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. PDF Appendix B: Vesicant/Irritant and Extravasation Management Guidelines Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. Accessibility The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? Bethesda, MD 20894, Web Policies 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. Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. FOIA 3/26/2014 5. Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. European Oncology Nursing Society extravasation guidelines. 2. Infuse in an extremity or area other than the one affected by extravasation. Conclusion 0 Another option is to aspirate with a syringe via the lowest Y-site and clamp off fluid from the minibag. The site is secure. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. Not a current ONS member or journal subscriber? Polovich M, Olsen M, LeFebvre KB, eds. You can email the site owner to let them know you were blocked. %PDF-1.7 MeSH 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". Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. UN vR7. 866-257-4ONS (866-257-4667). Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. 2008 Sep;12(4):357-61. Accessibility Lu H, Yang Q, Yang L, et al. 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. Please enable it to take advantage of the complete set of features! Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. endobj Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Because this termination site is distal to those of CVCs and peripherally inserted central catheters (PICCs), midline catheters are not considered to dwell in the central circulation.1Whereas the central termination site of CVCs and PICCs provide the ability to administer a wider range of infusates (eg, vesicants), this is not recommended with VADs terminating distal to the central circulation. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> It is also important to note that some medications are classified differently by different references. Bethesda, MD 20894, Web Policies 2 0 obj Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. ACR Committee on Drugs and Contrast Media. 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. 3/10/2014, 7. Plymouth Meeting, PA 19462. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org. Front Oncol. 2. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) Taxanes: vesicants, irritants, or just irritating? Careers. Federal government websites often end in .gov or .mil. Oncologist. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. 2023 Institute for Safe Medication Practices. To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. 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. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. American College of Radiology. Management of the extravasation of anti-neoplastic agents. Antidotes to vesicant chemotherapy extravasations. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). A central line is always required for vesicant or any chemotherapy in the home. These . Sodium Chloride. 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. References: 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. Pittsburg, PA: Oncology Nursing Society; 2014. 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. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. The information presented is current as of August 2, 2021. Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital 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 Vesicant Chemotherapy Extravasation Antidotes and Treatments In some regimens, enough data support sequencing of agents, but in others, data are lacking. Available antidote and treatment formulations and their preparation and administration also are discussed. Assessment of the risk of extravasation with the introduction of vincristine mini-bags to eliminate inadvertent intrathecal administration. 866-257-4ONS (866-257-4667). 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. Development of an evidence-based list of noncytotoxic vesicant medications and solutions. The procedure includes connecting the bag of saline to a long straight infusion set. eCollection 2018 Apr. (K k0|hzv 6gN5UzVa+91C+yTOOcV^t^IjpiOROeutcI9GOqs'."XA*c2@GfK!rKP;{4?|h=,G _wyNdfSc#A]LHq#@Gtn[YWk%1o*Bbyk'82h6~IOvvi2`6 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. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. 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. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Manage conservatively as first line option with supportive non-pharmacologic strategies. Reference: 1. European Oncology Nursing Society extravasation guidelines. 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. government site. 3. The Independent Clinical Oncology Network's Chemotherapy Administration. All rights reserved. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? The https:// ensures that you are connecting to the 2014 Aug;24(4):352-8. Managing Vesicant Extravasations | The Oncologist | Oxford Academic Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings. 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. Developing extravasation protocols and monitoring outcomes. Accessed August 2, 2021. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. <> Before 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. 3/26/2014, 4. Vesicant chemotherapy extravasation antidotes and treatments This site needs JavaScript to work properly. Prepared by: {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 8600 Rockville Pike Introduction 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. Abstract. Trissel LA. Vesicant chemotherapy extravasation antidotes and treatments. Listed below are a few non-chemo agents: Vancomycin. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. (PDF) Chemotherapy administration standards and guidelines: The By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Boulanger J, Ducharme A, Dufour A, et al. 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. There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. Minor updates to administration and patient education. government site. Gilbar PJ, Carrington CV. eCollection 2022. Copyright 2023 Oncology Nursing Society. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Rev. Reference 2. Eur J Oncol Nurs. Pediatr Rep. 2012 Aug 1;4(3):e28. This page was last edited 14:24, 26 April 2023 by. If using a peripheral vein, allow the infusion to flow via gravity. The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. Section V: Immediate Complications of cytotoxic therapy, p.105. Prevention is the most important approach to extravasation management. The https:// ensures that you are connecting to the 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. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. Best Practice #1 FAQ | Institute For Safe Medication Practices Before Pittsburg, PA: Oncology Nursing Society; 2014. 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. Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants. Vesicants and irritants with vesicant . MeSH Do not pinch the IV administration tubing because this can cause the vein to rupture. 2012;18(suppl):16-7. In, For more information on nurses, chemotherapy, and pregnancy, watch. 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. Vesicants: not just chemo agents! | Infusion Nurse Blog References: 1. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant .

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