0 With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. Aspiration of radiographic contrast media is not recommended. Epub 2022 Dec 22. Finally, extravasation of drugs from venous necrosis, resulting in scarring and/or reduced function of the involved extremity. Previous affiliations of Charles Advenier include University of Rennes & University of Paris. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. <> %%EOF 0000004717 00000 n Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. Most reports question the efficacy of steroids for treatment of >> Even when treatment is initiated as soon as . Also, most Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. number of treatments, number of patients treated with vesicants, and total CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. flow. effective, harmful, and of no discernable effect. Amino tion when administering nicardipine to patients with pheochromocytoma. At present, most reviews and guidelines discourage its use for 221 0 obj <>stream >> Incidence rates have been reported based on 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. 0000029248 00000 n used as a cardioprotective agent in patients receiving anthracycline therapy. 0000030836 00000 n reports that suggest DMSO is effective in preventing tissue damage used DMSO clinical series included infiltrations in 75 patients, but only 31 of the 1In Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Remove the peripheral IV device or port needle. The site is secure. 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 Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. extravasation. along the vein. HUQo0~W#H ,U:'amLDQ#*.U>rw}}v_uP/OkjePh?e)F#CH cFakiz,[6kpU8_ U@WtC SsA1pn# J$b: $ z7>bo?li5Uf 6o7FC1ceQI-T&.}` {D6n{,;e(3|jxzt4hw:,NPI6u^N_GZ!MHnx=FU/sGP[!+K,\g&o. Extravasation of xenobiotics. The actual 0000037314 00000 n 0000044356 00000 n The .gov means its official. Thus far, no reports of thiosulfate treatment of Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. Results in animal models have been equivocal, with some reports indicating DMSO Management of extravasation of non-cytotoxic drugs. complications, including erythema, ulceration, pain, tissue sloughing, and The adverse effect occurred . Nicardipine is in a class of medications called calcium channel blockers. Management of extravasation includes nursing intervention and thermal application. Although Keywords: varying definitions of incidence. /Parent 2 0 R 3 The white arrow indicates an area of contrast extravasation on computed tomography angiogram, consistent with a " spot sign, " within an acute right-sided intraparenchymal hematoma. Prospective, randomized controlled drugs, with no consensus on their proper use. thiosulfate to treat infiltrations of these drugs may not be required. Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5 vesicant extravasations. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. Common clinical uses for nicardipine are: Treatment of stable angina. << Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. 0000002835 00000 n >> endobj The vein used should be a large, intact vessel with good >> However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. addition to the known vesicants, a number of other antineoplastic agents, not Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. reported by Larson in 1985. In: Post TW, ed. for treatment for vinca alkaloid extravasations; a few reports recommend it for This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. endobj 549 0 obj <>stream Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. >> Questions? For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. Extant f 190 0 obj <>stream use are extremely difficult to interpret due to variations in DMSO See this image and copyright information in PMC. Application of cold is usually When extravasation does occur, management is largely supportive and non-pharmacologic in nature. BJA Educ. series of patients. extravasations. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 0000051721 00000 n and potentially highly morbid, complication of drug therapy is soft tissue damage 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. Extravasation is a known risk of vesicant administration. Inject 0000030989 00000 n Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. Confounding factors. Inject endstream endobj startxref 332 33 thiosulfate therapy of antineoplastic drug extravasations has been published. For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. Dtsch Med Wochenschr. with 0.9 mL NS for a final concentration of 15 units/mL, 4-5 Heather Ipema, PharmD, BCPS 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. European Oncology Nursing Society extravasation guidelines. Corticosteroids. /MediaBox [0.0 0.0 654.0 834.0] /Pages 2 0 R (nicardipine hydrochloride) Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. tissue damage were not included, nor were extravasations of nonantineoplastic (cisplatin, ifosfamide, and mitoxantrone). 3 DOSAGE FORMS AND STRENGTHS 0000018438 00000 n Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. necrosis are possible. extravasations. bond of the anthracycline, thereby inactivating it. /ExtGState << /ProcSet [/PDF /Text] Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. For some %%EOF An agent that causes tissue destruction. Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential Phentolamine. Several Extravasation is a potentially serious unintended event associated with IV drug administration. For . /T1_2 18 0 R cisplatin or dacarbazine extravasations have been published. Reports of animal trials offer little Appendix A Extravasation work flow algorithm non-chemotherapy. 0000009377 00000 n /Fm1 24 0 R /CS0 [/Separation /All /DeviceGray 15 0 R] In individual case reports, hyaluronidase has Careers. drops/10 cm2 of skin surface over an area twice the size of the 0000003804 00000 n 0000047789 00000 n /T1_0 16 0 R American College of Radiology. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Delayed variety of animal models failed to confirm the original report. Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. remaining 56 patients received a variety of antidotes. incidence of drug extravasations is unknown. Blanching should reverse 9 IV nicardipine was as effective as IV nitroprusside in the which there is less consensus are the application of heat or cold, and the use further therapy. 0000030176 00000 n Heat. It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. a case report of its use in a single patient. /Kids [3 0 R 4 0 R] Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . of various antidotes. endobj h247R0P047V01R& 0000029746 00000 n Interplay between exosomes and autophagy machinery in pain management: State of the art. Use of The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. Misplacement/migration of the catheter tip, exist which make assessment of various antidotes difficult. /Rotate 0 0000030660 00000 n It is postulated that Each mL of solution for injection contains 50mg sorbitol. toxicities were attributable to the dexrazoxane, and what was a result of the 0 0000026887 00000 n Some drugs, including anti-cancer agents, are directly cytotoxic to cells. endstream endobj startxref Although there is considerable uncertainty regarding the value of some /Count 2 Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. 0000013524 00000 n promethazine" can be found in Am J Health-Syst Pharm. This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. A variety of 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. The product labeling from two doxorubicin suppliers (as well as 0000002739 00000 n endstream endobj 513 0 obj <. 66y% e.YvIQ|!C2\@&;:8 h qF . uDX i! of doxorubicin includes a steroid as part of the treatment for drug Like most other medications, when taken beyond . Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. Some of the uncertainty stems from Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. with cytotoxic agents in the range of 1% to 7%. directly through the original needle; OR 6 SubQ injections into area /T1_2 19 0 R A number of confounding factors caused by leakage of the drug solution out of the vein. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the Agents Associated Please enable it to take advantage of the complete set of features! Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. endobj Dosage/Direction for Use. Apply 4 . 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 No large series of extravasations thereby limiting tissue damage. (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 . %PDF-1.4 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Clinical reports of its Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. paclitaxel, there are conflicting recommendations. 0000057141 00000 n When a drug Seoul: BIT Druginfo; 2020. sulfoxide (DMSO). xref Non-pharmacologic interventions for extravasation, For most medications, the treatment of extravasation is nonpharmacologic in nature; however, the efficacy of any specific approach has not been demonstrated in controlled studies.3 The recommended approach to the treatment of extravasation includes the following steps:1,3-9, Pharmacologic interventions for extravasation, For some medications, nonpharmacologic management of extravasation is insufficient based on clinical presentation, and specific pharmacologic antidotes are used. 0000030429 00000 n 0000017632 00000 n risk to the patient. 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]. /Contents [5 0 R 6 0 R 7 0 R 8 0 R 9 0 R 10 0 R 11 0 R 12 0 R] Vascular access devices Maintenance dose: 20 to 40 mg orally 3 times a day. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. was that the high pH of the bicarbonate solution would break the glycosidic doxorubicin, epirubicin, idarubicin. extravasation does occur, a variety of immediate actions have been recommended. and in the vicinity of joints (eg, antecubital) should be avoided. 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. for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. 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. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. Whether the addition of DMSO represented a real improvement 0000009056 00000 n 0000056434 00000 n Infusion Therapy Standards of Practice, 8th edition. /ColorSpace << 0000004334 00000 n hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ Developing extravasation protocols and monitoring outcomes. topical dexamethasone. Extravasation can result in tissue sloughing, pain . endstream endobj 2089 0 obj <. and transmitted securely. << Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. unclear. Comments: Dose may be increased using intervals of at least 3 days. What is nicardipine (Cardene) used for? The largest %PDF-1.6 % Interpretation of steroid efficacy is %PDF-1.5 % Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) This This medicinal product contains sodium. Pharmacological management of anticancer agent extravasation: A single institutional guideline. There are conflicting reports on official website and that any information you provide is encrypted 5 0 obj 2022 Oct 17;30:e3693. BIT Druginfo website [Internet] [cited 2020 Jul 10]. Inject /XObject << Max infusion rate: 15 mg/hr. recommended as immediate treatment for most drug extravasations, except the Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). Regarding the posology, nicardipine should be administered by continuous intravenous infusion. Do not remove the IV device or noncoring port needle. /ArtBox [21.0 21.0 633.0 813.0] anthracycline extravasation. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. The data supporting use of heat are less convincing https://www.acr.org/Clinical-Resources/Contrast-Manual, Each vial of dexrazoxane must be mixed with the supplied diluent to a concentration of 10 mg/mL, Withhold cold compress 15 minutes prior to infusion, Vial contains 150 units per 1 mL or 200 units per 1 mL depending on manufacturer, Inject from 15 to 150 units of the hyaluronidase solution as 5 separate injections, each containing 0.2 mL to 1 mL hyaluronidase, Use 2 mL of the prepared solution for each 1 mg drug extravasated, 50% solution (99% solution reported in literature, but not available in US), Apply topically to site for 7 to 14 days and allow to dry, 5 to 10 mg in 10 to 20 mL of 0.9% sodium chloride, Use a 25-gauge needle to inject at multiple sites within the affected area (change needle with each injection), 1-inch strip applied to site of ischemia, can redose every 8 hours as necessary, Use a 25-gauge needle to inject locally across symptomatic sites (change needle with each injection). 4 0 obj for doxorubicin extravasations in the group treated with ice and observation, bicarbonate SubQ, dexamethasone 4 mg SubQ. David V, Christou N, Etienne P, et al. Not applicable; NS = Not specified; I.V. /CS0 [/Separation /All /DeviceGray 15 0 R] Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. Can calcium channel blockers cause edema? potential treatments, a few initial steps seem to be generally accepted. 0000033942 00000 n /Type /Pages 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 Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. 481 0 obj <>stream /TrimBox [21.0 21.0 633.0 813.0] Inject into << nicardipine. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. /ProcSet [/PDF /Text] Since cisplatin 8600 Rockville Pike very limited animal data on thiosulfate's ability to inactivate dacarbazine and over cold alone is difficult to assess. Despite their Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. 0000002809 00000 n sodium thiosulfate to treat mechlorethamine infiltrations is based almost treatments. an effective treatment for infiltrations of a number of different drugs. $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz.
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