Rev. Would you like email updates of new search results? Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . 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. Always double check information at the primary references linked below. 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. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. European Oncology Nursing Society extravasation guidelines. Question: Our pediatric department is reluctant to administer vinCRIStine via a minibag through a peripheral IV line since many of our patients do not have a peripherally inserted central catheter (PICC) or central venous access device. Pittsburg, PA: Oncology Nursing Society; 2014. 3. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Gilbar PJ, Carrington CV. Caparas JV, Hu JP. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Vesicant chemotherapy extravasation antidotes and treatments. 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. 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. 2. Also, dilution of the vinca alkaloid likely reduces the impact of any extravasation that might occur. A description of the ASCO/ONS Chemotherapy Administration Safety Standards process for development, consensus, and refinement, as well as a discussion of the standards and results, is available on theASCO website. 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. www.hospira.com/Images/434047_32-91799_1.pdf, http://opp.sagepub.com/content/early/2014/01/13/1078155213517729, Medication Safety Officers Society (MSOS). Centers for Disease Control and Prevention. Midline catheters have properties that differ from both those of traditional peripheral IV catheters and central venous catheters (CVCs). 15 to 20 minutes at a time for at least four times per day for 24-48 hours, warm compresses for 30 to 60 minutes, then alternate off/on every 15 minutes for 1 day, 15 to 20 minutes at a time for at least four times per day for 24 hours. 3. Always obtain/ review MD order sent with delivery, identify patient with 2 identifiers. European Oncology Nursing Society extravasation guidelines. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. Midline catheters have properties unique from those of peripheral and central VADs. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. government site. Remove cold pack at least 15 minutes before dexrazoxane therapy. Listed below are a few non-chemo agents: Vancomycin. 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 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. 3. Properties of midline catheters 6. Once the infusion is complete, the short set is dropped to backfill the line with saline and then the remaining drug is infused. $on8+i5BqlA/K>I,ELi{z292%4ImIK=EYG[tlX5l6XjVYU>WyAfb;%a@ Nafcillin. Eur J Oncol Nurs. 2013;1(1):9- 16. Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. Overview, prevention and management of chemotherapy extravasation. and transmitted securely. It is also important to note that some medications are classified differently by different references. eCollection 2022. All rights reserved. Vesicants and irritants with vesicant . For every 1 mg of mechlorethamine suspected to have extravasated, inject 2 mL of the 1/6 molar sodium thiosulfate solution subcutaneously into the extravasation site using a 25 gauge or smaller needle. 2012;18(suppl):16-7. 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. Oncologist. Extravasation of noncytotoxic drugs. Question:Will administering vinCRIStine in a minibag increase the risk of extravasation? doi: 10.4081/pr.2012.e28. Reference Griffiths V. Midline catheters: indications, complications and maintenance. Cold (different suggestions depending on reference): Heat (different suggestions depending on reference): Cold - for 6 to 12 hours after administration of sodium thiosulfate. Reference: 1. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. Prepared by: Bookshelf 3/10/2014, 7. 8600 Rockville Pike Monitor for extravasation according to hospital policy. Rev. Extravasation of antineoplastic agents: prevention and treatments. Current ASCO/ONS standards address the safety of all routes of chemotherapy administration to adult patients in the outpatient and inpatient settings. There is not a comprehensive list of drugs that are appropriate for administration via midline catheter. 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 Polovich M, Olsen M, LeFebvre KB, eds. % J Oncol Pharm Pract. Available antidote and treatment formulations and their preparation and administration also are discussed. Some medications are more likely to have vesicant properties in high concentrations or large volumes. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 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. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. Calcium Gluconate. 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]. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. 2. 125 Enterprise Drive 2. 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. 139.59.111.99 References: 1. (An infusion pump is not recommended by the Oncology Nurses Society (ONS) to administer vinCRIStine in this situation1 .) In December 2008, ASCO and ONS held a workshop to develop a consensus regarding standards for the safe administration of chemotherapy to adult patients in the outpatient setting. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. government site. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. References: 1. 2006;12(2):113-8. Infuse in an extremity or area other than the one affected by extravasation. Polovich M, Olsen M, LeFebvre KB, eds. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. If an antidote is not going to be used, the venous access can be removed after aspiration of the extravasated fluid has been attempted. Pittsburgh, PA 15275 Introduction Nurgat Z, Smythe MP, Aljedai A. Answer:Some practitioners have expressed concern that administering diluted IV vinCRIStine via a minibag might increase the risk of extravasation and subsequent tissue injury. HHS Vulnerability Disclosure, Help The site is secure. This decision must be weighed in light of certain death if the drug is administered via the wrong route. 1. Assessment of the risk of extravasation with the introduction of vincristine mini-bags to eliminate inadvertent intrathecal administration. 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. Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. 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. 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. A study in Australia involving 68 cancer centers evaluated more than 44,000 doses of vinca alkaloids administered via syringe or minibag to adult and pediatric patients, found that the extravasation rates were similar and low0.03% with syringes and 0.04% with minibags.1 Preliminary data from another study conducted in children and adults found no cases of extravasation during administration via minibags.2 These data strongly support the safe use of minibags in adults and children.3 The risk of extravasation injury doesnt compare to the risk of severe neurological injury and near certain death resulting from the intrathecal administration of vinca alkaloids. 2. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . Pediatr Rep. 2012 Aug 1;4(3):e28. Question: Is the dilution of vinCRIStine in a minibag stable? Copyright 2023 Oncology Nursing Society. Find the answers to questions regarding symptoms, side effects, and more. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. 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. official website and that any information you provide is encrypted 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. 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. Extravasation of antineoplastic agents: prevention and treatments. All rights reserved. Accessibility (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 For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 Disclaimer. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood 2 0 obj The Independent Clinical Oncology Network's Chemotherapy Administration. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. 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. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. 3/10/2014, Institute for Safe MedicationPractices ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. 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 Caution: excessive cold can cause tissue damage. Blood Rev. A central line is always required for vesicant or any chemotherapy in the home. Accessibility 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. National Library of Medicine For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either.
