(Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) Before Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. References: 1. 3/10/2014, 7. Accessibility 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." When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. Rev. Avoid continuous vesicants or irritants (chemotherapy, vasopressors) . 2012;18(1):155-7. Special Considerations When Administering IV Chemotherapy - ONS Voice By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. Not a current ONS member or journal subscriber? Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. Clinical exam may reveal warmth, erythema, or tenderness. The flush line can be used before, during, and after the infusion to verify line patency and blood return for a flush solution if the chemotherapy must be stopped because of an adverse reaction. Lastly, they recommend avoidance of midline catheters in patients with a history of thrombosis, hypercoagulability, venous stasis, or with a need to preserve vein integrity, such as in patients with end-stage renal disease. www.hospira.com/Images/434047_32-91799_1.pdf, http://opp.sagepub.com/content/early/2014/01/13/1078155213517729, Medication Safety Officers Society (MSOS). 5-Safe administration of anti-cancer drugs | eviQ University of Illinois at Chicago College of Pharmacy. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. Polovich M, Olsen M, LeFebvre KB, eds. J Intraven Nurs. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 1998 Jul-Aug;21(4):232-9. 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. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. Ryan Rodriguez, PharmD, BCPS Polovich M, Olsen M, LeFebvre KB, eds. 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. 3. All rights reserved. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. 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. A subsequent 2013 revision Bookshelf This information is intended as an educational piece and should not be used as the sole source for clinical decision making. Infuse in an extremity or area other than the one affected by extravasation. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. The Hospira Brand of vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial package insert2 states: %%EOF Patients often seek explanations for why their extravasations occurred. Lu H, Hou Y, Chen J, et al. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Updated July 2017. 2014;(Epub ahead of print). National Library of Medicine 2012;18(suppl):16-7. 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. Extravasation is a known risk of vesicant administration. The action you just performed triggered the security solution. European Oncology Nursing Society extravasation guidelines. The https:// ensures that you are connecting to the endobj The procedure includes connecting the bag of saline to a long straight infusion set. Management of Chemotherapy Extravasations - U.S. Pharmacist Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. Chemotherapy Extravasation | PSNet - Agency for Healthcare Research and Gilbar PJ. Rev. Administering Vesicants | ONS Oncology Nursing Society releases updated guidelines on - Healio For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. sharing sensitive information, make sure youre on a federal 2108 0 obj <>/Filter/FlateDecode/ID[<79BA663E75301A408346CF53CE9BCBB7><05BE28B3380661489955B8DFD5505C1D>]/Index[2088 54]/Info 2087 0 R/Length 102/Prev 343790/Root 2089 0 R/Size 2142/Type/XRef/W[1 3 1]>>stream 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. References: 1. 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. Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta-analysis [published online ahead of print, 2020 Dec 29]. 1 0 obj Vesicant Administration Guidelines 1. Some medications are more likely to have vesicant properties in high concentrations or large volumes. Heat - 15 to 20 minutes at a time for at least four times per day for 24 to 48 hours. 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. Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital Seo H, Altshuler D, Dubrovskaya Y, et al. endobj $on8+i5BqlA/K>I,ELi{z292%4ImIK=EYG[tlX5l6XjVYU>WyAfb;%a@ **Some case reports of extravasation and injection site reactions or inflammation have been reported. Cloudflare Ray ID: 7c0b26d1e9b36bd5 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. TheAmerican Society of Clinical Oncology (ASCO)and ONS are conducting an ongoing collaborative project to use a rigorous, consensus-based process to develop standards for the safe administration of chemotherapy. Generally, drugs that are vesicants or have extremes of pH or osmolarity should not be administered via midline catheters. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. PDF Disconnecting Chemotherapy in the Patient's Home - University of Michigan 1. J Oncol Pharm Pract. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; Manage conservatively as first line option with supportive non-pharmacologic strategies. Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. Potassium Chloride. Paclitaxel, nanoparticle albumin-bound (Abraxane), Chemotherapy extravasation injury (UpToDate), ONS (Oncology Nursing Society) chemotherapy extravasation FAQs, Beatson West of Scotland Cancer Centre Chemotherapy extravasation guideline, West Suffolk Hospitals extravasation guideline, https://hemonc.org/w/index.php?title=Vesicant_%26_irritant_chemotherapy&oldid=68542, About HemOnc.org - A Hematology Oncology Wiki. 125 Enterprise Drive doi: 10.1097/GOX.0000000000001743. Nafcillin. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. All rights reserved. Gilbar P. Inadvertent intrathecal administration of vincristine: has anything changed? Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. Sodium Chloride. Polovich M, Olsen M, LeFebvre KB, eds. Minor updates to administration and patient education. References: 1. A central line is always required for vesicant or any chemotherapy in the home. Reviewed electronically by nursing reference committee. endstream endobj startxref <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>> 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. 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. Federal government websites often end in .gov or .mil. These medications are generally considered to be unlikely to cause injury when extravasation occurs: These medications are generally described as causing mild to moderate inflammation when extravasation occurs. Do not pinch the IV administration tubing because this can cause the vein to rupture. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? Venous irritation (chemical phlebitis) that occurs with drug administration into a vein that remains intact (eg, vinorelbine and epirubicin), and other cutaneous complications of chemotherapy are discussed elsewhere.
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