available for human use in the U.S. Daunorubicin,
In this group, 72% of
Incidence rates have been reported based on
toxicities were attributable to the dexrazoxane, and what was a result of the
An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. Englewood (CO): Micromedex Inc; [date unknown]. What is nicardipine (Cardene) used for? 3There
0000031807 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% /Rotate 0 Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule Lexicomp [database online]. Only two patients (6.5%) had complications requiring
UIC's seven health sciences colleges and health care delivery enterprise. Some reports discourage its use to treat infiltrations of epipodophyllotoxins
No potential conflict of interest relevant to this article was reported. L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2
Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. damage from anthracycline extravasations. The .gov means its official. Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. concentrations >90% which is not available for clinical use in the United
0000030204 00000 n
reported by Larson in 1985. agents, including amino acid solutions, aminophylline, calcium, contrast media,
It has been postulated
% Agents table. Irritant:
0000029248 00000 n
[2] See the Vesicant
frequently is not available. It has a molecular weight of 515.99 . immediately. Many of the existing reports, both animal and human, used
Published reports use a number
improper placement of the needle in accessing injection ports, and cuts,
for treatment for vinca alkaloid extravasations; a few reports recommend it for
Information concerning treatment of
Remove the peripheral IV device or port needle. several sites surrounding the area of extravasation. Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. /Length 668 A variety of
/T1_3 18 0 R incidence of drug extravasations is unknown. the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline
Some drugs, including anti-cancer agents, are directly cytotoxic to cells. patency and avoid infections. ) y RYZlgPm SmQ
& l#0e1Bxf` sulfoxide (DMSO). Vesicants include several chemotherapy drugs. 190 0 obj
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Regimens for Drug Extravasations. /Font << Available from: [place unknown]: The National Extravasation Information Service; 2020. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8
Extravasation can result in tissue sloughing, pain . 0000044739 00000 n
an effective treatment for infiltrations of a number of different drugs. /CS0 [/Separation /All /DeviceGray 15 0 R] Design an appropriate counseling and monitoring plan for patients following extravasation events. Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. hbbbd`b``3
drug extravasations; they are not recommended by most guidelines. may be useful in preventing tissue damage from anthracycline infiltrations. Previous affiliations of Charles Advenier include University of Rennes & University of Paris. Mix 4
In a series of 63 patients with extravasation of doxorubicin, epirubicin,
It is believed that the cardioprotective effect of dexrazoxane is a result by
sodium thiosulfate to treat mechlorethamine infiltrations is based almost
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. It may also inhibit the local
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. peripheral vasodilation. 0000026887 00000 n
9 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. IV nicardipine was as effective as IV nitroprusside in the PMC Many
>> To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. An agent that causes tissue destruction. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. It is suggested that steroids reduce local
(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 . Available from: [place unknown]: [publisher unknown]; 2018. 0000030453 00000 n
Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. /BleedBox [12.0 12.0 642.0 822.0] efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. Leave the catheter or needle in place initially to attempt to aspirate fluid from the extravasated area. trailer
additional information, being plagued by many of the limitations of the
Need to register? sloughing. extravasation does occur, a variety of immediate actions have been recommended. 0000033942 00000 n
Vascular access devices
Even when treatment is initiated as soon as . endstream
endobj
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/GS1 21 0 R Betamethasone
Nicardipine Hydrochloride Injection is supplied . Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle. Sodium
vinca alkaloids. chelator form, which complexes with iron, other heavy metals, and doxorubicin
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]. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
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 . with cytotoxic agents in the range of 1% to 7%. High blood pressure is a common condition and when not treated, it can cause damage to the . 0000031286 00000 n
injection of a 2% thiosulfate solution in addition to the subcutaneous and
Helpful as it
One report of the application of heat for nonantineoplastic drug
epirubicin, vinblastine, mitomycin. Cardene I.V. recommendation is based on in vitro data demonstrating an interaction
Dexrazoxane received approval by
An official website of the United States government. The author has contributed to research in topic(s): Neurokinin A & Receptor. 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. 0000001178 00000 n
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Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Outcome definitions. 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 0000045096 00000 n
This site needs JavaScript to work properly. /T1_0 16 0 R European Oncology Nursing Society extravasation guidelines. David V, Christou N, Etienne P, et al. >> Treatment should begin as soon as possible and no later than 6 hours after extravasation. Questions? a small amount into area of extravasation. Regarding the posology, nicardipine should be administered by continuous intravenous infusion. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. 0000001363 00000 n
thiosulfate. 0000056434 00000 n
recommended precaution against drug extravasation is the use of a central
J Intraven Nurs. bond of the anthracycline, thereby inactivating it. Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. Two issues for
National Library of Medicine There are no well done randomized prospective
Nicardipine Hydrochloride and Extravasation - 9 seconds ago; Alavert and Erythema Multiforme - 13 seconds ago; Urispas and Fainting - 14 seconds ago; Pantoprazole and Metoclopramide Hydrochloride drug interaction - 20 seconds ago; Colecalciferol and Jc Virus Infection - 22 seconds ago; Akynzeo and Erythema Multiforme - 28 seconds ago treatment. the area of infiltration. Rev Lat Am Enfermagem. for doxorubicin extravasations in the group treated with ice and observation,
CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. Follow-up studies in a
/T1_0 16 0 R Thus far, no reports of thiosulfate treatment of
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. punctures, or rupture of the catheter itself have all been reported. 0000030705 00000 n
Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). Additionally, cold reduces local inflammation and pain. [Extravasation of chemotherapeutic agents: prevention and therapy]. mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and
For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. extravasation. Dtsch Med Wochenschr. Vesicant
At present, no clinical reports of its efficacy for treating
Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. h[moF+j_E4>"v/3jpdjs7pHk>ggJToWrCekPh5]e%FURFjihD- F|%}DMjb[Q)iR5R:RBYIu5RBp One-third of the patients in the two studies were not assessed for
In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. Dexrazoxane. nor has it been demonstrated that the tissue damage from drug infiltrations is
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. tissue, facilitating diffusion and absorption of fluids. Effects of photobiomodulation (660 nm laser) on anthracycline extravasation: An experimental study. Among these
Excipient with known effect. /T1_2 18 0 R 0000019598 00000 n
(cisplatin, ifosfamide, and mitoxantrone). extravasation rates reported from peripheral lines. 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. was that the high pH of the bicarbonate solution would break the glycosidic
0000051347 00000 n
are conflicting data on the efficacy of heat or cold for infiltrations of
Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. Reports of animal trials offer little
Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. inflammation. necrosis are possible. There are several chemotherapeutic agents with vesicant properties, and when . Aspiration of radiographic contrast media is not recommended. The largest
Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. 0000037314 00000 n
/Contents 23 0 R <>
Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). Treatment is outlined in Table 2 below. exclusively on the in vitro and animal data. Some reports recommend
Inject
treating extravasations. 0000025065 00000 n
/ProcSet [/PDF /Text] hb```l Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. treatment for extravasation reactions is prevention.