Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Oncol Nurs Forum. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. This site needs JavaScript to work properly. Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. Conclusion But chemo agents are not the only vesicants that cause extravasation injuries. J Oncol Pharm Pract. FOIA Gilbar P. Inadvertent intrathecal administration of vincristine: has anything changed? Updated January 2021. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. Calcium Gluconate. endobj 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. Vesicant & irritant chemotherapy - A Hematology Oncology Wiki official website and that any information you provide is encrypted 866-257-4ONS (866-257-4667). Pittsburg, PA: Oncology Nursing Society; 2014. Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. www.hospira.com/Images/434047_32-91799_1.pdf, http://opp.sagepub.com/content/early/2014/01/13/1078155213517729, Medication Safety Officers Society (MSOS). Courtney Krueger, PharmD, BCPS Before Version number changed to v.5. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. 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 PDF Antineoplastic Drug Administration: Vesicant and Irritant Agents The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. Extravasation of antineoplastic agents: prevention and treatments. J Oncol Pharm Pract. PDF BC Cancer Extravasation Hazard Table The safety of midline catheters for intravenous therapy at a large academic medical center. Bethesda, MD 20894, Web Policies 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. Safety and feasibility assessment of extending the flushing interval in totally implantable venous access port flushing during the non-treatment stage for patients with breast cancer. Plast Reconstr Surg Glob Open. (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 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 Oncology Nursing Society (ONS) is a professional association that represents 100,000 nurses and is the professional home to more than 35,000 members. Prepared by: 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. This decision must be weighed in light of certain death if the drug is administered via the wrong route. The Independent Clinical Oncology Network's Chemotherapy Administration. References and bibliography updated. e.YvIQ|!C2\@&;:8 h qF . uDX i! What are current recommendations for treatment of drug extravasation? ACR Committee on Drugs and Contrast Media. 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]. World J Clin Oncol. Access to this article is restricted. National Library of Medicine Unable to load your collection due to an error, Unable to load your delegates due to an error. Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. 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. Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org. Prevention is the most important approach to extravasation management. Lu H, Hou Y, Chen J, et al. Do not pinch the IV administration tubing because this can cause the vein to rupture. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. 1998 Jul-Aug;21(4):232-9. doi: 10.1097/GOX.0000000000001743. Furthermore, in vitro evidence suggested that vancomycin-associated endothelial damage is caused by factors other than pH. Gorski LA, Hadaway L, Hagle ME, et al. Pittsburg, PA: Oncology Nursing Society; 2014. (An infusion pump is not recommended by the Oncology Nurses Society (ONS) to administer vinCRIStine in this situation1 .) American Society of Clinical Oncology (ASCO), Personal Protective Equipment for Use with Hazardous Drugs. National Library of Medicine Updated July 2017. 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. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Gilbar PJ, Carrington CV. In some regimens, enough data support sequencing of agents, but in others, data are lacking. J Oncol Pharm Pract. If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. 9fGr,zGa$9:WSs["8d/#'K f.'nw_EET Bethesda, MD 20894, Web Policies Monitor for extravasation according to hospital policy. Ex: Name & date of birth 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. eCollection 2018 Apr. 5-Safe administration of anti-cancer drugs | eviQ References: 1. A subsequent 2013 revision 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 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 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. The site is secure. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. 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. The .gov means its official. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. HHS Vulnerability Disclosure, Help Listed below are a few non-chemo agents: Vancomycin. Facebook - National Cancer Institute Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings. In, For more information on nurses, chemotherapy, and pregnancy, watch. NCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. Reference The Hospira Brand of vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial package insert2 states: Unauthorized use of these marks is strictly prohibited. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. 3 0 obj 2. Copyright 2023 Oncology Nursing Society. 3/26/2014, 4. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. Rev. Rev.12/2/2014. Kapucu S, zkaraman A, Uysal N, Bagcivan G, eref F, Elz A. Asia Pac J Oncol Nurs. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. This site needs JavaScript to work properly. sharing sensitive information, make sure youre on a federal The https:// ensures that you are connecting to the <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>> Preventing and managing vesicant chemotherapy extravasations 1. The Oncology Nursing Society and Infusion Nurses Society have published guidelines for vesicant administration and extravasation management. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. 5200 Butler Pike 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. 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. The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. 2088 0 obj <> endobj Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants. This page was last edited 14:24, 26 April 2023 by. 3/10/2014, 7. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. %PDF-1.7 HHS Vulnerability Disclosure, Help Vesicant extravasation: myths and realities. Disclaimer. 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. Disclaimer. Clinical exam may reveal warmth, erythema, or tenderness. VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. References: 1. However, the INS Task Force identified limited literature describing extravasation of vancomycin. Two important safety features are important here. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. Heat - 15 to 20 minutes at a time for at least four times per day for 24 to 48 hours.