Version number changed to v.5. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. 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. 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]. Copyright 2023 Oncology Nursing Society. The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. 2088 0 obj <> endobj All rights reserved. Gilbar PJ, Carrington CV. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. Special Considerations When Administering IV Chemotherapy - ONS Voice Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. References: 1. 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. The vinCRIStine is infused via gravity through the peripheral line. Gilbar P. Inadvertent intrathecal administration of vincristine: has anything changed? %PDF-1.6 % PDF NCCN Chemotherapy Order Templates The Hospira Brand of vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial package insert2 states: %PDF-1.7 The safety of midline catheters for intravenous therapy at a large academic medical center. Irritants and Vesicants Guide to Intravenous Administration via Midline Catheters . PDF Vesicant Chemotherapy Extravasation Antidotes and Treatments - ResearchGate Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. Cloudflare Ray ID: 7c0b26d1e9b36bd5 4. Introduction 3/26/2014 5. 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). Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. Calcium Chloride. Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. What do you recommend? Oncology Nursing Society releases updated guidelines on - Healio Would you like email updates of new search results? 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. Available antidote and treatment formulations and their preparation and administration also are discussed. Pittsburgh, PA 15275 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. doi: 10.1097/GOX.0000000000001743. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Clinical exam may reveal warmth, erythema, or tenderness. 833 S. Wood St., Suite B12, College of Pharmacy, (MC 886), Chicago, IL 60612, 2023 The Board of Trustees of the University of Illinois, UI Health is UICs academic health enterprise. 866-257-4ONS (866-257-4667). Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? 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. Federal government websites often end in .gov or .mil. A subsequent 2013 revision 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." Clinical Associate Professor, Drug Information Specialist, Updated by: Manage conservatively as first line option with supportive non-pharmacologic strategies. 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. J Intraven Nurs. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. 3/10/2014, 7. Lu H, Yang Q, Yang L, et al. ASCO/ONS Chemotherapy Administration Safety Standards 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]. In order from most likely to least likely to cause damage when extravasation occurs: vesicants (most likely), exfoliants, irritants, inflammitants, and neutrals (least likely). Clipboard, Search History, and several other advanced features are temporarily unavailable. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; stream Some medications are more likely to have vesicant properties in high concentrations or large volumes. 1990 Mar-Apr;13(2):111-4. Drug Safety and Administration - Cancer Care Ontario FOIA 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. 3/10/2014, Institute for Safe MedicationPractices National Library of Medicine Properties of midline catheters Vesicant chemotherapy extravasation antidotes and treatments <> This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. All rights reserved. Handbook of Injectable Drugs 17th Edition. 5200 Butler Pike Before Gilbar PJ. Oncologist. The procedure includes connecting the bag of saline to a long straight infusion set. J Oncol Pharm Pract. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. 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. Polovich M, Olsen M, LeFebvre KB, eds. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. 2021 Update: What are considerations for determining whether a drug may If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. Epub 2014 Jul 3. 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. All rights reserved. Performance & security by Cloudflare. UIC's seven health sciences colleges and health care delivery enterprise. Boulanger J, Ducharme A, Dufour A, et al. Midline catheters have properties unique from those of peripheral and central VADs. Do not pinch the IV administration tubing because this can cause the vein to rupture. The action you just performed triggered the security solution. 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. Please enable it to take advantage of the complete set of features! Also, dilution of the vinca alkaloid likely reduces the impact of any extravasation that might occur. and transmitted securely. 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. Rev. This page was last edited 14:24, 26 April 2023 by. Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. Disclaimer. Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. 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. Furthermore, in vitro evidence suggested that vancomycin-associated endothelial damage is caused by factors other than pH. Bethesda, MD 20894, Web Policies Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. Heat - Apply warm compresses to extravasation site for 1 hour. Would you like email updates of new search results? doi: 10.4081/pr.2012.e28. Rev.12/2/2014. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? 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. FOIA For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Generally, drugs that are vesicants or have extremes of pH or osmolarity should not be administered via midline catheters. 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. 2012;18(suppl):16-7. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2016 Feb 10; 7(1): 8797. For permissions, please contacthelp@ons.org. National Library of Medicine Abstract. www.hospira.com/Images/434047_32-91799_1.pdf Vesicant extravasation: myths and realities. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. Pittsburg, PA: Oncology Nursing Society; 2014. 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. Eur J Oncol Nurs. The venous access should not be removed immediately, since it can be used to attempt aspirating extravasated fluid and for administration of an antidote, if clinically appropriate. These . sharing sensitive information, make sure youre on a federal Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Infuse in an extremity or area other than the one affected by extravasation. Best Practice #1 FAQ | Institute For Safe Medication Practices Patients often seek explanations for why their extravasations occurred. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. Preventing and Managing Vesicant Chemotherapy Extravasations 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. References: 1. R*#;Wv777UtB4o"*v fgf?m[q\.>:TM=U)!f7STG.(Ky\B/Uc>L3}4d##0 ~!m I/>fwo8X p#D:}(edI? *(rC?Qe<=O%cfkkdsWq(u ?|b1k#^b!*tne{R^i5 }ikSbRI{xlQYSgAoKmgx~f 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. (PDF) Chemotherapy administration standards and guidelines: The Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment . The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). Caution: excessive heat can cause tissue damage. Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. 2013;1(1):9- 16. 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. 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. Cold (different suggestions depending on reference): Heat (different suggestions depending on reference): Cold - for 6 to 12 hours after administration of sodium thiosulfate. official website and that any information you provide is encrypted Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. 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. Blood Rev. 1990 Mar;4(1):41-60. doi: 10.1016/0268-960x(90)90015-k. Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. Careers. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Seo H, Altshuler D, Dubrovskaya Y, et al. Most importantly, organizations must weigh the risk of possible extravasation versus certain death from the accidental administration of vinCRIStine by the intrathecal route when making decisions about changing practice. Developing extravasation protocols and monitoring outcomes. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Not a current ONS member or journal subscriber? Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. This site needs JavaScript to work properly. Preventing and managing vesicant chemotherapy extravasations Accidental administration of vincristine in pediatric patients. 2. PMC 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. 1. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Plast Reconstr Surg Glob Open. The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. 2141 0 obj <>stream 4 0 obj Oncol Nurs Forum. 8600 Rockville Pike The information presented is current as of August 2, 2021. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. 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. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Tubing features can present another challenge when considering how to best administer chemotherapy agents. 2018 Apr 19;6(4):e1743. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. 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 Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Reference: 1. If not clearly defined in the literature. Pittsburgh, PA 15275 Updated January 2021. x][8~Gi"K6$Yd cG_")X=@zdbXb"f]FyMQrt2i[Fl')o:{pO^}~[~9>aP,p"yKxb}t+~{x:?OA9?tvK:0+M*7y wg|[]okN(6cw1gQX$|6x5Q^Xn{~(8klFaL8?k|9}YjO"?}M8OC?}T-Qezi^D1@olKSw8E[D7:z,eQ,rY!'HT|9,}O$. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. 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". 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET But chemo agents are not the only vesicants that cause extravasation injuries. 2. eCollection 2022. 1998 Jul-Aug;21(4):232-9. Prepared by: 866-257-4ONS (866-257-4667). eCollection 2012 Jul 31. (An infusion pump is not recommended by the Oncology Nurses Society (ONS) to administer vinCRIStine in this situation1 .) PDF Antineoplastic Drug Administration: Vesicant and Irritant Agents 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 Extravasation is a known risk of vesicant administration. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. 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. An official website of the United States government. HHS Vulnerability Disclosure, Help 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. American Society of Clinical Oncology (ASCO), Personal Protective Equipment for Use with Hazardous Drugs. A central line is always required for vesicant or any chemotherapy in the home. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. To discuss the information in this article with other oncology nurses, visit the ONS Communities. Conclusion Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. The .gov means its official. Lu H, Hou Y, Chen J, et al. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) 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. In, For more information on nurses, chemotherapy, and pregnancy, watch. HHS Vulnerability Disclosure, Help Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. Taxanes: vesicants, irritants, or just irritating? 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. 8600 Rockville Pike Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. 125 Enterprise Drive Reference Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings. World J Clin Oncol. endobj Antidotes to vesicant chemotherapy extravasations. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Secondary infusions are safest administered with the use of secondary tubing attached with a Luer lock connector to the primary line containing a compatible IV solution. Apply ice to the area for 15 to 20 minutes each hour for 4 hours. 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. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. Extravasation injury from chemotherapy and other non - UpToDate The practice of monitoring the administration of vinCRIStine and other vinca alkaloids in a minibag to avoid extravasation via a peripheral IV is essentially the same as if it was administered IV push. 1 Bookshelf Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Additionally, the risk of cytotoxicity is reduced by intermittent compared with continuous infusion, as well as by dilution of vancomycin to concentrations of 2 to 5 mg/mL. Pittsburg, PA: Oncology Nursing Society; 2014. eCollection 2012 Jul 31. Gilbar PJ, Carrington CV. Copyright 2023 Oncology Nursing Society. The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. PDF Guidelines on treatment of extravasation - Thames Valley Cancer Alliance Unauthorized use of these marks is strictly prohibited. 3/26/2014, 5. 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. Vesicant Chemotherapy Extravasation Antidotes and Treatments J Pediatr Oncol. Before For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 What are current recommendations for treatment of drug extravasation? 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Nurses, Chemotherapy, and Pregnancy: What Do We Know? Extravasation of noncytotoxic drugs. (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 Trissel LA. PDF Appendix B: Vesicant/Irritant and Extravasation Management Guidelines Treatment of cutaneous injuries of neonates induced by drug extravasation with hyaluronidase and hirudoid. 5-Safe administration of anti-cancer drugs | eviQ Inject 5 mL subcutaneously using a 25 gauge needle, changing needles between each injection, into affected area in a pinwheel fashion. endstream endobj startxref endobj Rev. 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. 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.