09/04/2019. Performance & security by Cloudflare. To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org. Midline catheters represent a unique vascular access device (VAD) for patients requiring intravenous (IV) administration of drugs or other infusates.1,2After their introduction in the 1950s, hypersensitivity and phlebitis reactions to the manufacturing materials led to a temporary decline in the use of midline catheters through the 1990s; however, a redesign of these products in recent years has led to their renewed adoption. A subsequent 2013 revision Irritants and Vesicants Guide to Intravenous Administration via Midline Catheters . Federal government websites often end in .gov or .mil. Hyaluronidase may be used in extreme scenarios such as large volume extravasation or severe irritation. 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. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, sel Calcium Chloride. The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. 2008 Mar;13(3):284-8. doi: 10.1634/theoncologist.2007-0191. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 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. 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. Question:Wouldnt the administration of vinCRIStine IV push using a syringe be much shorter in duration and with less chance of extravasation than administration using a minibag? doi: 10.1097/GOX.0000000000001743. 3/26/2014 5. 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. 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Braun Recalls Certain Lots of Blood Administration Sets, FDA Approves Sunitinib Malate for Adjuvant Treatment of Renal Cell Carcinoma, News, Views, and Advocacy From the Oncology Nursing Society, Copyright 2023 Oncology Nursing Society, ONSs Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, ONS and American Society of Clinical Oncology standards, Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 3/10/2014, 7. The safety of midline catheters for intravenous therapy at a large academic medical center. Accessibility Accessed August 2, 2021. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Before By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. 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. Intravascular catheter-related infection (BSI). A central line is always required for vesicant or any chemotherapy in the home. Boulanger J, Ducharme A, Dufour A, et al. 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. 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. <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>>
www.hospira.com/Images/434047_32-91799_1.pdf Centers for Disease Control and Prevention. David V, Christou N, Etienne P, et al. Some medications are more likely to have vesicant properties in high concentrations or large volumes. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. Updated July 2017. PDF Chemotherapy Drugs for Cancer Treatment: Administration, Safe Handling Rev.12/2/2014. Advocating for the Provision of Alternate Responsibilities for Nurses Who Are Pregnant, Breastfeeding, or Trying to Conceive, Medical surveillance programs are recommended to detect changes in the health status of those working with hazardous drugs. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. 2141 0 obj
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2.13.2 Vesicant chemotherapy administered through a peripheral intravenous must be infused IV push as ordered or via a short-term gravity intravenous line. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. %PDF-1.7
Once the infusion is complete, the short set is dropped to backfill the line with saline and then the remaining drug is infused. Nafcillin. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. 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 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. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. Rev. Of the utmost importance is that the administration setup ensures chemotherapy is given safely and allows for prompt nursing intervention in the event of an adverse reaction or infiltration. Vesicants: not just chemo agents! | Infusion Nurse Blog Clinical Assistant Professor, Drug Information Specialist 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. (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 Content on this site is protected by U.S. and international copyright laws. 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 . hbbd```b``
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References: 1. Accidental administration of vincristine in pediatric patients. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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 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. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. J Oncol Pharm Pract. 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. European Oncology Nursing Society extravasation guidelines. Front Oncol. Central VADs may also be more appropriate in patients needing longer-term therapy.3 Although some evidence has supported lower thrombosis risk with midline catheters compared with CVCs,1 a recent systematic review of 12 studies in 40,871 patients found that risk of venous thromboembolism was significantly higher with a midline catheter compared with a PICC (3.97% versus 2.29%; relative risk, 1.53; 95% CI, 1.33 to 1.76; p<0.00001).4 However, evidence evaluating the risk of catheter-related bloodstream infections (CRBSI) continues to find similar or improved rates of infection with midline catheters compared with PICCs.5, Compared with midline catheters, peripheral IV catheters are inserted more distally and most often utilize veins of the dorsum of the hand for cannulation.1-3Peripheral IV catheters have high first-attempt failure rates (26% in adults, 54% in children) and often require recannulation in larger more proximal sites.1,2Therefore, midline catheters may reduce the need for recannulation and thereby afford a longer dwell time. American Society of Clinical Oncology (ASCO), Personal Protective Equipment for Use with Hazardous Drugs. 139.59.111.99 2009]. Always stop infusion of the causative medication first and, if appropriate, elevate the affected extremity. Accessibility These . The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. Ex: Name & date of birth 2. For example, many cytotoxic agents (ie, chemotherapy) are considered vesicants and should not be administered via midline catheters according to INS standards.10,11Additionally, in 2017, the INS assigned a Vesicant Task Force to publish a list of noncytotoxic vesicant medications and solutions.11The Table below, while not exhaustive, details drugs from this list, as well as drugs that have extremes of pH or osmolarity that have been associated with vascular injury or extravasation.8,9, One drug that has generated controversy regarding its appropriateness for administration via midline catheter is vancomycin. Plymouth Meeting, PA 19462. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. sharing sensitive information, make sure youre on a federal MeSH eCollection 2012 Jul 31. 6. The information presented is current as of August 2, 2021. 2012;18(suppl):16-7. J Oncol Pharm Pract. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? Reference: 1. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. Gorski LA, Stranz M, Cook LS, et al. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. **Some case reports of extravasation and injection site reactions or inflammation have been reported.