vesicant chemotherapy administration guidelines

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. stream (An infusion pump is not recommended by the Oncology Nurses Society (ONS) to administer vinCRIStine in this situation1 .) Nafcillin. Sodium Chloride. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. www.hospira.com/Images/434047_32-91799_1.pdf, http://opp.sagepub.com/content/early/2014/01/13/1078155213517729, Medication Safety Officers Society (MSOS). Unable to load your collection due to an error, Unable to load your delegates due to an error. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. J Pediatr Oncol. The practice of monitoring the administration of vinCRIStine and other vinca alkaloids in a minibag to avoid extravasation via a peripheral IV is essentially the same as if it was administered IV push. Treatment of cutaneous injuries of neonates induced by drug extravasation with hyaluronidase and hirudoid. Taxanes: vesicants, irritants, or just irritating? Polovich M, Olsen M, LeFebvre KB, eds. Abstract. 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. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. Vesicant Chemotherapy Extravasation Antidotes and Treatments Epub 2014 Jul 3. All rights reserved. Question:Will administering vinCRIStine in a minibag increase the risk of extravasation? endobj European Oncology Nursing Society extravasation guidelines. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment . 2014;(Epub ahead of print). Chemotherapy Extravasation Management - AAHA 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 Blood Rev. A similar sized bag for the back flushing, such as a 25 mL bag of 0.9% saline is used for both adults and pediatric patients. Find the answers to questions regarding symptoms, side effects, and more. FOIA However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. Overview, prevention and management of chemotherapy extravasation. 1990 Mar-Apr;13(2):111-4. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. References: 1. Pittsburg, PA: Oncology Nursing Society; 2014. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Pittsburg, PA: Oncology Nursing Society; 2014. <> If using a peripheral vein, allow the infusion to flow via gravity. Accessibility Bethesda, MD 20894, Web Policies PMC Lu H, Yang Q, Yang L, et al. Access to this article is restricted. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). 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$. The following information is a compilation from the various resources listed below.[1][2][3][4][5][6][7][8]. Oncologist. 2. 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. The action you just performed triggered the security solution. 3. PDF BC Cancer Extravasation Hazard Table Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. 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. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. 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. Rev.12/2/2014. Copyright 2023 Oncology Nursing Society. In some regimens, enough data support sequencing of agents, but in others, data are lacking. 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. 6. Best Practice #1 FAQ | Institute For Safe Medication Practices Generally, drugs that are vesicants or have extremes of pH or osmolarity should not be administered via midline catheters. Rev. This page was last edited 14:24, 26 April 2023 by. government site. Unauthorized use of these marks is strictly prohibited. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. The site is secure. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. Accessed August 2, 2021. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Facebook - National Cancer Institute sharing sensitive information, make sure youre on a federal The safety of midline catheters for intravenous therapy at a large academic medical center. Conclusion doi: 10.1097/GOX.0000000000001743. Bethesda, MD: American Society of Healthsystem Pharmacists; 2012:1104-5. Two important safety features are important here. Gorski LA, Hadaway L, Hagle ME, et al. 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. Administering Vesicants | ONS J Oncol Pharm Pract. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? 09/04/2019. Vesicant & irritant chemotherapy - A Hematology Oncology Wiki Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. Reference: 1. **Some case reports of extravasation and injection site reactions or inflammation have been reported. official website and that any information you provide is encrypted These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, sel eCollection 2012 Jul 31. Accessibility Answer: To prevent excessive drug loss, some organizations are utilizing a back flushing method to infuse the remaining volume of drug that may remain in the IV tubing. The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. Vesicants: not just chemo agents! | Infusion Nurse Blog 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". 866-257-4ONS (866-257-4667). 5-Safe administration of anti-cancer drugs | eviQ 2018 Apr 19;6(4):e1743. 2022 Dec 2;12:1021488. doi: 10.3389/fonc.2022.1021488. 2014 Aug;24(4):352-8. PMC Extravasation is a known risk of vesicant administration. Preventing and managing vesicant chemotherapy extravasations The https:// ensures that you are connecting to the A subsequent 2013 revision Cloudflare Ray ID: 7c0b26d1e9b36bd5 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. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. References: 1. endobj This site needs JavaScript to work properly. You can email the site owner to let them know you were blocked. 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. Careers. 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. The .gov means its official. Rev. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Plast Reconstr Surg Glob Open. Oncology Nursing Society releases updated guidelines on - Healio Unable to load your collection due to an error, Unable to load your delegates due to an error. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, selecting an appropriate administration site for peripheral vesicant administration, and checking for a blood return prior to and during vesicant administration. Always double check information at the primary references linked below. Your IP: All rights reserved. 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 Updated July 2017. Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. 1 0 obj Monitor for extravasation according to hospital policy. Bethesda, MD 20894, Web Policies 2.13.2 Vesicant chemotherapy administered through a peripheral intravenous must be infused IV push as ordered or via a short-term gravity intravenous line. 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 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. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Midline catheters have properties unique from those of peripheral and central VADs. Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. 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. Updated January 2021. References and bibliography updated. PDF Antineoplastic Drug Administration: Vesicant and Irritant Agents Also, dilution of the vinca alkaloid likely reduces the impact of any extravasation that might occur. In December 2008, ASCO and ONS held a workshop to develop a consensus regarding standards for the safe administration of chemotherapy to adult patients in the outpatient setting. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood 3/10/2014, Institute for Safe MedicationPractices Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. This site needs JavaScript to work properly. ACR manual on contrast media. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Careers. Hyaluronidase may be used in extreme scenarios such as large volume extravasation or severe irritation. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. Pediatr Rep. 2012 Aug 1;4(3):e28. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. The Independent Clinical Oncology Network's Chemotherapy Administration. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. Preventing and Managing Vesicant Chemotherapy Extravasations PDF Appendix B: Vesicant/Irritant and Extravasation Management Guidelines <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>> An official website of the United States government. 1995 Jan-Feb;22(1):57-67. 3. Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. 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. To discuss the information in this article with other oncology nurses, visit the ONS Communities. Pittsburg, PA: Oncology Nursing Society; 2014. 2012;18(suppl):16-7. eCollection 2022. Ensure the best possible outcomes with ONS standards. Manage conservatively as first line option with supportive non-pharmacologic strategies. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. Answer:Yes, the product is stable in a minibag. 1 Package insert for vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial. government site. Disclaimer. The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Development of an evidence-based list of noncytotoxic vesicant medications and solutions. Flare reaction: A skin reaction to a medication which is an allergic response. eCollection 2012 Jul 31. Front Oncol. This section focuses on drug administration, including cycle definition (which contains the cycle length, number of cycles, and other schedule-related information), dosing, frequency, and routes of administration. 125 Enterprise Drive 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. 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. References: 1. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. Exfoliants:An agent that is capable of causing inflammation and skin shedding, but less likely to cause tissue damage. Clinical Associate Professor, Drug Information Specialist, Updated by: The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. Boulanger J, Ducharme A, Dufour A, et al. and transmitted securely. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; Content on this site is protected by U.S. and international copyright laws. It is also important to note that some medications are classified differently by different references. Reviewed electronically by nursing reference committee. Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. Remove cold pack at least 15 minutes before dexrazoxane therapy. PDF Guidelines on treatment of extravasation - Thames Valley Cancer Alliance 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. MeSH Prepared by: Special Considerations When Administering IV Chemotherapy - ONS Voice 2. Extravasation of antineoplastic agents: prevention and treatments. Ex: Name & date of birth 2. 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. %PDF-1.7 References: 1. 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 . Antidotes to vesicant chemotherapy extravasations. 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. 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. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. The .gov means its official. Bookshelf {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Avoid continuous vesicants or irritants (chemotherapy, vasopressors) . Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. Clinical exam may reveal warmth, erythema, or tenderness. Caution: excessive cold can cause tissue damage. Email ONSs clinical inbox at clinical@ons.org to reach one of our oncology clinical specialists, who can advise on ONS recommendations, best practices, and evidence support. 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . 8}-Fb}" "R5xPQ%Flm^%/jV 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. However, the INS Task Force identified limited literature describing extravasation of vancomycin. Current ASCO/ONS standards address the safety of all routes of chemotherapy administration to adult patients in the outpatient and inpatient settings. Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. 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. 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. 2021 Update: What are considerations for determining whether a drug may Rev.

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