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. Infusion therapy standards of practice. 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. Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. Blood Rev. Clinicians considering drug administration via this VAD should review the chemical properties of the drug under consideration from reputable resources (eg, prescribing information) to compare them with the guidance above. Ex: Name & date of birth 2. J Oncol Pharm Pract. What are current recommendations for treatment of drug extravasation? 3 0 obj 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. Assessment of the risk of extravasation with the introduction of vincristine mini-bags to eliminate inadvertent intrathecal administration. Click to reveal Rev. %PDF-1.7 and transmitted securely. Administering Vesicants | ONS Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. Managing Vesicant Extravasations | The Oncologist | Oxford Academic Prevention is the most important approach to extravasation management. This decision must be weighed in light of certain death if the drug is administered via the wrong route. References: 1. 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. HHS Vulnerability Disclosure, Help No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. To discuss the information in this article with other oncology nurses, visit the ONS Communities. American College of Radiology. Manage conservatively as first line option with supportive non-pharmacologic strategies. Polovich M, Olsen M, LeFebvre KB, eds. The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. Pediatr Rep. 2012 Aug 1;4(3):e28. 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. Two important safety features are important here. Plast Reconstr Surg Glob Open. Please enable it to take advantage of the complete set of features! However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. Oncol Nurs Forum. UIC's seven health sciences colleges and health care delivery enterprise. Hospira. Taxanes: vesicants, irritants, or just irritating? Cloudflare Ray ID: 7c0b26d1e9b36bd5 Tubing features can present another challenge when considering how to best administer chemotherapy agents. Please enable it to take advantage of the complete set of features! The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. The site is secure. 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. Griffiths V. Midline catheters: indications, complications and maintenance. Nafcillin. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. Vesicants and irritants with vesicant . 3. The information presented is current as of August 2, 2021. Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. Rev. Special Considerations When Administering IV Chemotherapy - ONS Voice Gorski LA, Hadaway L, Hagle ME, et al. 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". endstream endobj startxref Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. Lu H, Hou Y, Chen J, et al. 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. Updated January 2021. Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. eCollection 2012 Jul 31. e.YvIQ|!C2\@&;:8 h qF . uDX i! 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. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. This site needs JavaScript to work properly. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. PMC The safety of midline catheters for intravenous therapy at a large academic medical center. 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). 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. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. Listed below are a few non-chemo agents: Vancomycin. Plymouth Meeting, PA 19462. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). www.hospira.com/Images/434047_32-91799_1.pdf An official website of the United States government. Disclaimer. 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. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. 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. Best Practice #1 FAQ | Institute For Safe Medication Practices PDF Disconnecting Chemotherapy in the Patient's Home - University of Michigan Extravasation of antineoplastic agents: prevention and treatments. General recommendations for midline administration: A. 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET All rights reserved. J Pediatr Oncol. Developing extravasation protocols and monitoring outcomes. J Intraven Nurs. Pittsburg, PA: Oncology Nursing Society; 2014. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. 2 0 obj 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. According to Trissels Handbook on Injectable Drugs 17th Edition, vinCRIStine is stable at a concentration of 20 mg/L in dextrose 5% in water, Lactated Ringers, and 0.9% sodium chloride for at least 24 hours and up to 21 days with little or no drug loss (under 10%) at 4C and 25C when in the dark. 5200 Butler Pike This page was last edited 14:24, 26 April 2023 by. Bethesda, MD: American Society of Healthsystem Pharmacists; 2012:1104-5. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. Careers. If using a peripheral vein, allow the infusion to flow via gravity. 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. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. 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.