vesicant chemotherapy administration guidelines
Dodane 10 maja 2023Disclaimer. Plast Reconstr Surg Glob Open. Bookshelf The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2022 Dec 2;12:1021488. doi: 10.3389/fonc.2022.1021488. 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. Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Overview, prevention and management of chemotherapy extravasation. 2141 0 obj <>stream endobj 8}-Fb}" "R5xPQ%Flm^%/jV PMC 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. If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. J Pediatr Oncol. 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. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. 125 Enterprise Drive This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Two important safety features are important here. endstream endobj 2089 0 obj <. Nafcillin. endobj 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. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . Please enable it to take advantage of the complete set of features! Once the infusion is complete, the short set is dropped to backfill the line with saline and then the remaining drug is infused. 3/26/2014, 5. The flush line can be used before, during, and after the infusion to verify line patency and blood return for a flush solution if the chemotherapy must be stopped because of an adverse reaction. Some medications are more likely to have vesicant properties in high concentrations or large volumes. Careers. A subsequent 2013 revision Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. 2021 Update: What are considerations for determining whether a drug may be administered via a midline catheter? 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. PMC The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. Accessibility {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Clinical Associate Professor, Drug Information Specialist, Updated by: Click to reveal For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. Tubing features can present another challenge when considering how to best administer chemotherapy agents. Clinical exam may reveal warmth, erythema, or tenderness. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Find the answers to questions regarding symptoms, side effects, and more. 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. Introduction. The https:// ensures that you are connecting to the Would you like email updates of new search results? and transmitted securely. 5200 Butler Pike %PDF-1.7 Development of an evidence-based list of noncytotoxic vesicant medications and solutions. Oncologist. 2014 Aug;24(4):352-8. General recommendations for midline administration: A. eCollection 2012 Jul 31. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Dosing Guidelines for Drugs Used to Manage Extravasations: Dexrazoxane: 1000mg/m2 (maximum dose= 2000mg/day) by intravenous infusion on days 1 and 2, followed by 500mg/m2 (maximum dose = 1000mg/day) by intravenous infusion on day 3. Apply ice to the area for 15 to 20 minutes each hour for 4 hours. 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. Furthermore, in vitro evidence suggested that vancomycin-associated endothelial damage is caused by factors other than pH. American College of Radiology. Intermountain Medical Center . Pittsburgh, PA 15275 %PDF-1.6 % 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. The .gov means its official. 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. FOIA Blood Rev. eCollection 2022. UN vR7. Reviewed electronically by nursing reference committee. 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. endstream endobj startxref hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. 2013;1(1):9- 16. Also, dilution of the vinca alkaloid likely reduces the impact of any extravasation that might occur. Eur J Oncol Nurs. The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . National Library of Medicine J Oncol Pharm Pract. 2. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. 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. Chemical phlebitis may be caused by drugs that irritate the vasculature, usually because of extremes of pH or osmolarity.3Infusates with an osmolarity over 600 mOsm/L are associated with symptoms when extravasation occurs, and those over 800 mOsm/L are usually recommended to be given via a CVAD.9 Infusates with a pH between below 5.5 or above 8.5 can cause tissue damage, with alkaline agents generally producing worse toxicity than acidic agents. Question: Our pediatric department is reluctant to administer vinCRIStine via a minibag through a peripheral IV line since many of our patients do not have a peripherally inserted central catheter (PICC) or central venous access device. The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. The following information is a compilation from the various resources listed below.[1][2][3][4][5][6][7][8]. Caparas JV, Hu JP. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. 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. According to Trissels Handbook on Injectable Drugs 17th Edition, vinCRIStine is stable at a concentration of 20 mg/L in dextrose 5% in water, Lactated Ringers, and 0.9% sodium chloride for at least 24 hours and up to 21 days with little or no drug loss (under 10%) at 4C and 25C when in the dark. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. The vinCRIStine is infused via gravity through the peripheral line. Not a current ONS member or journal subscriber? Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. 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. Ex: Name & date of birth 2. Listed below are a few non-chemo agents: Vancomycin. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. J Oncol Pharm Pract. Minor updates to administration and patient education. Please. Before Accessed August 2, 2021. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. 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]. 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. 3. 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. Gorski LA, Stranz M, Cook LS, et al. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. Remove cold pack at least 15 minutes before dexrazoxane therapy. Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. 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. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. J Oncol Pharm Pract. The Independent Clinical Oncology Network's Chemotherapy Administration. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. Griffiths V. Midline catheters: indications, complications and maintenance. European Oncology Nursing Society extravasation guidelines. Potassium Chloride. Extravasation is a known risk of vesicant administration. 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. Epub 2014 Jul 3. What do you recommend? Unauthorized use of these marks is strictly prohibited. Trissel LA. Prevention is the most important approach to extravasation management. Accidental administration of vincristine in pediatric patients. Seo H, Altshuler D, Dubrovskaya Y, et al. 3/10/2014, Institute for Safe MedicationPractices Handbook of Injectable Drugs 17th Edition. 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. 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. 139.59.111.99 Careers. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). J Intraven Nurs. 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. Section V: Immediate Complications of cytotoxic therapy, p.105. Pittsburg, PA: Oncology Nursing Society; 2014. official website and that any information you provide is encrypted This section focuses on drug administration, including cycle definition (which contains the cycle length, number of cycles, and other schedule-related information), dosing, frequency, and routes of administration. Flare reaction: A skin reaction to a medication which is an allergic response. References: 1. doi: 10.4081/pr.2012.e28. 2023 Institute for Safe Medication Practices. Centers for Disease Control and Prevention. Vesicants and irritants with vesicant . 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. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. 2088 0 obj <> endobj An official website of the United States government. HHS Vulnerability Disclosure, Help Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. A central line is always required for vesicant or any chemotherapy in the home. Nurses, Chemotherapy, and Pregnancy: What Do We Know? e.YvIQ|!C2\@&;:8 h qF . uDX i! 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 Federal government websites often end in .gov or .mil. Treatment of cutaneous injuries of neonates induced by drug extravasation with hyaluronidase and hirudoid. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. Lu H, Yang Q, Yang L, et al. Answer:Yes, the product is stable in a minibag. Before 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. 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.
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