endobj The vinCRIStine is infused via gravity through the peripheral line. J Oncol Pharm Pract. 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. 1990 Mar-Apr;13(2):111-4. Overview, prevention and management of chemotherapy extravasation. Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. No current standard or scoring system exists for the . Careers. Infuse in an extremity or area other than the one affected by extravasation. Clinical exam may reveal warmth, erythema, or tenderness. J Intraven Nurs. sharing sensitive information, make sure youre on a federal Caution: excessive heat can cause tissue damage. 833 S. Wood St., Suite B12, College of Pharmacy, (MC 886), Chicago, IL 60612, 2023 The Board of Trustees of the University of Illinois, UI Health is UICs academic health enterprise. FOIA Answer:Some practitioners have expressed concern that administering diluted IV vinCRIStine via a minibag might increase the risk of extravasation and subsequent tissue injury. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Advocating for the Provision of Alternate Responsibilities for Nurses Who Are Pregnant, Breastfeeding, or Trying to Conceive, Medical surveillance programs are recommended to detect changes in the health status of those working with hazardous drugs. Vesicant & irritant chemotherapy - A Hematology Oncology Wiki Chemotherapy Extravasation Management - AAHA Rev. Facebook - National Cancer Institute 3. For permissions, please contacthelp@ons.org. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; Always double check information at the primary references linked below. official website and that any information you provide is encrypted Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. Accidental administration of vincristine in pediatric patients. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment information, and advocated for patient care, all in an effort to improve the quality of life and outcomes for patients with cancer and their families. 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. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. Gilbar PJ, Carrington CV. Find the answers to questions regarding symptoms, side effects, and more. Calcium Chloride. References: 1. Rev. If an antidote is not going to be used, the venous access can be removed after aspiration of the extravasated fluid has been attempted. Intermountain Medical Center . Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital Developing extravasation protocols and monitoring outcomes. 2. 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. The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. 2021 Update: What are considerations for determining whether a drug may be administered via a midline catheter? Introduction Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. The site is secure. 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.6 Although the extremes are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas with osmolarity exceeding 900 mOsm/L. 3/26/2014, 4. Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. Avoid the "blame game.". Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. eCollection 2018 Apr. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. To discuss the information in this article with other oncology nurses, visit the ONS Communities. R*#;Wv777UtB4o"*v fgf?m[q\.>:TM=U)!f7STG.(Ky\B/Uc>L3}4d##0 ~!m I/>fwo8X p#D:}(edI? *(rC?Qe<=O%cfkkdsWq(u ?|b1k#^b!*tne{R^i5 }ikSbRI{xlQYSgAoKmgx~f Available antidote and treatment formulations and their preparation and administration also are discussed. 125 Enterprise Drive Hemonc Today | During the past several years, the Oncology Nursing Society developed and maintained Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, providing a unique and . x][8~Gi"K6$Yd cG_")X=@zdbXb"f]FyMQrt2i[Fl')o:{pO^}~[~9>aP,p"yKxb}t+~{x:?OA9?tvK:0+M*7y wg|[]okN(6cw1gQX$|6x5Q^Xn{~(8klFaL8?k|9}YjO"?}M8OC?}T-Qezi^D1@olKSw8E[D7:z,eQ,rY!'HT|9,}O$. Vesicant chemotherapy extravasation antidotes and treatments and transmitted securely. This page was last edited 14:24, 26 April 2023 by. 0 6. Most importantly, organizations must weigh the risk of possible extravasation versus certain death from the accidental administration of vinCRIStine by the intrathecal route when making decisions about changing practice. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. In some regimens, enough data support sequencing of agents, but in others, data are lacking. This information is intended as an educational piece and should not be used as the sole source for clinical decision making. Oncology Nursing Society releases updated guidelines on - Healio This decision must be weighed in light of certain death if the drug is administered via the wrong route. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. 3 0 obj References: 1. doi: 10.1097/GOX.0000000000001743. 3. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Federal government websites often end in .gov or .mil. 2006;12(2):113-8. The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. The procedure includes connecting the bag of saline to a long straight infusion set. Sodium Chloride. Another option is to aspirate with a syringe via the lowest Y-site and clamp off fluid from the minibag. Irritants and Vesicants Guide to Intravenous Administration via Midline Catheters . 2021 Update: What are considerations for determining whether a drug may The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Lu H, Yang Q, Yang L, et al. Managing Extravasation During Chemotherapy Administration A subsequent 2013 revision The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. 2016 Feb 10; 7(1): 8797. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. 8600 Rockville Pike Heat - Apply warm compresses to extravasation site for 1 hour. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. 1998 Jul-Aug;21(4):232-9. 2014 Aug;24(4):352-8. The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. Bethesda, MD: American Society of Healthsystem Pharmacists; 2012:1104-5. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? Conclusion Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. Plymouth Meeting, PA 19462. 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. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. Bookshelf Answer:Yes, the product is stable in a minibag. Manage conservatively as first line option with supportive non-pharmacologic strategies. 2023 Institute for Safe Medication Practices. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Depending on treatment complexity, ONS's Chemotherapy and Biotherapy Guidelines and Recommendations for Practice state that chemotherapy agents being administered by infusion "may be connected directly to the IV catheter or to a line of compatible maintenance solution."
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