Eur J Oncol Nurs. Careers. Performance & security by Cloudflare. References: 1. 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. Avoid the "blame game.". 6. 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . Vesicants and irritants with vesicant . PDF Vesicant Chemotherapy Extravasation Antidotes and Treatments - ResearchGate Remove cold pack at least 15 minutes before dexrazoxane therapy. Access to this article is restricted. Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. The https:// ensures that you are connecting to the Pediatr Rep. 2012 Aug 1;4(3):e28. To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. References: 1. 3 0 obj Rev. Vesicant chemotherapy extravasation antidotes and treatments Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. $on8+i5BqlA/K>I,ELi{z292%4ImIK=EYG[tlX5l6XjVYU>WyAfb;%a@ Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings. Caution: excessive cold can cause tissue damage. 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. *Follow guidelines and treat like a vesicant. 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. eCollection 2018 Apr. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? The Oncology Nursing Society4 recommends administering IV vinCRIStine and other vinca alkaloids via a minibag to prevent errors with intrathecal chemotherapy administration. 3. Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital 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. 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. Heat - Apply warm compresses to extravasation site for 1 hour. Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. Bethesda, MD 20894, Web Policies 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. Chemotherapy Extravasation Management - AAHA Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood 1995 Jan-Feb;22(1):57-67. Copyright 2023 Oncology Nursing Society. 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. 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. Pittsburgh, PA 15275 doi: 10.4081/pr.2012.e28. 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. Rev. 2088 0 obj <> endobj Oncol Nurs Forum. Some medications are more likely to have vesicant properties in high concentrations or large volumes. 8}-Fb}" "R5xPQ%Flm^%/jV In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. Intravascular catheter-related infection (BSI). Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 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. Clin J Oncol Nurs. Would you like email updates of new search results? 4 0 obj 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. The site is secure. Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. This site needs JavaScript to work properly. eCollection 2012 Jul 31. Rev. 2021 Update: What are considerations for determining whether a drug may 4. Polovich M, Olsen M, LeFebvre KB, eds. Introduction PDF Appendix B: Vesicant/Irritant and Extravasation Management Guidelines (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) 5-Safe administration of anti-cancer drugs | eviQ and transmitted securely. Before Generally, drugs that are vesicants or have extremes of pH or osmolarity should not be administered via midline catheters. 2. 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 The .gov means its official. The information presented is current as of August 2, 2021. Careers. Antidotes to vesicant chemotherapy extravasations. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Infuse in an extremity or area other than the one affected by extravasation. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. Developing extravasation protocols and monitoring outcomes. Unauthorized use of these marks is strictly prohibited. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. ACR manual on contrast media. 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. Drug Safety and Administration - Cancer Care Ontario Available antidote and treatment formulations and their preparation and administration also are discussed. 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. University of Illinois at Chicago College of Pharmacy. 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 procedure includes connecting the bag of saline to a long straight infusion set. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. Courtney Krueger, PharmD, BCPS 139.59.111.99 Please. Nurses, Chemotherapy, and Pregnancy: What Do We Know? 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. There are non-chemo medications and solutions that have vesicant properties as well and can cause extravasation. Polovich M, Olsen M, LeFebvre KB, eds. Pittsburg, PA: Oncology Nursing Society; 2014. Manage conservatively as first line option with supportive non-pharmacologic strategies. There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. Polovich M, Olsen M, LeFebvre KB, eds. Gorski LA, Stranz M, Cook LS, et al. PDF Disconnecting Chemotherapy in the Patient's Home - University of Michigan 0 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. Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . J Oncol Pharm Pract. Pittsburg, PA: Oncology Nursing Society; 2014. American Society of Clinical Oncology (ASCO), Personal Protective Equipment for Use with Hazardous Drugs. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate.

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