The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Unauthorized use of these marks is strictly prohibited. 1995 Jan-Feb;22(1):57-67. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. 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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. Ensure the best possible outcomes with ONS standards. 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. Vesicants and irritants with vesicant . Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. 4. Eur J Oncol Nurs. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Unauthorized use of these marks is strictly prohibited. Pittsburgh, PA 15275 Reference: 1. Section V: Immediate Complications of cytotoxic therapy, p.105. These . Irritants and Vesicants Guide to Intravenous Administration via Midline Catheters . In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. 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. Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Ex: Name & date of birth 2. 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. 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. 125 Enterprise Drive Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 Pediatr Rep. 2012 Aug 1;4(3):e28. Before 6. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. You can email the site owner to let them know you were blocked. 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." Pittsburg, PA: Oncology Nursing Society; 2014. University of Illinois at Chicago College of Pharmacy. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. Vesicant chemotherapy extravasation antidotes and treatments. What are current recommendations for treatment of drug extravasation? J Oncol Pharm Pract. An official website of the United States government. 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. 2021 Update: What are considerations for determining whether a drug may be administered via a midline catheter? 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. Please. 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. 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. Intravascular catheter-related infection (BSI). Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Chemotherapy Extravasation | PSNet - Agency for Healthcare Research and Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. Question:Will administering vinCRIStine in a minibag increase the risk of extravasation? No formal recommendation, but depending on clinical condition could consider extrapolating from management of other vinca alkaloids: Apply cold pack initially for 30 to 60 minutes, then repeat every 15 minutes on day 1 only. Pittsburg, PA: Oncology Nursing Society; 2014. endobj Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. 3/10/2014, 7. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. eCollection 2018 Apr. Minor updates to administration and patient education. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. Bookshelf Taxanes: vesicants, irritants, or just irritating? Two important safety features are important here. 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. European Oncology Nursing Society extravasation guidelines. National Library of Medicine 2141 0 obj <>stream Pittsburg, PA: Oncology Nursing Society; 2014. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. 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. 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. Your IP: Use VADs for vesicant administration, continuous infusions of vesicants, anticipated long-term administration of chemotherapy, poor venous access, and for children or older adult patients.a,b Ensure clear visualization of the site throughout the infusion. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Caparas JV, Hu JP. 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. 2023 Institute for Safe Medication Practices. However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. Heat - Apply warm compresses to extravasation site for 1 hour. 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.
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