Would you like email updates of new search results? 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. If not clearly defined in the literature. Nurgat Z, Smythe MP, Aljedai A. If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. 4. Cold (different suggestions depending on reference): Heat (different suggestions depending on reference): Cold - for 6 to 12 hours after administration of sodium thiosulfate. National Library of Medicine Taxanes: vesicants, irritants, or just irritating? (PDF) Chemotherapy administration standards and guidelines: The An official website of the United States government. 3/26/2014, 5. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into affected area in a pinwheel fashion. Gilbar PJ. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. References and bibliography updated. Development of an evidence-based list of noncytotoxic vesicant medications and solutions. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. 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 Listed below are a few non-chemo agents: Vancomycin. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. J Oncol Pharm Pract. Access to this article is restricted. Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta-analysis [published online ahead of print, 2020 Dec 29]. 2. 3/10/2014, 7. The site is secure. This information is intended as an educational piece and should not be used as the sole source for clinical decision making. Plymouth Meeting, PA 19462. 2012;18(suppl):16-7. Once the infusion is complete, the short set is dropped to backfill the line with saline and then the remaining drug is infused. Bethesda, MD 20894, Web Policies National Library of Medicine However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. Bookshelf 2006;12(2):113-8. Facebook - National Cancer Institute Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. Extravasation of antineoplastic agents: prevention and treatments. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? 866-257-4ONS (866-257-4667). Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Preventing and managing vesicant chemotherapy extravasations The procedure includes connecting the bag of saline to a long straight infusion set. 3/10/2014, 6. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. References: 1. Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. 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. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. 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. Extravasation of noncytotoxic drugs. 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]. 2008 Sep;12(4):357-61. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. The ASCO/ONS Chemotherapy Administration Safety Standards are intended to reduce the risk of error when providing adult patients with chemotherapy, and to provide a framework for best practices in cancer care. 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. 1998 Jul-Aug;21(4):232-9. This decision must be weighed in light of certain death if the drug is administered via the wrong route. PDF Antineoplastic Drug Administration: Vesicant and Irritant Agents However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. 2088 0 obj <> endobj A description of the ASCO/ONS Chemotherapy Administration Safety Standards process for development, consensus, and refinement, as well as a discussion of the standards and results, is available on theASCO website. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. Epub 2014 Jul 3. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 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. Federal government websites often end in .gov or .mil. <> 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. 2141 0 obj <>stream Handbook of Injectable Drugs 17th Edition. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. Pittsburg, PA: Oncology Nursing Society; 2014. 5-Safe administration of anti-cancer drugs | eviQ 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. What do you recommend? doi: 10.1097/GOX.0000000000001743. 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. 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. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. TheAmerican Society of Clinical Oncology (ASCO)and ONS are conducting an ongoing collaborative project to use a rigorous, consensus-based process to develop standards for the safe administration of chemotherapy. 3/10/2014, Institute for Safe MedicationPractices 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. Conclusion 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. But chemo agents are not the only vesicants that cause extravasation injuries. Caparas JV, Hu JP. Hyaluronidase may be used in extreme scenarios such as large volume extravasation or severe irritation. 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 3. PDF Vesicant Chemotherapy Extravasation Antidotes and Treatments - ResearchGate Heat - Apply warm compresses to extravasation site for 1 hour. Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. What are other facilities doing to avoid excessive drug loss in the tubing? Oncol Nurs Forum. Intravascular catheter-related infection (BSI). Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. 2012;18(1):155-7. Administering Vesicants | ONS Oncologist. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, selecting an appropriate administration site for peripheral vesicant administration, and checking for a blood return prior to and during vesicant administration. Disclaimer. 2013;1(1):9- 16. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. In addition, whenever an extravasation occurs or is suspected, vesicant administration must immediately cease, and the appropriate antidote or treatment needs to be promptly administered. 09/04/2019. Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants. Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. 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. Vesicant: An agent that has the potential to cause pain, inflammation, blistering and irreversible tissue damage, including necrosis and loss of limb function and mobility. An official website of the United States government. 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. Prepared by: Chemotherapy Extravasation Management - AAHA Best Practice #1 FAQ | Institute For Safe Medication Practices Unauthorized use of these marks is strictly prohibited. Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. 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. The https:// ensures that you are connecting to the References: 1. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. Section V: Immediate Complications of cytotoxic therapy, p.105. Vesicant chemotherapy extravasation antidotes and treatments. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. Manage conservatively as first line option with supportive non-pharmacologic strategies. Remove cold pack at least 15 minutes before dexrazoxane therapy. Clipboard, Search History, and several other advanced features are temporarily unavailable. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; 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. Calcium Gluconate. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. Flare reaction: A skin reaction to a medication which is an allergic response. Clinical exam may reveal warmth, erythema, or tenderness. Centers for Disease Control and Prevention. All rights reserved. Generally, drugs that are vesicants or have extremes of pH or osmolarity should not be administered via midline catheters. 2006;12(2):113-8. Updated January 2021. American College of Radiology. endstream endobj startxref hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. In order from most likely to least likely to cause damage when extravasation occurs: vesicants (most likely), exfoliants, irritants, inflammitants, and neutrals (least likely). Prevention is the most important approach to extravasation management. If chemical phlebitis occurs, consideration should be given to the need for alternative vascular access, an alternative medication, a slower infusion rate, or further dilution of the medication.6. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. The 2008 European Oncology Nursing Society extravasation guidelines recommend this management for the following medications: From HemOnc.org - A Hematology Oncology Wiki, Chemotherapy vesicant & irritant properties and suggested management for extravasation, "Localize and neutralize" or "disperse and dilute". Vesicant extravasation: myths and realities. The .gov means its official. 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. Please enable it to take advantage of the complete set of features! The action you just performed triggered the security solution. 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. Eur J Oncol Nurs. sharing sensitive information, make sure youre on a federal This site needs JavaScript to work properly. The Independent Clinical Oncology Network's Chemotherapy Administration. Do not pinch the IV administration tubing because this can cause the vein to rupture. No formal recommendation, but depending on clinical condition could consider extrapolating from management of other vinca alkaloids: Apply cold pack initially for 30 to 60 minutes, then repeat every 15 minutes on day 1 only. For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 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. Extravasation of antineoplastic agents: prevention and treatments. 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. Safe Administration of Chemotherapy: Safety During Chemotherapy Ordering, Transcribing, Dispensing, and Patient Identification Safe Administration of Systemic Cancer Therapy: Administration of Chemotherapy and Management of Preventable Adverse Event UIC's seven health sciences colleges and health care delivery enterprise. Pediatr Rep. 2012 Aug 1;4(3):e28. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. endobj J Intraven Nurs. government site. Vesicants: not just chemo agents! | Infusion Nurse Blog eCollection 2012 Jul 31. Tubing features can present another challenge when considering how to best administer chemotherapy agents. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . 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. Introduction. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. Before Bethesda, MD: American Society of Healthsystem Pharmacists; 2012:1104-5. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. %%EOF Management of extravasation injuries: a focused evaluation of noncytotoxic medications. 2023 Institute for Safe Medication Practices. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, sel Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. Extravasation is a known risk of vesicant administration. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Reference: 1. 2014 Aug;24(4):352-8. 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. In, For more information on nurses, chemotherapy, and pregnancy, watch. 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. 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. Answer:Yes, the product is stable in a minibag. and transmitted securely. Boulanger J, Ducharme A, Dufour A, et al. 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. University of Illinois at Chicago College of Pharmacy. To discuss the information in this article with other oncology nurses, visit the ONS Communities. 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. References: 1. This page was last edited 14:24, 26 April 2023 by. 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. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. Patients often seek explanations for why their extravasations occurred. 2. PMC Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. FOIA Version number changed to v.5. The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. Polovich M, Olsen M, LeFebvre KB, eds. In 2021 the Infusion Nurses Society (INS) updated their 2016 guidelines and recommended consideration of midline catheters when the anticipated duration of therapy was 5 to 14 days with a preference for peripheral catheters for shorter durations of therapy and CVCs when longer durations of therapy are required.6 A recent study supports use of midline catheters for prolonged courses of therapy up to 14 days, but there remains limited data for use of midline catheters beyond 2 weeks.7 Currently, the CDC recommends consideration of midline catheters when the duration of IV therapy is likely to exceed 6 days.1,8, Considerations for drugs administered via midline catheter www.hospira.com/Images/434047_32-91799_1.pdf UN vR7. Determinations regarding the administration of drugs via midline catheter should consider properties of each drug individually because no definitive guidance is available to list the appropriateness of all drugs. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). The information presented is current as of August 2, 2021. 3 0 obj Polovich M, Olsen M, LeFebvre KB, eds. World J Clin Oncol. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. Special Considerations When Administering IV Chemotherapy - ONS Voice
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