Find the answers to questions regarding symptoms, side effects, and more. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; 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. Vesicant Chemotherapy Extravasation Antidotes and Treatments Eur J Oncol Nurs. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment . A subsequent 2013 revision 3. Click to reveal Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Available antidote and treatment formulations and their preparation and administration also are discussed. 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. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. 2018 Apr 19;6(4):e1743. endobj Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. The 2021 INS guidelines recommend against the use of midline catheters for continuous administration of vesicant therapy, parenteral nutrition, or other infusates with extremes of pH or osmolarity.6 Although the extremes are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas with osmolarity exceeding 900 mOsm/L. Gilbar P. Inadvertent intrathecal administration of vincristine: has anything changed? Introduction. ASCO/ONS Chemotherapy Administration Safety Standards %PDF-1.7 2. Sodium Chloride. The safety of midline catheters for intravenous therapy at a large academic medical center. Pittsburgh, PA 15275 Cloudflare Ray ID: 7c0b26d1e9b36bd5 References: 1. 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." The https:// ensures that you are connecting to the Nurgat Z, Smythe MP, Aljedai A. 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. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. One randomized controlled trial found that the incidence of total complications, phlebitis, and thrombosis did not significantly differ when vancomycin was administered for less than 6 days via midline catheter versus PICC.3,14. Vesicants: not just chemo agents! | Infusion Nurse Blog Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. Reference: 1. 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. Federal government websites often end in .gov or .mil. J Oncol Pharm Pract. Federal government websites often end in .gov or .mil. The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. Clinical exam may reveal warmth, erythema, or tenderness. All rights reserved. sharing sensitive information, make sure youre on a federal MeSH To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org. PMC Calcium Gluconate. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. The vinCRIStine is infused via gravity through the peripheral line. Pittsburg, PA: Oncology Nursing Society; 2014. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . Pittsburg, PA: Oncology Nursing Society; 2014. J Oncol Pharm Pract. Before 0 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. 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. doi: 10.4081/pr.2012.e28. Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. Clinical Associate Professor, Drug Information Specialist, Updated by: Antidotes to vesicant chemotherapy extravasations. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. 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. Please enable it to take advantage of the complete set of features! 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. 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. Careers. 6. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. Centers for Disease Control and Prevention. In some regimens, enough data support sequencing of agents, but in others, data are lacking. 3/10/2014, Institute for Safe MedicationPractices 4. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. Accessibility The site is secure. PMC Polovich M, Olsen M, LeFebvre KB, eds. Development of an evidence-based list of noncytotoxic vesicant medications and solutions. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. 3. Epub 2014 Jul 3. Reference endstream endobj 2089 0 obj <. 3/10/2014, 6. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) This website is using a security service to protect itself from online attacks. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Do not pinch the IV administration tubing because this can cause the vein to rupture. 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. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. Question: Is the dilution of vinCRIStine in a minibag stable? (PDF) Chemotherapy administration standards and guidelines: The Plymouth Meeting, PA 19462. The following information is a compilation from the various resources listed below.[1][2][3][4][5][6][7][8]. 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. Calcium Chloride. eCollection 2012 Jul 31. You can email the site owner to let them know you were blocked. www.hospira.com/Images/434047_32-91799_1.pdf The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. Furthermore, in vitro evidence suggested that vancomycin-associated endothelial damage is caused by factors other than pH. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. Ryan Rodriguez, PharmD, BCPS Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. Copyright 2023 Oncology Nursing Society. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. FOIA Rev. In, For more information on nurses, chemotherapy, and pregnancy, watch. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Remove cold pack at least 15 minutes before dexrazoxane therapy. Management of Chemotherapy Extravasations - U.S. Pharmacist %%EOF 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. <> Section V: Immediate Complications of cytotoxic therapy, p.105. Ensure the best possible outcomes with ONS standards. Unable to load your collection due to an error, Unable to load your delegates due to an error. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. 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 Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. 1 2012;18(1):155-7. 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 eCollection 2012 Jul 31. The 2021 INS guidelines recommend against the use of midline catheters for continuous administration of vesicant therapy, parenteral nutrition, or other infusates with "extremes" of pH or osmolarity. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Polovich M, Olsen M, LeFebvre KB, eds. Rev. 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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. 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. Prevention is the most important approach to extravasation management. Reviewed electronically by nursing reference committee. Also, dilution of the vinca alkaloid likely reduces the impact of any extravasation that might occur. 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. National Library of Medicine (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 Patients often seek explanations for why their extravasations occurred. 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. 2023 Institute for Safe Medication Practices. 2016 Updated American Society of Clinical Oncology/Oncology Including 2 0 obj Caution: excessive heat can cause tissue damage. e.YvIQ|!C2\@&;:8 h qF . uDX i! 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. Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 PDF Appendix B: Vesicant/Irritant and Extravasation Management Guidelines
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