Unable to load your collection due to an error, Unable to load your delegates due to an error. The vinCRIStine is infused via gravity through the peripheral line. 3/10/2014, Institute for Safe MedicationPractices Polovich M, Olsen M, LeFebvre KB, eds. References and bibliography updated. Reference: 1. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 2. Manage conservatively as first line option with supportive non-pharmacologic strategies. To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. In December 2008, ASCO and ONS held a workshop to develop a consensus regarding standards for the safe administration of chemotherapy to adult patients in the outpatient setting. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. David V, Christou N, Etienne P, et al. References: 1. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. 2018 Apr 19;6(4):e1743. Please. For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. 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. However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. Clin J Oncol Nurs. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. Conclusion 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. 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. Managing Extravasation During Chemotherapy Administration hbbd```b``
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Reference: 1. Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . In, For more information on nurses, chemotherapy, and pregnancy, watch. Midline catheters have properties unique from those of peripheral and central VADs. Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. The https:// ensures that you are connecting to the ACR Committee on Drugs and Contrast Media. For every 1 mg of mechlorethamine suspected to have extravasated, inject 2 mL of the 1/6 molar sodium thiosulfate solution subcutaneously into the extravasation site using a 25 gauge or smaller needle. Paclitaxel, nanoparticle albumin-bound (Abraxane), Chemotherapy extravasation injury (UpToDate), ONS (Oncology Nursing Society) chemotherapy extravasation FAQs, Beatson West of Scotland Cancer Centre Chemotherapy extravasation guideline, West Suffolk Hospitals extravasation guideline, https://hemonc.org/w/index.php?title=Vesicant_%26_irritant_chemotherapy&oldid=68542, About HemOnc.org - A Hematology Oncology Wiki. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and recommendations made by professional oncology organizations are useful resources in this process. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 This site needs JavaScript to work properly. Gilbar PJ, Carrington CV. Accidental administration of vincristine in pediatric patients. 1990 Mar;4(1):41-60. doi: 10.1016/0268-960x(90)90015-k. Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Lu H, Yang Q, Yang L, et al. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. European Oncology Nursing Society extravasation guidelines. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. This site needs JavaScript to work properly. When the institution implements the use of minibags to administer vinCRIStine, the following nursing guidelines should be followed to further reduce the risk of harm from extravasation. Click to reveal 2014 Aug;24(4):352-8. The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. Oncology Nursing Society releases updated guidelines on - Healio Nonetheless, a review of literature of known vesicants and drugs reported to cause vascular injury or extravasation indicates some drugs that may present higher risk when administered via midline catheter. Additionally, the risk of cytotoxicity is reduced by intermittent compared with continuous infusion, as well as by dilution of vancomycin to concentrations of 2 to 5 mg/mL. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. Griffiths V. Midline catheters: indications, complications and maintenance. Pittsburg, PA: Oncology Nursing Society; 2014. Extravasation of noncytotoxic drugs. Version number changed to v.5. Your IP: Potassium Chloride. 5200 Butler Pike In general--aside from the exceptions listed below--keeping the extravasation cold is preferable to cause vasoconstriction, to prevent spread of the medication, and to decrease inflammation/pain. Manage conservatively; shield exposed tissues from light. government site. 2013;1(1):9- 16. e.YvIQ|!C2\@&;:8 h qF . uDX i! American College of Radiology. UN
vR7. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital %PDF-1.7
Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . Ex: Name & date of birth 2. References: 1. Gilbar PJ, Carrington CV. The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. The practice of monitoring the administration of vinCRIStine and other vinca alkaloids in a minibag to avoid extravasation via a peripheral IV is essentially the same as if it was administered IV push. Updated January 2021. endobj
139.59.111.99 Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. This decision must be weighed in light of certain death if the drug is administered via the wrong route. Avoiding the use of infusion pumps for vesicant administration via short infusion using a peripheral vein (Polovich et al., 2009) www2.ons.org/ClinicalResources/Vincristine/Safety Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? Additionally, patient mobility is greater with midline catheters because of the location of their insertion site.2 Lastly, compared with drug administration via peripheral IV catheter, the risk of phlebitis may be reduced with administration via midline catheter because of its termination in an area with a higher rate of blood flow.2The rates of CRBSI have also been reported to be lower with midline versus peripheral catheters (0 to 0.2 versus 0.5 per 1,000 catheter days).1, Overall, the properties of midline catheters may make them preferable for specific durations of therapy. PMC These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, sel 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. Lu H, Hou Y, Chen J, et al. doi: 10.4081/pr.2012.e28. When administering chemotherapy, nurses should always be able to say that safe handling has been considered and opportunity for exposure has been limited, but also that clinical staff have accounted for ensuring the dose is received in its entirety and they can rapidly intervene should an adverse event or complication occur. Clipboard, Search History, and several other advanced features are temporarily unavailable. References: 1. Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. Preventing and Managing Vesicant Chemotherapy Extravasations Facebook - National Cancer Institute Federal government websites often end in .gov or .mil. Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. Although relevant guidelines and policy statements existed (e.g., OSHA'sControlling Occupational Exposure to Hazardous Drugs, Chapter 2: Safe Handling of Chemotherapy Drugs, the ONSChemotherapy and Biotherapy Guidelines and Recommendations for Practice, ASCO'sCriteria for Facilities and Personnel for the Administration of Parenteral Systemic Antineoplastic Therapy), specific requirements to promote patient safety had not been well-defined by key stakeholders. European Oncology Nursing Society extravasation guidelines. 2023 Institute for Safe Medication Practices. Tubing features can present another challenge when considering how to best administer chemotherapy agents. The procedure includes connecting the bag of saline to a long straight infusion set. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
9fGr,zGa$9:WSs["8d/#'K f.'nw_EET 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. Current ASCO/ONS standards address the safety of all routes of chemotherapy administration to adult patients in the outpatient and inpatient settings. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. Prepared by: Eur J Oncol Nurs. 2 0 obj
2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. Gilbar P. Inadvertent intrathecal administration of vincristine: has anything changed? 6. 2016 Feb 10; 7(1): 8797. Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . Hospira. 3. 2014;(Epub ahead of print). Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. Gilbar PJ. The site is secure. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. endstream
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Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. National Library of Medicine 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. Vesicant Administration Guidelines 1. Apply cold pack intermittently for 15 minutes at a time, four times per day for 3 days, Apply cold pack 15 to 20 minutes at a time for at least four times per day for 24 hours. Monitor for extravasation according to hospital policy. 1,2 Recognize that when a vinca alkaloid is prepared in a minibag, it is likely more dilute than in a syringe, and thus the impact of tissue injury is even less if extravasation should occur. 3. 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. The safety of midline catheters for intravenous therapy at a large academic medical center. Front Oncol. 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. J Pediatr Oncol. 2009]. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. 2088 0 obj
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Question:Will administering vinCRIStine in a minibag increase the risk of extravasation? Venous irritation (chemical phlebitis) that occurs with drug administration into a vein that remains intact (eg, vinorelbine and epirubicin), and other cutaneous complications of chemotherapy are discussed elsewhere. Unable to load your collection due to an error, Unable to load your delegates due to an error. Midline catheters have properties that differ from both those of traditional peripheral IV catheters and central venous catheters (CVCs). Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Pittsburgh, PA 15275 References: 1. Extravasation injury from chemotherapy and other non - UpToDate Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. J Oncol Pharm Pract. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Sodium Chloride. Gorski LA, Stranz M, Cook LS, et al. Caution: excessive cold can cause tissue damage. Vesicant extravasation: myths and realities. sharing sensitive information, make sure youre on a federal Would you like email updates of new search results? Plymouth Meeting, PA 19462. Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. Managing Vesicant Extravasations | The Oncologist | Oxford Academic The Oncology Nursing Society4 recommends administering IV vinCRIStine and other vinca alkaloids via a minibag to prevent errors with intrathecal chemotherapy administration. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. 2022 Dec 2;12:1021488. doi: 10.3389/fonc.2022.1021488. The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta-analysis [published online ahead of print, 2021 May 15]. Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. Table 7 in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice discusses special features required for administration, but package inserts should be referred to for the most up-to-date information. Midline catheters differ from other VADs with regard to their insertion and termination sites.1,3Midline catheters are inserted peripherally into the antecubital fossa or upper arm via the basilic, cephalic, or brachial vein, and extend from 8 to 20 cm centrally, where the catheter tip terminates at or below the axillary vein. Reference Midline catheters represent a unique vascular access device (VAD) for patients requiring intravenous (IV) administration of drugs or other infusates.1,2After their introduction in the 1950s, hypersensitivity and phlebitis reactions to the manufacturing materials led to a temporary decline in the use of midline catheters through the 1990s; however, a redesign of these products in recent years has led to their renewed adoption. These medications are generally considered to be unlikely to cause injury when extravasation occurs: These medications are generally described as causing mild to moderate inflammation when extravasation occurs. There are non-chemo medications and solutions that have vesicant properties as well and can cause extravasation. University of Illinois at Chicago College of Pharmacy. This page was last edited 14:24, 26 April 2023 by. J Oncol Pharm Pract. Available antidote and treatment formulations and their preparation and administration also are discussed. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Clinicians considering drug administration via this VAD should review the chemical properties of the drug under consideration from reputable resources (eg, prescribing information) to compare them with the guidance above. 866-257-4ONS (866-257-4667). Handbook of Injectable Drugs 17th Edition. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. Extravasation of antineoplastic agents: prevention and treatments. Also, dilution of the vinca alkaloid likely reduces the impact of any extravasation that might occur. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. Management of the extravasation of anti-neoplastic agents. Vesicant chemotherapy extravasation antidotes and treatments. Accessibility 2021 Update: What are considerations for determining whether a drug may The venous access should not be removed immediately, since it can be used to attempt aspirating extravasated fluid and for administration of an antidote, if clinically appropriate.
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