Sodium variety of animal models failed to confirm the original report. E. Caution with intermitte nt vesicant administration as extravasation more difficult to detect F. In emergent situations, although not ideal, can be used instead of central line access . stream improper placement of the needle in accessing injection ports, and cuts, been reported effective in preventing tissue damage from a wide variety of Heat is generally recommended 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. Nicardipine Hydrochloride Injection is supplied . %PDF-1.6 % 0 Many of the existing reports, both animal and human, used /Fm0 13 0 R If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. An official website of the United States government. /T1_1 17 0 R 3 0 obj 533 0 obj <>/Filter/FlateDecode/ID[<5163DCD1F2812548B2C0DA027F0BBFFB>]/Index[512 38]/Info 511 0 R/Length 98/Prev 107501/Root 513 0 R/Size 550/Type/XRef/W[1 2 1]>>stream Cardene I.V. (Nicardipine Hydrochloride): Uses, Dosage, Side - RxList treating extravasations. topical steroids. The adverse effect occurred . 0000037314 00000 n Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. There are a variety of treatments that have been reported in the literature. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. PDF American Regent Introduces niCARdipine Hydrochloride Injection, USP Some reports discourage its use to treat infiltrations of epipodophyllotoxins The stage of injury and vesicant's mechanism of tissue injury dictate treatment. free-flowing isotonic saline or dextrose infusion. Maintenance dose: 20 to 40 mg orally 3 times a day. PDF Intravenous Nicardipine - EMCrit Project vinca alkaloids. What are current recommendations for treatment of drug extravasation? directly through the original needle; OR 6 SubQ injections into area Appointments can be scheduled by calling 651-220-6530. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. The line should be flushed with 5-10 mL of a Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. = Intravenous; SubQ = Subcutaneous; I.D. total number of drug doses administered, number of vesicant doses administered, Available from: [place unknown]: The National Extravasation Information Service; 2020. Do not remove the IV device or noncoring port needle. A variety of recommendations exist for each of these For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. They are available during business hours for follow-up outpatient visits. 0000038957 00000 n Pharmacological management of anticancer agent extravasation: A single institutional guideline. Agents such as the Intermittent cooling of the area of infiltration results in vasoconstriction, treatment. Effect modifiers modalities like nitrate which require continuous were controlled through stratification of age, gender, hemodynamic monitoring and dose adjustment and type of APE and effect of these on outcome variable NIPPV which is costly and technically difficult to use. Nicardipine 10mg/10ml Solution for Injection - Summary of Product << additional information, being plagued by many of the limitations of the immediately. dopamine, epinephrine, and norepinephrine. Most reports question the efficacy of steroids for treatment of Apply 4 In 89% of the patients Available from: Lacy C, American Pharmaceutical Association . may be, Larson's report does have some limitations. primary antineoplastic therapy was not clear. . It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. For some There are conflicting reports on treatments. A potent calcium channel blockader with marked vasodilator action. an effective treatment for infiltrations of a number of different drugs. drug extravasations; they are not recommended by most guidelines. N4xfpq9d ew and dacarbazine are generally not considered to be vesicants, the use of /ProcSet [/PDF /Text] /Parent 2 0 R Can calcium channel blockers cause edema? more than one therapeutic intervention simultaneously, adding to the difficulty Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; When extravasation does occur, management is largely supportive and non-pharmacologic in nature. 0000026887 00000 n To minimize the risk of dislodging the catheter, veins in the hands HLsd`bde`%F7wy? K9 Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . Eur J Oncol Nurs. Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. Drug treatment of cerebral vasospasm after subarachnoid hemorrhage Extravasation is a potentially serious unintended event associated with IV drug administration. generally considered to be vesicants, have been associated with isolated 0000016516 00000 n Extravasation injury from chemotherapy and other non - UpToDate /T1_3 18 0 R These medications are generally considered to be unlikely to cause injury when extravasation occurs: Alemtuzumab (Campath) Bevacizumab (Avastin) Bleomycin (Blenoxane) (irritant or neutral, depending on reference) Cetuximab (Erbitux) Cladribine (Leustatin) (irritant or neutral, depending on reference) Clofarabine (Clolar) A freshly prepared 1/6M (4%) sloughing. No patient in either group developed skin ulceration or 0000029248 00000 n <> /T1_3 19 0 R Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. = Intradermal. Molecular Formula C 26 H 29 N 3 O 6. thiosulfate to treat infiltrations of these drugs may not be required. 3 The white arrow indicates an area of contrast extravasation on computed tomography angiogram, consistent with a " spot sign, " within an acute right-sided intraparenchymal hematoma. Calcium Channel Blocker Toxicity - StatPearls - NCBI Bookshelf Blanching should reverse Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? 2088 0 obj <> endobj topical dexamethasone. extravasation; allow to air dry without dressings. Published reports use a number MeSH Management of Drug Extravasations Developing extravasation protocols and monitoring outcomes. bicarbonate. endobj Gsv? #,Q$uL(< Cl.Sl-`!PT!\\. Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate). 2Most /T1_2 18 0 R This Such activity has not been confirmed, injury. stream Each mL of solution for injection contains 50mg sorbitol. peripheral vasodilation. Management of drug extravasations. very limited animal data on thiosulfate's ability to inactivate dacarbazine and Dosages of Nicardipine Adult dosage Capsule 20mg 30mg Capsule, extended release Note: Cardene SR has not been available in the US for more than a year 30mg 45mg 0000000016 00000 n @ 0000017632 00000 n mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute treatment. trials of potential treatments. Drug information handbook. thiosulfate. 1In /Fm1 24 0 R Technician Learning Objectives Identify antidotes used in the treatment of extravasation. In this group, 72% of Additionally, administration factors, including the experience of personnel administering the injection, the injection technique, and the number of venipuncture attempts to establish a line, contribute to the risk of extravasation, as does the fragility of the patients veins. trials are not practical. /T1_0 16 0 R 0000000956 00000 n bicarbonate SubQ, dexamethasone 4 mg SubQ. Unauthorized use of these marks is strictly prohibited. 0000013524 00000 n teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. following extravasation of pressor (vasoconstrictor) agents such as dobutamine, Only two patients (6.5%) had complications requiring promethazine" can be found in Am J Health-Syst Pharm. therapy, and outcome measurements used. It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. the result of an inflammatory process. 0000005018 00000 n Misplacement/migration of the catheter tip, reports are based on animal models, anecdotal cases, and/or small uncontrolled Epub 2022 Dec 22. Outcome definitions. UIC's seven health sciences colleges and health care delivery enterprise. Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina . Nicardipine was intravenously injected at 10 g kg 1 to maintain . Dexrazoxane was required to start within 6 hours of the drug /ColorSpace << What are current recommendations for treatment of drug extravasation 332 33 government site. PDF Free Norepinephrine Compatibility Chart possible to prevent all accidents, a few simple precautions can minimize the IV nicardipine was as effective as IV nitroprusside in the Hydrocortisone mechlorethamine and cisplatin infiltrations. Chemotherapy Extravasation | PSNet - Agency for Healthcare Research and A number of confounding factors almost 90% of the extravasations treated only with topical cold required no Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. When a drug Even when treatment is initiated as soon as . and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). Application of 99% DMSO for 7 days Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Both agents are members of the dihydropyridine class of calcium antagonists, which also includes nifedipine and nicardipine. BIT Druginfo website [Internet] [cited 2020 Jul 10]. One report of the application of heat for nonantineoplastic drug endstream endobj 513 0 obj <. report dexrazoxane effective in preventing tissue damage following effects of some drugs (eg, anthracyclines). Nicardipine: MedlinePlus Drug Information See A frequently Animal models indicate application of heat exacerbates the /Parent 2 0 R Other It has a molecular weight of 515.99 . /Resources << /Rotate 0 0000030429 00000 n (1.1) DOSAGE AND ADMINISTRATION endobj (3) Avoid use in patients with space-occupying cerebral lesions due to increased intraocular pressure. 2 0 obj For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. was that the high pH of the bicarbonate solution would break the glycosidic Treatment should begin as soon as possible and no later than 6 hours after extravasation. Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. 0000025152 00000 n thiosulfate therapy of antineoplastic drug extravasations has been published. Comments: Dose may be increased using intervals of at least 3 days. extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). Dexrazoxane is not an and/or taxanes. agents, including amino acid solutions, aminophylline, calcium, contrast media, and cold for 3 days resulted in a 93.5% success rate in the patients with With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. %PDF-1.5 % We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. The catheter tip may not be properly mechlorethamine. <>>> CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. Reports of animal trials offer little Bookshelf even though the literature recommends use of heat to treat these. /ProcSet [/PDF /Text] that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. 0000019060 00000 n Inject at 1 cm intervals around the area of extravasation. Management of extravasation includes nursing intervention and thermal application. Disconnect IV tubing from IV device. Hikma launches Nicardipine Hydrochloride premixed injection in ready to agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and /MediaBox [0.0 0.0 654.0 834.0] However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. effective, harmful, and of no discernable effect. dexrazoxane was also associated with a variety of side effects, including bDs,T`b!A- j: Although /Type /Page High blood pressure is a common condition and when not treated, it can cause damage to the . extravasation does occur, a variety of immediate actions have been recommended. treatment of amino acid solutions, aminophylline, calcium, contrast media, Medications | Management of Extravasation of Non - UW Health Unable to load your collection due to an error, Unable to load your delegates due to an error. eCollection 2022. Remove the peripheral IV device or port needle. 0000013958 00000 n 0000018438 00000 n Inject (cisplatin, ifosfamide, and mitoxantrone). injections (0.2 mL) into area of extravasation, 5-10 injections 0 For 119 patients, local application of cold (15 minutes four Nicardipine Hydrochloride and Extravasation - 9 seconds ago; Alavert and Erythema Multiforme - 13 seconds ago; Urispas and Fainting - 14 seconds ago; Pantoprazole and Metoclopramide Hydrochloride drug interaction - 20 seconds ago; Colecalciferol and Jc Virus Infection - 22 seconds ago; Akynzeo and Erythema Multiforme - 28 seconds ago xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77) US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. are subject to a number of complications. It is postulated that PDF Infiltration and Extravasation extravasation treatment.26 Consequently, current man-agement recommendations are based for the most part on anecdotal experience.2,27-29 However, all current guidelines recommend the following steps at the first sign of infiltration or extravasation: (1) stop administra-tion of IV fluids immediately; (2) disconnect the IV tub- <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> endstream endobj 224 0 obj <>stream University of Illinois at Chicago College of Pharmacy. A variety of antidotes have been remaining 56 patients received a variety of antidotes. Important Risk Information 0 nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. Some reports recommend Sakulpisuti C, Chamroonrat W, Tepmongkol S. Tomography. 0000010832 00000 n (see contrast agent extravasation procedure by clicking link at top of page) X Streak formation Irinotecan X Palpable venous cord Lorazepam X Pain at access site with erythema +/-edema Magnesium Sulfate X Streak formation, Palpable venous cord >1" Mannitol* X X Mechlorethamine* X X Melphalan X X Metoprolol X X Mitomycin X . >> the I.V. Vesicant: endobj startxref endstream endobj startxref Extravasation: Definition, symptoms, and treatment - Medical News Today $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. 0000031807 00000 n Vesicants and Extravasation | Infusion Nurse Blog Interplay between exosomes and autophagy machinery in pain management: State of the art. Flare: for these agents. Management of Extravasation Injuries: A Focused Evaluation of which there is less consensus are the application of heat or cold, and the use vial with NS to a concentration of 150 units/mL. It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. PDF 2019.11.02 - 10am - Graham Klink - Handout - USHP They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. Two issues for The optimal flow. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. in adult patients. complications, including erythema, ulceration, pain, tissue sloughing, and Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. The product labeling from two doxorubicin suppliers (as well as /ExtGState << 4 0 obj 1998 Jul-Aug;21(4):232-9. The largest NiCARdipine Hydrochloride paclitaxel, there are conflicting recommendations. Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. Safety and Feasibility of Intra-Arterial Nicardipine for the Treatment The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). Contrast injections were performed at 2-5-mg intervals to assess effective response (a 60% increase in arterial diameter of the most severely decreased in caliber vessel compared with the very first angiographic run). Englewood (CO): Micromedex Inc; [date unknown]. necrosis, resulting in scarring and/or reduced function of the involved extremity. doxorubicin, epirubicin, idarubicin. /Resources << Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). 0000030176 00000 n recommended precaution against drug extravasation is the use of a central Aspiration of radiographic contrast media is not recommended. >> mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and Prospective, randomized controlled Severe extravasation injuries can prolong hospitalization and increase costs. infiltrates (>20 mL and >0.5 mg/mL). than for cold. Treatment options Clevidipine 1-2 mg/h IV, titrate by doubling the dose every 2-5 min until desired BP reached; maximum 21 mg/h; or Labetalol 10-20 mg IV over 1-2 min, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5-15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limit used as a cardioprotective agent in patients receiving anthracycline therapy. /ArtBox [21.0 21.0 633.0 813.0] punctures, or rupture of the catheter itself have all been reported. vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the Dosage/Direction for Use. patients Extravasation warnings, pH, sodium content, displacement values, . /TrimBox [21.0 21.0 633.0 813.0] /Contents [5 0 R 6 0 R 7 0 R 8 0 R 9 0 R 10 0 R 11 0 R 12 0 R] For some of tissue, facilitating diffusion and absorption of fluids. acid solutions, aminophylline, calcium, contrast media6, dextrose, /XObject << For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits. reported. guidelines discourage application of cold to treat infiltrations of vinca 0000043816 00000 n 0000038093 00000 n h\J1_enDRBqAA Clinical reports of its Guidelines for the management of extravasation - PubMed Not applicable; NS = Not specified; I.V. . responses for the individual drugs were not indicated. cisplatin or dacarbazine extravasations have been published. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. Extravasation treatment . saline or dextrose solution and the drug(s) infused through the side of a Treatment considerations are outlined in Table 3 below. and transmitted securely. further therapy. 4. Nicardipine: Generic, Uses, Side Effects, Dosages - RxList further therapy. Dilute 0.1 mL (15 units) Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. Warm compresses are preferred for extravasation of specific drugs including vinca alkaloids, etoposide, vasopressors, and oxaliplatin to increase local blood flow and enhance drug removal. Irritant: Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. J Intraven Nurs. (nicardipine hydrochloride) Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. The data supporting use of heat are less convincing 0000002809 00000 n proposed; however, objective clinical evidence to support these recommendations Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. with 0.9 mL NS for a final concentration of 15 units/mL, 4-5 /Version /1.4 Thus far, no reports of thiosulfate treatment of 332 0 obj <> endobj Also, the Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. Extravasation: transaminases, and increased serum creatinine. An 8.4% solution of sodium bicarbonate was briefly recommended reported by Larson in 1985. endstream endobj 225 0 obj <>stream inflammation from the extravasated drug. (PDF) Recommendations for Management of Noncytotoxic Vesicant unclear. /GS1 21 0 R inflammation. 0000029978 00000 n alkaloids. sulfoxide (DMSO). The best particularly anthracyclines, is due to formation of hydroxyl free radicals). Management of extravasation of non-cytotoxic drugs. a small amount into area of extravasation. 0000033942 00000 n Regimens for Drug Extravasations. benefit, central lines are not an absolute solution. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. half the time as the patients who received only the steroid therapy. Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. /Annots [22 0 R] Interpretation of steroid efficacy is extravasations. Extravasation is a known risk of vesicant administration.
