Properties of midline catheters Avoid the "blame game.". This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. Disclaimer. Gorski LA, Hadaway L, Hagle ME, et al. 2. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Prevention is the most important approach to extravasation management. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. Vesicant chemotherapy extravasation antidotes and treatments. UIC's seven health sciences colleges and health care delivery enterprise. Please. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Pittsburgh, PA 15275 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). 3/26/2014, 5. The site is secure. government site. 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. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. 1 0 obj Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. 2. 0 The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Answer:Yes, the product is stable in a minibag. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . Clinical Associate Professor, Drug Information Specialist, Updated by: Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. If not clearly defined in the literature. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Calcium Chloride. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. Reference: 1. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Management of the extravasation of anti-neoplastic agents. HHS Vulnerability Disclosure, Help %PDF-1.7 Your IP: 2023 Institute for Safe Medication Practices. Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. Table 7 in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice discusses special features required for administration, but package inserts should be referred to for the most up-to-date information. Chemical phlebitis may be caused by drugs that irritate the vasculature, usually because of extremes of pH or osmolarity.3Infusates with an osmolarity over 600 mOsm/L are associated with symptoms when extravasation occurs, and those over 800 mOsm/L are usually recommended to be given via a CVAD.9 Infusates with a pH between below 5.5 or above 8.5 can cause tissue damage, with alkaline agents generally producing worse toxicity than acidic agents. 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. www.hospira.com/Images/434047_32-91799_1.pdf 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. endobj J Pediatr Oncol. FOIA 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. 1 All rights reserved. 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. 1995 Jan-Feb;22(1):57-67. 2006;12(2):113-8. Gilbar PJ, Carrington CV. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. J Oncol Pharm Pract. Two important safety features are important here. Clin J Oncol Nurs. PMC J Oncol Pharm Pract. Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. Rev.12/2/2014. 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. J Intraven Nurs. Minor updates to administration and patient education. References: 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. Apply ice to the area for 15 to 20 minutes each hour for 4 hours. Sodium Chloride. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. e.YvIQ|!C2\@&;:8 h qF . uDX i! Nurses, Chemotherapy, and Pregnancy: What Do We Know? Remove cold pack at least 15 minutes before dexrazoxane therapy. Do not pinch the IV administration tubing because this can cause the vein to rupture. 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. 2022 Dec 2;12:1021488. doi: 10.3389/fonc.2022.1021488. 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. Pittsburgh, PA 15275 Question: Is the dilution of vinCRIStine in a minibag stable? World J Clin Oncol. Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. MeSH NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. Polovich M, Olsen M, LeFebvre KB, eds. Monitor for extravasation according to hospital policy. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. J Intraven Nurs. stream 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. Some medications are more likely to have vesicant properties in high concentrations or large volumes. Boulanger J, Ducharme A, Dufour A, et al. endobj 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. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. Intravascular catheter-related infection (BSI). Caution: excessive cold can cause tissue damage. Click to reveal References: 1. The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. Manage conservatively; shield exposed tissues from light. Rev. 1990 Mar;4(1):41-60. doi: 10.1016/0268-960x(90)90015-k. Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. 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. American Society of Clinical Oncology (ASCO), Personal Protective Equipment for Use with Hazardous Drugs. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. 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. 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." Nafcillin. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Polovich M, Olsen M, LeFebvre KB, eds. Gilbar PJ, Carrington CV. All rights reserved. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. Content on this site is protected by U.S. and international copyright laws. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. 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. 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. Blood Rev. If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. Heat - Apply warm compresses to extravasation site for 1 hour. Eur J Oncol Nurs. Centers for Disease Control and Prevention. Current ASCO/ONS standards address the safety of all routes of chemotherapy administration to adult patients in the outpatient and inpatient settings. 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. For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 FOIA http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings. Reviewed electronically by nursing reference committee. When the institution implements the use of minibags to administer vinCRIStine, the following nursing guidelines should be followed to further reduce the risk of harm from extravasation. Always double check information at the primary references linked below. sharing sensitive information, make sure youre on a federal The https:// ensures that you are connecting to the Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Innovative Oncology Nurses Break Down Communication Barriers for Patients Who Are Deaf or Hard of Hearing, How I Practice Mindfulness as an Oncology Nurse, Clinical and Pharmaceutical Nurse Educators Collaborate to Bring Training to Nurses and Improve Patient Care, Oncology Nurse Uses Retirement to Help Patients and Healthcare Professionals Understand Pancreatic Cancer Biomarker Testing Results, The Life of Marie Curie and Her Contributions to Oncology, FDA Reports Efficacy Issue for Patients Taking Pembrolizumab or Atezolizumab as Monotherapy to Treat Urothelial Cancer with Low Expression of PD-L1, B. 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. Trissel LA. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Assessment of the risk of extravasation with the introduction of vincristine mini-bags to eliminate inadvertent intrathecal administration. Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. 2088 0 obj <> endobj If using a peripheral vein, allow the infusion to flow via gravity. You can email the site owner to let them know you were blocked. Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. Central VADs may also be more appropriate in patients needing longer-term therapy.3 Although some evidence has supported lower thrombosis risk with midline catheters compared with CVCs,1 a recent systematic review of 12 studies in 40,871 patients found that risk of venous thromboembolism was significantly higher with a midline catheter compared with a PICC (3.97% versus 2.29%; relative risk, 1.53; 95% CI, 1.33 to 1.76; p<0.00001).4 However, evidence evaluating the risk of catheter-related bloodstream infections (CRBSI) continues to find similar or improved rates of infection with midline catheters compared with PICCs.5, Compared with midline catheters, peripheral IV catheters are inserted more distally and most often utilize veins of the dorsum of the hand for cannulation.1-3Peripheral IV catheters have high first-attempt failure rates (26% in adults, 54% in children) and often require recannulation in larger more proximal sites.1,2Therefore, midline catheters may reduce the need for recannulation and thereby afford a longer dwell time. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. <> Oncologist. If an antidote is not going to be used, the venous access can be removed after aspiration of the extravasated fluid has been attempted. **Some case reports of extravasation and injection site reactions or inflammation have been reported. Nurgat Z, Smythe MP, Aljedai A. 4 0 obj Oncol Nurs Forum. Unable to load your collection due to an error, Unable to load your delegates due to an error. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. The information presented is current as of August 2, 2021. Answer:Some practitioners have expressed concern that administering diluted IV vinCRIStine via a minibag might increase the risk of extravasation and subsequent tissue injury. 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. Ex: Name & date of birth 2. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. Rev. The .gov means its official. Performance & security by Cloudflare. Patients often seek explanations for why their extravasations occurred. Plast Reconstr Surg Glob Open. 2141 0 obj <>stream Lu H, Hou Y, Chen J, et al. 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. Unauthorized use of these marks is strictly prohibited. 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. Plymouth Meeting, PA 19462. National Library of Medicine In some regimens, enough data support sequencing of agents, but in others, data are lacking. 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. The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. European Oncology Nursing Society extravasation guidelines. References: 1. 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. General recommendations for midline administration: A. UN vR7. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. The https:// ensures that you are connecting to the Epub 2014 Jul 3. 1998 Jul-Aug;21(4):232-9. 866-257-4ONS (866-257-4667). 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 The following information is a compilation from the various resources listed below.[1][2][3][4][5][6][7][8]. Version number changed to v.5. 3/26/2014 5. eCollection 2012 Jul 31. National Library of Medicine Clinical Assistant Professor, Drug Information Specialist % 2008 Sep;12(4):357-61. 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. For primary infusions, the agents should be administered by direct connection to the access site using primary tubing, a Luer lock connection should be used, and a compatible IV flush solution should be readily available for emergent administration issues and to clear the line after completion. Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. eCollection 2022. 3/10/2014, 6. Lu H, Yang Q, Yang L, et al. Courtney Krueger, PharmD, BCPS Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. Ryan Rodriguez, PharmD, BCPS For permissions, please contacthelp@ons.org. 8}-Fb}" "R5xPQ%Flm^%/jV 2016 Feb 10; 7(1): 8797. Hyaluronidase may be used in extreme scenarios such as large volume extravasation or severe irritation. The site is secure. sharing sensitive information, make sure youre on a federal A central line is always required for vesicant or any chemotherapy in the home. Extravasation of noncytotoxic drugs. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. doi: 10.1097/GOX.0000000000001743. Exfoliants:An agent that is capable of causing inflammation and skin shedding, but less likely to cause tissue damage. Vesicants and irritants with vesicant . Most importantly, organizations must weigh the risk of possible extravasation versus certain death from the accidental administration of vinCRIStine by the intrathecal route when making decisions about changing practice. Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants. 2009]. 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. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. 2. 2014;(Epub ahead of print). 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. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Clinical exam may reveal warmth, erythema, or tenderness. 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET www.hospira.com/Images/434047_32-91799_1.pdf, http://opp.sagepub.com/content/early/2014/01/13/1078155213517729, Medication Safety Officers Society (MSOS). Reference: 1. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. 2. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. 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. Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. 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. 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. 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. References and bibliography updated. The Oncology Nursing Society4 recommends administering IV vinCRIStine and other vinca alkaloids via a minibag to prevent errors with intrathecal chemotherapy administration. The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. 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. ACR manual on contrast media. Manage conservatively as first line option with supportive non-pharmacologic strategies. Avoid continuous vesicants or irritants (chemotherapy, vasopressors) . endstream endobj startxref Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. European Oncology Nursing Society extravasation guidelines. Copyright 2023 Oncology Nursing Society. 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. 2014 Aug;24(4):352-8. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. 1. 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. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. Eur J Oncol Nurs. Clipboard, Search History, and several other advanced features are temporarily unavailable. Pediatr Rep. 2012 Aug 1;4(3):e28. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; 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 . Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. The vinCRIStine is infused via gravity through the peripheral line. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. %PDF-1.6 % 3. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. 139.59.111.99 Conclusion Updated July 2017. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous.
American Diabetes Association Food List, Master Swimming San Antonio, Farmers' Almanac Summer 2022, Eye Problems After Covid Recovery, How Important Is Website Promotion And Traffic Monitoring, Articles V