vesicant chemotherapy administration guidelines

eCollection 2012 Jul 31. Preventing and Managing Vesicant Chemotherapy Extravasations 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Boulanger J, Ducharme A, Dufour A, et al. Due to some references not using this classification, the only drugs listed in this section are ones which were unclassified by some resources, yet classified by others as inflammitants. endobj Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. World J Clin Oncol. Accessed August 2, 2021. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). 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Braun Recalls Certain Lots of Blood Administration Sets, FDA Approves Sunitinib Malate for Adjuvant Treatment of Renal Cell Carcinoma, News, Views, and Advocacy From the Oncology Nursing Society, Copyright 2023 Oncology Nursing Society, ONSs Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, ONS and American Society of Clinical Oncology standards, Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 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. Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. PDF Antineoplastic Drug Administration: Vesicant and Irritant Agents This site needs JavaScript to work properly. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. Lastly, they recommend avoidance of midline catheters in patients with a history of thrombosis, hypercoagulability, venous stasis, or with a need to preserve vein integrity, such as in patients with end-stage renal disease. Polovich M, Olsen M, LeFebvre KB, eds. Eur J Oncol Nurs. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. Rev. References: 1. HHS Vulnerability Disclosure, Help Introduction. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. 3/26/2014, 4. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. 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. 2021 Update: What are considerations for determining whether a drug may be administered via a midline catheter? Minor updates to administration and patient education. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. This website is using a security service to protect itself from online attacks. doi: 10.4081/pr.2012.e28. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. official website and that any information you provide is encrypted There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. Administering Vesicants | ONS 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. Vesicant & irritant chemotherapy - A Hematology Oncology Wiki sharing sensitive information, make sure youre on a federal 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Ex: Name & date of birth 2. Bethesda, MD: American Society of Healthsystem Pharmacists; 2012:1104-5. Oncologist. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Preventing and managing vesicant chemotherapy extravasations 2016 Updated American Society of Clinical Oncology/Oncology Including Centers for Disease Control and Prevention. 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. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. Accessibility Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. Package insert for vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial. References: 1. Polovich M, Olsen M, LeFebvre KB, eds. Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. 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. But chemo agents are not the only vesicants that cause extravasation injuries. National Library of Medicine National Library of Medicine Extravasation is a known risk of vesicant administration. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. The procedure includes connecting the bag of saline to a long straight infusion set. 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. Front Oncol. Content on this site is protected by U.S. and international copyright laws. J Oncol Pharm Pract. Copyright 2023 Oncology Nursing Society. Of the utmost importance is that the administration setup ensures chemotherapy is given safely and allows for prompt nursing intervention in the event of an adverse reaction or infiltration. References and bibliography updated. Abstract. 2006;12(2):113-8. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Vesicants: not just chemo agents! | Infusion Nurse Blog Clinical Assistant Professor, Drug Information Specialist By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Prepared by: Federal government websites often end in .gov or .mil. Intermountain Medical Center . Please enable it to take advantage of the complete set of features! (PDF) Chemotherapy administration standards and guidelines: The Email ONSs clinical inbox at clinical@ons.org to reach one of our oncology clinical specialists, who can advise on ONS recommendations, best practices, and evidence support. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Preparation for flexible plastic container VinCRIStine sulfate injection, USP when diluted with 0.9% sodium chloride injection in concentrations from 0.0015 mg/mL to 0.08 mg/mL is stable for up to 24 hours when protected from light or 8 hours under normal light at 25C. 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 . 0 The Hospira Brand of vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial package insert2 states: 8}-Fb}" "R5xPQ%Flm^%/jV Updated July 2017. MeSH American Society of Clinical Oncology (ASCO), Personal Protective Equipment for Use with Hazardous Drugs. Cloudflare Ray ID: 7c0b26d1e9b36bd5 Nafcillin. official website and that any information you provide is encrypted 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Please enable it to take advantage of the complete set of features! Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. PMC However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. 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. Rev.12/2/2014. The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. www.hospira.com/Images/434047_32-91799_1.pdf Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. Developing extravasation protocols and monitoring outcomes. Flare reaction: A skin reaction to a medication which is an allergic response. Trissel LA. doi: 10.1097/GOX.0000000000001743. Manage conservatively as first line option with supportive non-pharmacologic strategies. 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. UIC's seven health sciences colleges and health care delivery enterprise. If not clearly defined in the literature. Patients often seek explanations for why their extravasations occurred. 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." Best Practice #1 FAQ | Institute For Safe Medication Practices 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. *Follow guidelines and treat like a vesicant. 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. Chemotherapy Extravasation Management - AAHA Your IP: Potassium Chloride. Management of the extravasation of anti-neoplastic agents. 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET and transmitted securely. Accidental administration of vincristine in pediatric patients. This review provides an overview of midline catheters and a summary of properties that influence the determination of whether a drug is appropriate for administration via midline catheter. MeSH Overview, prevention and management of chemotherapy extravasation. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. $on8+i5BqlA/K>I,ELi{z292%4ImIK=EYG[tlX5l6XjVYU>WyAfb;%a@ References: 1. Secondary infusions are safest administered with the use of secondary tubing attached with a Luer lock connector to the primary line containing a compatible IV solution. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; Answer:Some practitioners have expressed concern that administering diluted IV vinCRIStine via a minibag might increase the risk of extravasation and subsequent tissue injury. 2. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment . Clipboard, Search History, and several other advanced features are temporarily unavailable. For example, many cytotoxic agents (ie, chemotherapy) are considered vesicants and should not be administered via midline catheters according to INS standards.10,11Additionally, in 2017, the INS assigned a Vesicant Task Force to publish a list of noncytotoxic vesicant medications and solutions.11The Table below, while not exhaustive, details drugs from this list, as well as drugs that have extremes of pH or osmolarity that have been associated with vascular injury or extravasation.8,9, One drug that has generated controversy regarding its appropriateness for administration via midline catheter is vancomycin. 2012;18(suppl):16-7. Vesicant Chemotherapy Extravasation Antidotes and Treatments FOIA (An infusion pump is not recommended by the Oncology Nurses Society (ONS) to administer vinCRIStine in this situation1 .) Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. 125 Enterprise Drive This site needs JavaScript to work properly. 2008 Sep;12(4):357-61. 1 3. The main consideration in determining whether a drug is appropriate for administration via midline catheter is its propensity for causing phlebitis.2Phlebitis is inflammation of a vein caused by damage to the tunica intima, which may be accompanied by erythema, swelling, pain, heat, and a palpable cord if thrombosis is present. Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? 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. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Version number changed to v.5. University of Illinois at Chicago College of Pharmacy. Calcium Gluconate. sharing sensitive information, make sure youre on a federal Extravasation of antineoplastic agents: prevention and treatments. Oncologist. This decision must be weighed in light of certain death if the drug is administered via the wrong route. Before 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. Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, sel Careers. Before Polovich M, Olsen M, LeFebvre KB, eds. J Intraven Nurs. Managing Vesicant Extravasations | The Oncologist | Oxford Academic To discuss the information in this article with other oncology nurses, visit the ONS Communities. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. However, the INS Task Force identified limited literature describing extravasation of vancomycin.