J Oncol Pharm Pract. Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. This page was last edited 14:24, 26 April 2023 by. Ensure the best possible outcomes with ONS standards. 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. The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. Vesicants and irritants with vesicant . Please. 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. 3. 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. 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. Gilbar P. Inadvertent intrathecal administration of vincristine: has anything changed? Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta-analysis [published online ahead of print, 2021 May 15]. The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. Rev. Nurses, Chemotherapy, and Pregnancy: What Do We Know? 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. Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. www.hospira.com/Images/434047_32-91799_1.pdf 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). 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 If using a peripheral vein, allow the infusion to flow via gravity. government site. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. 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." Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. Remove cold pack at least 15 minutes before dexrazoxane therapy. The Hospira Brand of vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial package insert2 states: PMC Oncol Nurs Forum. 3. Caution: excessive heat can cause tissue damage. To report a content error, inaccuracy, or typo, email [email protected]. Lu H, Yang Q, Yang L, et al. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. stream
Copyright 2023 Oncology Nursing Society. Clin J Oncol Nurs. Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. Accidental administration of vincristine in pediatric patients. Use VADs for vesicant administration, continuous infusions of vesicants, anticipated long-term administration of chemotherapy, poor venous access, and for children or older adult patients.a,b Ensure clear visualization of the site throughout the infusion. Find the answers to questions regarding symptoms, side effects, and more. 1998 Jul-Aug;21(4):232-9. 2012;18(suppl):16-7. Polovich M, Olsen M, LeFebvre KB, eds. 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 Oncology Nursing Society (ONS) is a professional association that represents 100,000 nurses and is the professional home to more than 35,000 members. Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. Midline catheters have properties that differ from both those of traditional peripheral IV catheters and central venous catheters (CVCs). 2006;12(2):113-8. Email ONSs clinical inbox at [email protected] to reach one of our oncology clinical specialists, who can advise on ONS recommendations, best practices, and evidence support. J Oncol Pharm Pract. David V, Christou N, Etienne P, et al. Reference: 1. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. Sodium Chloride. 3/26/2014, 5. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 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. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 1990 Mar-Apr;13(2):111-4. and transmitted securely. Gorski LA, Hadaway L, Hagle ME, et al. No formal recommendation, but depending on clinical condition could consider extrapolating from management of other vinca alkaloids: Apply cold pack initially for 30 to 60 minutes, then repeat every 15 minutes on day 1 only. %PDF-1.7
To discuss the information in this article with other oncology nurses, visit the ONS Communities. government site. Monitor for extravasation according to hospital policy. Do not pinch the IV administration tubing because this can cause the vein to rupture. If an antidote is not going to be used, the venous access can be removed after aspiration of the extravasated fluid has been attempted. 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. Two important safety features are important here. Prevention is the most important approach to extravasation management. Vesicant chemotherapy extravasation antidotes and treatments. 09/04/2019. 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. Answer:Some practitioners have expressed concern that administering diluted IV vinCRIStine via a minibag might increase the risk of extravasation and subsequent tissue injury. References: 1. This decision must be weighed in light of certain death if the drug is administered via the wrong route. Front Oncol. In order from most likely to least likely to cause damage when extravasation occurs: vesicants (most likely), exfoliants, irritants, inflammitants, and neutrals (least likely). Accessed August 2, 2021. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. References: 1. J Intraven Nurs. Your IP: {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8
Introduction. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. 2016 Feb 10; 7(1): 8797. 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 . Boulanger J, Ducharme A, Dufour A, et al. Ex: Name & date of birth 2. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. When administering chemotherapy, nurses should always be able to say that safe handling has been considered and opportunity for exposure has been limited, but also that clinical staff have accounted for ensuring the dose is received in its entirety and they can rapidly intervene should an adverse event or complication occur. Pediatr Rep. 2012 Aug 1;4(3):e28. All rights reserved. Tubing features can present another challenge when considering how to best administer chemotherapy agents. An official website of the United States government. MeSH Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. 1995 Jan-Feb;22(1):57-67. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Infuse in an extremity or area other than the one affected by extravasation. Epub 2014 Jul 3. This site needs JavaScript to work properly. In contrast, the Chemotherapy and Biotherapy Guidelines and Recommendations for Practice recommended against infusing vesicant agents peripherally for more than 30-60 min, but they also fail to categorize specifically chemotherapeutic agents as vesicants or irritants [Polovich et al. Pittsburg, PA: Oncology Nursing Society; 2014. Rev. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
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