vesicant chemotherapy administration guidelines
1990 Mar-Apr;13(2):111-4. Taxanes: vesicants, irritants, or just irritating? 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. Access to this article is restricted. The https:// ensures that you are connecting to the e.YvIQ|!C2\@&;:8 h qF . uDX i! Vesicant chemotherapy extravasation antidotes and treatments. Managing Extravasation During Chemotherapy Administration 3. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. 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. The .gov means its official. 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. Click to reveal Vesicant chemotherapy extravasation antidotes and treatments Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Unauthorized use of these marks is strictly prohibited. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. %PDF-1.7 In order from most likely to least likely to cause damage when extravasation occurs: vesicants (most likely), exfoliants, irritants, inflammitants, and neutrals (least likely). 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. 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. eCollection 2018 Apr. A subsequent 2013 revision Oncology Nursing Society releases updated guidelines on - Healio Administering Vesicants | ONS 2023 Institute for Safe Medication Practices. 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. 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. Seo H, Altshuler D, Dubrovskaya Y, et al. eCollection 2012 Jul 31. 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. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. Managing Vesicant Extravasations | The Oncologist | Oxford Academic 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. Extravasation of antineoplastic agents: prevention and treatments. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment . What do you recommend? 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. 3/10/2014, Institute for Safe MedicationPractices 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. Question:Will administering vinCRIStine in a minibag increase the risk of extravasation? 09/04/2019. For permissions, please contacthelp@ons.org. Please enable it to take advantage of the complete set of features! Antidotes to vesicant chemotherapy extravasations. *Follow guidelines and treat like a vesicant. Before These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, sel Nurgat Z, Smythe MP, Aljedai A. Disclaimer. Clipboard, Search History, and several other advanced features are temporarily unavailable. Rev.12/2/2014. David V, Christou N, Etienne P, et al. Drug Safety and Administration - Cancer Care Ontario Clipboard, Search History, and several other advanced features are temporarily unavailable. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. The minibag of vinCRIStine, using a short infusion set, is connected to the Y-site closest to the patient. References: 1. Question: Is the dilution of vinCRIStine in a minibag stable? Gorski LA, Hadaway L, Hagle ME, et al. Rev. Introduction. Management of Chemotherapy Extravasations - U.S. Pharmacist 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. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Before Section V: Immediate Complications of cytotoxic therapy, p.105. Monitor for extravasation according to hospital policy. www.hospira.com/Images/434047_32-91799_1.pdf Oncol Nurs Forum. Midline catheters have properties unique from those of peripheral and central VADs. Management of the extravasation of anti-neoplastic agents. 3/10/2014, 7. References: 1. The https:// ensures that you are connecting to the References: 1. 6. Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. The loss of drug in the tubing exceeds the 5% dose variability acceptable for our chemotherapy doses per our hospital policy. www.hospira.com/Images/434047_32-91799_1.pdf, http://opp.sagepub.com/content/early/2014/01/13/1078155213517729, Medication Safety Officers Society (MSOS). Avoid continuous vesicants or irritants (chemotherapy, vasopressors) . government site. 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 UIC's seven health sciences colleges and health care delivery enterprise. Polovich M, Olsen M, LeFebvre KB, eds. Furthermore, in vitro evidence suggested that vancomycin-associated endothelial damage is caused by factors other than pH. 3/26/2014 5. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Reference: 1. Gilbar P. Inadvertent intrathecal administration of vincristine: has anything changed? The .gov means its official. Although vesicant chemotherapy extravasations cannot be entirely prevented, the risk of extravasation can be reduced by adhering to guidelines for safe vesicant administration. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 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. Email ONSs clinical inbox at clinical@ons.org to reach one of our oncology clinical specialists, who can advise on ONS recommendations, best practices, and evidence support. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. 2006 Nov 27;33(6):1134-41. doi: 10.1188/06.ONF.1134-1141.
