vesicant chemotherapy administration guidelines

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. Tubing features can present another challenge when considering how to best administer chemotherapy agents. All rights reserved. **Some case reports of extravasation and injection site reactions or inflammation have been reported. Ryan Rodriguez, PharmD, BCPS 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. *Follow guidelines and treat like a vesicant. Answer:Some practitioners have expressed concern that administering diluted IV vinCRIStine via a minibag might increase the risk of extravasation and subsequent tissue injury. Extravasation of noncytotoxic drugs. 3. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment . However, the INS Task Force identified limited literature describing extravasation of vancomycin. endobj Furthermore, in vitro evidence suggested that vancomycin-associated endothelial damage is caused by factors other than pH. (An infusion pump is not recommended by the Oncology Nurses Society (ONS) to administer vinCRIStine in this situation1 .) 8}-Fb}" "R5xPQ%Flm^%/jV J Oncol Pharm Pract. Pittsburgh, PA 15275 In, For more information on nurses, chemotherapy, and pregnancy, watch. 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. Click to reveal 125 Enterprise Drive Polovich M, Olsen M, LeFebvre KB, eds. Gilbar PJ, Carrington CV. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. Rev.12/2/2014. 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. (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 Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. References: 1. Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. These . If not clearly defined in the literature. Caution: excessive cold can cause tissue damage. Oncol Nurs Forum. 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. HHS Vulnerability Disclosure, Help Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. 3/10/2014, 6. Conclusion Vesicant extravasation: myths and realities. 8600 Rockville Pike J Intraven Nurs. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Assessment of the risk of extravasation with the introduction of vincristine mini-bags to eliminate inadvertent intrathecal administration. 2. 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. This site needs JavaScript to work properly. Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. 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 Flare reaction: A skin reaction to a medication which is an allergic response. Nurgat Z, Smythe MP, Aljedai A. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Bethesda, MD 20894, Web Policies References: 1. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. Eur J Oncol Nurs. Properties of midline catheters Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. 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. European Oncology Nursing Society extravasation guidelines. It is also important to note that some medications are classified differently by different references. In some regimens, enough data support sequencing of agents, but in others, data are lacking. References: 1. 2. References: 1. 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. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Available antidote and treatment formulations and their preparation and administration also are discussed. Answer:Yes, the product is stable in a minibag. 2023 Institute for Safe Medication Practices. 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. Handbook of Injectable Drugs 17th Edition. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. This site needs JavaScript to work properly. 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. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. 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. Package insert for vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Unable to load your collection due to an error, Unable to load your delegates due to an error. All rights reserved. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. References and bibliography updated. When assessing a chemotherapy extravasation, it is important to understand the classification of the chemotherapeutic agent in terms of its potential to cause cellular damage if extravasated. Accidental administration of vincristine in pediatric patients. <> There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. 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. Disclaimer. Careers. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). Intermountain Medical Center . The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. and transmitted securely. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . 1 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. Pittsburg, PA: Oncology Nursing Society; 2014. The Independent Clinical Oncology Network's Chemotherapy Administration. e.YvIQ|!C2\@&;:8 h qF . uDX i! <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>> J Intraven Nurs. Minor updates to administration and patient education. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? 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. www.hospira.com/Images/434047_32-91799_1.pdf Rev. General recommendations for midline administration: A. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. 2014 Aug;24(4):352-8. %PDF-1.7 By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. 2016 Feb 10; 7(1): 8797. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. 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 Development of an evidence-based list of noncytotoxic vesicant medications and solutions. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. 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 action you just performed triggered the security solution. 2021 Update: What are considerations for determining whether a drug may be administered via a midline catheter? x][8~Gi"K6$Yd cG_")X=@zdbXb"f]FyMQrt2i[Fl')o:{pO^}~[~9>aP,p"yKxb}t+~{x:?OA9?tvK:0+M*7y wg|[]okN(6cw1gQX$|6x5Q^Xn{~(8klFaL8?k|9}YjO"?}M8OC?}T-Qezi^D1@olKSw8E[D7:z,eQ,rY!'HT|9,}O$. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. 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. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. No current standard or scoring system exists for the . endobj 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 made by professional oncology organizations are useful resources in this process. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. Listed below are a few non-chemo agents: Vancomycin. 2013;1(1):9- 16. eCollection 2022. Gilbar PJ. Irritants and Vesicants Guide to Intravenous Administration via Midline Catheters . 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. 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. Rev. Would you like email updates of new search results? Reference: 1. Before stream But chemo agents are not the only vesicants that cause extravasation injuries. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. 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. 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. 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. Question: Is the dilution of vinCRIStine in a minibag stable? Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. 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. Eur J Oncol Nurs. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. 2014;(Epub ahead of print). 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. 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]. official website and that any information you provide is encrypted ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. These medications are generally considered to be unlikely to cause injury when extravasation occurs: These medications are generally described as causing mild to moderate inflammation when extravasation occurs. 2. What are other facilities doing to avoid excessive drug loss in the tubing? Infuse in an extremity or area other than the one affected by extravasation. The safety of midline catheters for intravenous therapy at a large academic medical center. Extravasation of antineoplastic agents: prevention and treatments. UN vR7. 2018 Apr 19;6(4):e1743. Federal government websites often end in .gov or .mil. Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. Extravasation of antineoplastic agents: prevention and treatments. government site. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 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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. European Oncology Nursing Society extravasation guidelines. Two important safety features are important here. Vesicants and irritants with vesicant . For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. Monitor for extravasation according to hospital policy. doi: 10.4081/pr.2012.e28. 4 0 obj 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. 3. Oncologist. <> Boulanger J, Ducharme A, Dufour A, et al. Manage conservatively as first line option with supportive non-pharmacologic strategies. There are non-chemo medications and solutions that have vesicant properties as well and can cause extravasation. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. Before endobj Generally, drugs that are vesicants or have extremes of pH or osmolarity should not be administered via midline catheters. Polovich M, Olsen M, LeFebvre KB, eds. The information presented is current as of August 2, 2021. government site. 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. All rights reserved. 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET 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. Venous irritation (chemical phlebitis) that occurs with drug administration into a vein that remains intact (eg, vinorelbine and epirubicin), and other cutaneous complications of chemotherapy are discussed elsewhere. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. Copyright 2023 Oncology Nursing Society. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. To report a content error, inaccuracy, or typo, email [email protected]. For primary infusions, the agents should be administered by direct connection to the access site using primary tubing, a Luer lock connection should be used, and a compatible IV flush solution should be readily available for emergent administration issues and to clear the line after completion. 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 made by professional oncology organizations are useful resources in this process. Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. 2006;12(2):113-8. 3. 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. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. FOIA Intravascular catheter-related infection (BSI). Remove cold pack at least 15 minutes before dexrazoxane therapy. 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. Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. 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. University of Illinois at Chicago College of Pharmacy. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. Answer:In regard to duration of administration: It is true that the process of administering a vinca alkaloid via a syringe is probably of shorter duration when compared to administering via a minibag. 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." <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Gilbar P. Inadvertent intrathecal administration of vincristine: has anything changed? Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. 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 . 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 Bethesda, MD 20894, Web Policies The https:// ensures that you are connecting to the Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) 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. Eur J Oncol Nurs. 15 to 20 minutes at a time for at least four times per day for 24-48 hours, warm compresses for 30 to 60 minutes, then alternate off/on every 15 minutes for 1 day, 15 to 20 minutes at a time for at least four times per day for 24 hours. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. 3 0 obj Gilbar PJ, Carrington CV. Answer:For those patients who do not have a PICC or central venous access device, a peripheral IV line can still be used to administer vinCRIStine in a minibag. 2012;18(suppl):16-7. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari.

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