vesicant chemotherapy administration guidelines vesicant chemotherapy administration guidelines

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. 2. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Eur J Oncol Nurs. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Front Oncol. If chemical phlebitis occurs, consideration should be given to the need for alternative vascular access, an alternative medication, a slower infusion rate, or further dilution of the medication.6. 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. 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. Please enable it to take advantage of the complete set of features! Cold (different suggestions for anthracyclines depending on reference): (off-label, based on general management strategies for anthracyclines), Cold - 15 to 20 minutes at a time for at least four times per day for 24 hours, Irritant or neutral, depending on reference, Cold - Every 8 hours for 3 days; if using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate, Vesicant/Irritant (depending on reference). Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. There are non-chemo medications and solutions that have vesicant properties as well and can cause extravasation. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. This information is intended as an educational piece and should not be used as the sole source for clinical decision making. Question: Is the dilution of vinCRIStine in a minibag stable? Once the infusion is complete, the short set is dropped to backfill the line with saline and then the remaining drug is infused. However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. References and bibliography updated. European Oncology Nursing Society extravasation guidelines. Polovich M, Olsen M, LeFebvre KB, eds. Answer:Some practitioners have expressed concern that administering diluted IV vinCRIStine via a minibag might increase the risk of extravasation and subsequent tissue injury. 2022 Dec 2;12:1021488. doi: 10.3389/fonc.2022.1021488. Trissel LA. and transmitted securely. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. Rev. 1 Vesicants and irritants with vesicant . J Intraven Nurs. Seo H, Altshuler D, Dubrovskaya Y, et al. Centers for Disease Control and Prevention. Extravasation of antineoplastic agents: prevention and treatments. All rights reserved. %%EOF Reviewed electronically by nursing reference committee. Bethesda, MD 20894, Web Policies 2014;(Epub ahead of print). eCollection 2022. Access to this article is restricted. eCollection 2018 Apr. Nafcillin. 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. www.hospira.com/Images/434047_32-91799_1.pdf Version number changed to v.5. European Oncology Nursing Society extravasation guidelines. 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. 3/10/2014, 7. Answer:Yes, the product is stable in a minibag. Gilbar PJ, Carrington CV. Another option is to aspirate with a syringe via the lowest Y-site and clamp off fluid from the minibag. 3/10/2014, Institute for Safe MedicationPractices 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>> (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 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. All rights reserved. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. J Oncol Pharm Pract. This page was last edited 14:24, 26 April 2023 by. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? 8600 Rockville Pike Updated January 2021. American Society of Clinical Oncology (ASCO), Personal Protective Equipment for Use with Hazardous Drugs. 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 https:// ensures that you are connecting to the 2016 Feb 10; 7(1): 8797. 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. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. The https:// ensures that you are connecting to the Please enable it to take advantage of the complete set of features! Midline catheters represent a unique vascular access device (VAD) for patients requiring intravenous (IV) administration of drugs or other infusates.1,2After their introduction in the 1950s, hypersensitivity and phlebitis reactions to the manufacturing materials led to a temporary decline in the use of midline catheters through the 1990s; however, a redesign of these products in recent years has led to their renewed adoption. Clin J Oncol Nurs. 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. 2 0 obj In some regimens, enough data support sequencing of agents, but in others, data are lacking. Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Oncologist. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. 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. J Oncol Pharm Pract. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. endobj 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. Overview, prevention and management of chemotherapy extravasation. Ensure the best possible outcomes with ONS standards. 6. 1. 2141 0 obj <>stream In contrast, the Chemotherapy and Biotherapy Guidelines and Recommendations for Practice recommended against infusing vesicant agents peripherally for more than 30-60 min, but they also fail to categorize specifically chemotherapeutic agents as vesicants or irritants [Polovich et al. 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. Always double check information at the primary references linked below. Ryan Rodriguez, PharmD, BCPS European Oncology Nursing Society extravasation guidelines. 2013;1(1):9- 16. The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. Before Gilbar PJ, Carrington CV. Epub 2014 Jul 3. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. J Pediatr Oncol. FOIA {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 American College of Radiology. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. 3/10/2014, 6. Vesicant chemotherapy extravasation antidotes and treatments. But chemo agents are not the only vesicants that cause extravasation injuries. Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. 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. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. Some medications are more likely to have vesicant properties in high concentrations or large volumes. Extravasation of noncytotoxic drugs. Would you like email updates of new search results? The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. %PDF-1.6 % Bookshelf 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. Gilbar PJ. The action you just performed triggered the security solution. official website and that any information you provide is encrypted 2. References: 1. Available antidote and treatment formulations and their preparation and administration also are discussed. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. 125 Enterprise Drive 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. Midline catheters have properties that differ from both those of traditional peripheral IV catheters and central venous catheters (CVCs). The procedure includes connecting the bag of saline to a long straight infusion set. HHS Vulnerability Disclosure, Help Calcium Gluconate. doi: 10.1097/GOX.0000000000001743. endobj Remove cold pack at least 15 minutes before dexrazoxane therapy. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. %PDF-1.7 Additionally, patient mobility is greater with midline catheters because of the location of their insertion site.2 Lastly, compared with drug administration via peripheral IV catheter, the risk of phlebitis may be reduced with administration via midline catheter because of its termination in an area with a higher rate of blood flow.2The rates of CRBSI have also been reported to be lower with midline versus peripheral catheters (0 to 0.2 versus 0.5 per 1,000 catheter days).1, Overall, the properties of midline catheters may make them preferable for specific durations of therapy. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Pittsburgh, PA 15275 Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. 8600 Rockville Pike endstream endobj 2089 0 obj <. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. 09/04/2019. MeSH Unable to load your collection due to an error, Unable to load your delegates due to an error. Because this termination site is distal to those of CVCs and peripherally inserted central catheters (PICCs), midline catheters are not considered to dwell in the central circulation.1Whereas the central termination site of CVCs and PICCs provide the ability to administer a wider range of infusates (eg, vesicants), this is not recommended with VADs terminating distal to the central circulation. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. 139.59.111.99 References: 1. 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". Rev. Lu H, Hou Y, Chen J, et al. Question:Wouldnt the administration of vinCRIStine IV push using a syringe be much shorter in duration and with less chance of extravasation than administration using a minibag? Hospira. 125 Enterprise Drive In addition, whenever an extravasation occurs or is suspected, vesicant administration must immediately cease, and the appropriate antidote or treatment needs to be promptly administered. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Handbook of Injectable Drugs 17th Edition. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. 3 0 obj What do you recommend? 2014 Aug;24(4):352-8. Depending on treatment complexity, ONSs 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. Therefore, critical and collaborative consideration of the components of each regimen and the clinical presentation of the patient should be part of the treatment planning process. Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Bookshelf ACR Committee on Drugs and Contrast Media. Courtney Krueger, PharmD, BCPS Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. 1995 Jan-Feb;22(1):57-67. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Boulanger J, Ducharme A, Dufour A, et al. Heat - Apply warm compresses to extravasation site for 1 hour. (An infusion pump is not recommended by the Oncology Nurses Society (ONS) to administer vinCRIStine in this situation1 .) doi: 10.4081/pr.2012.e28. Disclaimer. Rev. University of Illinois at Chicago College of Pharmacy. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. 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. Oncologist. Rev. 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. 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. 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. 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. official website and that any information you provide is encrypted The .gov means its official. Vesicant Administration Guidelines 1. 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. Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants.