Content on this site is protected by U.S. and international copyright laws. In 2021 the Infusion Nurses Society (INS) updated their 2016 guidelines and recommended consideration of midline catheters when the anticipated duration of therapy was 5 to 14 days with a preference for peripheral catheters for shorter durations of therapy and CVCs when longer durations of therapy are required.6 A recent study supports use of midline catheters for prolonged courses of therapy up to 14 days, but there remains limited data for use of midline catheters beyond 2 weeks.7 Currently, the CDC recommends consideration of midline catheters when the duration of IV therapy is likely to exceed 6 days.1,8, Considerations for drugs administered via midline catheter Sodium Chloride. To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. www.hospira.com/Images/434047_32-91799_1.pdf 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. For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>>
Copyright 2023 Oncology Nursing Society. Hospira. However, the INS Task Force identified limited literature describing extravasation of vancomycin. 125 Enterprise Drive If using a peripheral vein, allow the infusion to flow via gravity. 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. Rev. Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. Vesicant Administration Guidelines 1. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141. Some medications are more likely to have vesicant properties in high concentrations or large volumes. Vesicant extravasation: myths and realities. In general--aside from the exceptions listed below--keeping the extravasation cold is preferable to cause vasoconstriction, to prevent spread of the medication, and to decrease inflammation/pain. 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. If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. 1 2023 Institute for Safe Medication Practices. Ryan Rodriguez, PharmD, BCPS J Pediatr Oncol. Nonetheless, a review of literature of known vesicants and drugs reported to cause vascular injury or extravasation indicates some drugs that may present higher risk when administered via midline catheter. Caution: excessive cold can cause tissue damage. What are other facilities doing to avoid excessive drug loss in the tubing? There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. Calcium Chloride. Accidental administration of vincristine in pediatric patients. Midline catheters differ from other VADs with regard to their insertion and termination sites.1,3Midline catheters are inserted peripherally into the antecubital fossa or upper arm via the basilic, cephalic, or brachial vein, and extend from 8 to 20 cm centrally, where the catheter tip terminates at or below the axillary vein. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. In some regimens, enough data support sequencing of agents, but in others, data are lacking. 2 0 obj
Ex: Name & date of birth 2. Oncologist. 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. Unauthorized use of these marks is strictly prohibited. 125 Enterprise Drive 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. Lu H, Hou Y, Chen J, et al. American College of Radiology. Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. J Intraven Nurs. 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. 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. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. 3/26/2014 5. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. Email ONSs clinical inbox at clinical@ons.org to reach one of our oncology clinical specialists, who can advise on ONS recommendations, best practices, and evidence support. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. Updated July 2017. 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. 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. 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. Overview, prevention and management of chemotherapy extravasation. government site. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) 4. ACR manual on contrast media. 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. All rights reserved. Federal government websites often end in .gov or .mil. The .gov means its official. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Courtney Krueger, PharmD, BCPS Clipboard, Search History, and several other advanced features are temporarily unavailable. Infusion therapy standards of practice. 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. 2. eCollection 2012 Jul 31. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. 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 Clinical exam may reveal warmth, erythema, or tenderness. eCollection 2022. FOIA 2. 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. hbbd```b``
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Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. 09/04/2019. J Oncol Pharm Pract. References: 1. 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. Furthermore, in vitro evidence suggested that vancomycin-associated endothelial damage is caused by factors other than pH. Apply ice to the area for 15 to 20 minutes each hour for 4 hours. doi: 10.4081/pr.2012.e28. In addition, whenever an extravasation occurs or is suspected, vesicant administration must immediately cease, and the appropriate antidote or treatment needs to be promptly administered. 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. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. The procedure includes connecting the bag of saline to a long straight infusion set. eCollection 2018 Apr. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . <>
HHS Vulnerability Disclosure, Help 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. 1 0 obj
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. **Some case reports of extravasation and injection site reactions or inflammation have been reported. 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. Prevention is the most important approach to extravasation management. 866-257-4ONS (866-257-4667). J Oncol Pharm Pract. References: 1. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . government site. The Oncology Nursing Society4 recommends administering IV vinCRIStine and other vinca alkaloids via a minibag to prevent errors with intrathecal chemotherapy administration. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. endstream
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However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. 2014;(Epub ahead of print). Unable to load your collection due to an error, Unable to load your delegates due to an error. This site needs JavaScript to work properly. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. Extravasation of antineoplastic agents: prevention and treatments. $on8+i5BqlA/K>I,ELi{z292%4ImIK=EYG[tlX5l6XjVYU>WyAfb;%a@ Potassium Chloride. (K k0|hzv 6gN5UzVa+91C+yTOOcV^t^IjpiOROeutcI9GOqs'."XA*c2@GfK!rKP;{4?|h=,G _wyNdfSc#A]LHq#@Gtn[YWk%1o*Bbyk'82h6~IOvvi2`6 The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. European Oncology Nursing Society extravasation guidelines. sharing sensitive information, make sure youre on a federal You can email the site owner to let them know you were blocked. Polovich M, Olsen M, LeFebvre KB, eds. National Library of Medicine Introduction 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. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, selecting an appropriate administration site for peripheral vesicant administration, and checking for a blood return prior to and during vesicant administration. Clinical Associate Professor, Drug Information Specialist, Updated by: Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. A subsequent 2013 revision Avoiding the use of infusion pumps for vesicant administration via short infusion using a peripheral vein (Polovich et al., 2009) www2.ons.org/ClinicalResources/Vincristine/Safety By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. 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. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Plast Reconstr Surg Glob Open. PMC Find the answers to questions regarding symptoms, side effects, and more. 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET Although relevant guidelines and policy statements existed (e.g., OSHA'sControlling Occupational Exposure to Hazardous Drugs, Chapter 2: Safe Handling of Chemotherapy Drugs, the ONSChemotherapy and Biotherapy Guidelines and Recommendations for Practice, ASCO'sCriteria for Facilities and Personnel for the Administration of Parenteral Systemic Antineoplastic Therapy), specific requirements to promote patient safety had not been well-defined by key stakeholders.
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