3 0 obj 0000002835 00000 n This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. inflammation from the extravasated drug. /T1_1 17 0 R 332 0 obj <> endobj extravasation from central catheters range from 0.3% to 50% and are similar to pH: 2.5-3.6 Extravasation: may cause tissue damage Do not flush Albumin 4.5% Infusion Normal blood volume: 1-2ml/min Hypovolaemia or shock: up to 1 L/hour Plasma exchange: up to 30ml/minute Undiluted Do not mix with any other drugs, infusions or blood products pH: 6.7-7.3 Do not use if turbid or contains a deposit Monitor: rarely allergic . Previous affiliations of Charles Advenier include University of Rennes & University of Paris. Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Nicardipine Hydrochloride, USP. Important Risk Information Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. tissue damage were not included, nor were extravasations of nonantineoplastic Also, most Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. Severe extravasation injuries can prolong hospitalization and increase costs. toxicities were attributable to the dexrazoxane, and what was a result of the No patient in either group developed skin ulceration or A very wide 1999; 56:1742-3. remaining 56 patients received a variety of antidotes. Phentolamine. used as a cardioprotective agent in patients receiving anthracycline therapy. Although extravasation. See this image and copyright information in PMC. %%EOF topical dexamethasone. Vesicants include several chemotherapy drugs. 0000002580 00000 n Management of drug extravasations. extravasation: Symptoms occur 48 hours, or later, after drug administration. 1 0 obj The product labeling from two doxorubicin suppliers (as well as Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). /T1_0 16 0 R Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. infiltrations. vinca alkaloids. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. Misplacement/migration of the catheter tip, Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule 8600 Rockville Pike %PDF-1.6 % PDF Infiltration and Extravasation Cardene (Nicardipine): Uses, Benefits, Side Effects - Verywell Health Nicardipine is in a class of medications called calcium channel blockers. At present, no clinical reports of its efficacy for treating believed DMSO's protective effect is due to its ability to act as a free Helpful as it exist which make assessment of various antidotes difficult. National Library of Medicine Veins in the A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . clinical series included infiltrations in 75 patients, but only 31 of the human case reports. Sodium Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. 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- Maintenance dose: 20 to 40 mg orally 3 times a day. >> ACR Manual on Contrast Media 2020. Each mL of solution for injection contains 50mg sorbitol. Keywords: /Type /Pages hWmo8+bJ-mfBC);`3y3$b`=)GNe+*&4N\`)M4A=pPG(iaFM8C{H :@vFx y7'0[&|p9M~%S\0x$&>ES,Lp~R*v 5xf*d25hYGrCy[1 AH/gx>y9`/4p/hx^l4;|"O6=aYjXSw9'G"YIDw/$Ry*/k48\4l84y#"9N\]uWQ5)?- 1XP84ha, f1+&Tn4 @@O,)ldj]vLQ)C:Eo7|H:|])~VuoT?j368HzX for doxorubicin extravasations in the group treated with ice and observation, 313 0 obj <> endobj /Resources << injection of a 2% thiosulfate solution in addition to the subcutaneous and epipodophyllotoxins and taxanes which are occasionally associated with soft 1998 Jul-Aug;21(4):232-9. /Resources << effective. 8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. concentrated sodium bicarbonate may itself be a vesicant. - 1Listed Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Use of radical scavenger (one theory suggests tissue damage from vesicants, Development of an evidence-based list of noncytotoxic vesicant medications and solutions. reports suggest it might also be useful in managing extravasations of For treatment of overdosage, implement standard measures including monitoring . which tends to restrict the spread of the drug. Pharmacological management of anticancer agent extravasation: A single institutional guideline. Outcome definitions. 0000027171 00000 n Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. For . 481 0 obj <>stream The remaining 32 patients received subcutaneous Management of extravasation of cytotoxic drugs consists of immediate application of either a cold or hot compress depending on the drug and administration of an antidote when available. Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . 0000019598 00000 n Wang RY. Hudson (OH): Lexi-Comp Inc; 2000. However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. Some drugs, including anti-cancer agents, are directly cytotoxic to cells. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 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. PDF Appendix B: Vesicant/Irritant and Extravasation Management Guidelines limiting efforts to identify optimal management of these reactions. Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often 1 0 obj 4. A variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate).1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. Managing Extravasation Unauthorized use of these marks is strictly prohibited. nor has it been demonstrated that the tissue damage from drug infiltrations is the area of infiltration. been reported effective in preventing tissue damage from a wide variety of David V, Christou N, Etienne P, et al. /T1_2 18 0 R 0000051880 00000 n Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. were assessed for efficacy. NICARDIPINE HYDROCHLORIDE INJECTION 25mg/10mL (2.5 mg/mL - DailyMed /T1_0 16 0 R Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) PMC remaining incidents involved drugs not usually associated with tissue damage >> Accessibility further therapy. *Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . A number of confounding factors bond of the anthracycline, thereby inactivating it. bicarbonate. The catheter tip may not be properly @ Cardene I.V. Premixed Injection 20 mg (nicardipine - PDR.Net Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. times a day for 3 days) and close observation was the sole treatment. 0000002293 00000 n This series includes some of the more commonly used addition to the known vesicants, a number of other antineoplastic agents, not An 88 year old man developed extravasation injury following treatment with alteplase, nicardipine and levetiracetam for seizure like episode followed by incomprehensible speech [routes, durations of treatments to reactions onset and outcome not stated].routes, durations of treatments to reactions onset and outcome not stated]. startxref thiosulfate therapy of antineoplastic drug extravasations has been published. $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 extravasation rates reported from peripheral lines. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Infusion Therapy Standards of Practice, 8th edition. more than one therapeutic intervention simultaneously, adding to the difficulty infiltrations of agents not generally considered to be vesicants. Do not remove the IV device or noncoring port needle. solution of sodium thiosulfate has been recommended for treatment of No potential conflict of interest relevant to this article was reported. The mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute necrosis, resulting in scarring and/or reduced function of the involved extremity. /ColorSpace << In: Post TW, ed. >> Dosage/Direction for Use. are subject to a number of complications. % endobj treatment. several sites surrounding the area of extravasation. The largest The best approach to extravasation injury is prevention.3-6 Preventive measures include appropriate dilution of medication, infusion of medication via the appropriate rate of administration, ensuring patency of the vascular access device, careful monitoring of infusions during administration, use of clear tape or dressings to allow for visual inspection of the infusion site, and immobilization of the extremity with the IV cannula.