<>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Griffiths V. Midline catheters: indications, complications and maintenance. Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. Federal government websites often end in .gov or .mil. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. Special Considerations When Administering IV Chemotherapy - ONS Voice government site. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). J Oncol Pharm Pract. 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. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Clinical exam may reveal warmth, erythema, or tenderness. However, the INS Task Force identified limited literature describing extravasation of vancomycin. 2016 Updated American Society of Clinical Oncology/Oncology Including Development of an evidence-based list of noncytotoxic vesicant medications and solutions. Minor updates to administration and patient education. FOIA The Oncology Nursing Society4 recommends administering IV vinCRIStine and other vinca alkaloids via a minibag to prevent errors with intrathecal chemotherapy administration. 8600 Rockville Pike Vesicant Administration Guidelines 1. 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. Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. Pittsburg, PA: Oncology Nursing Society; 2014. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. You can email the site owner to let them know you were blocked. 4. Pittsburg, PA: Oncology Nursing Society; 2014. European Oncology Nursing Society extravasation guidelines. Rev. Cold - If using sodium thiosulfate, apply cold pack for 6 to 12 hours after administration of sodium thiosulfate. Flare reaction: A skin reaction to a medication which is an allergic response. 1 Note: for sterility reasons, USP 797 recommends a beyond-use date, which is less than the maximum stability above. References: 1. 2088 0 obj <> endobj 1 0 obj Please. stream 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, For more information on nurses, chemotherapy, and pregnancy, watch. 2021 Update: What are considerations for determining whether a drug may Sodium Chloride. Current ASCO/ONS standards address the safety of all routes of chemotherapy administration to adult patients in the outpatient and inpatient settings. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? Avoid the "blame game.". 2012;18(1):155-7. 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]. 3/10/2014, 6. 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. Cloudflare Ray ID: 7c0b26d1e9b36bd5 2023 Institute for Safe Medication Practices. Avoid continuous vesicants or irritants (chemotherapy, vasopressors) . (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? By using a thorough medical and occupational history questionnaire, you will gain a cost-effective way of monitoring employee health over time. doi: 10.4081/pr.2012.e28. 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. 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. HHS Vulnerability Disclosure, Help The Hospira Brand of vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial package insert2 states: 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . Answer: To prevent excessive drug loss, some organizations are utilizing a back flushing method to infuse the remaining volume of drug that may remain in the IV tubing. ACR manual on contrast media. Careers. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 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. MeSH Caution: excessive heat can cause tissue damage. Content on this site is protected by U.S. and international copyright laws. Abstract. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. Centers for Disease Control and Prevention. When assessing a chemotherapy extravasation, it is important to understand the classification of the chemotherapeutic agent in terms of its potential to cause cellular damage if extravasated. J Intraven Nurs. Extravasation of noncytotoxic drugs. 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. Accessibility J Oncol Pharm Pract. Find the answers to questions regarding symptoms, side effects, and more. Polovich M, Olsen M, LeFebvre KB, eds. HHS Vulnerability Disclosure, Help 3/10/2014, Institute for Safe MedicationPractices 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. The https:// ensures that you are connecting to the 6. 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 Vesicant & irritant chemotherapy - A Hematology Oncology Wiki Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. Package insert for vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial. There are non-chemo medications and solutions that have vesicant properties as well and can cause extravasation. Cold (different suggestions depending on reference): Heat (different suggestions depending on reference): Cold - for 6 to 12 hours after administration of sodium thiosulfate. 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. Boulanger J, Ducharme A, Dufour A, et al. Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. Blood Rev. 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? 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.6 Although the extremes are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas with osmolarity exceeding 900 mOsm/L. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. This site needs JavaScript to work properly. Listed below are a few non-chemo agents: Vancomycin. Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital 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. Managing Extravasation During Chemotherapy Administration http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. Rev. Polovich M, Olsen M, LeFebvre KB, eds. Ryan Rodriguez, PharmD, BCPS Disclaimer. References: 1. Reviewed electronically by nursing reference committee. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. Bethesda, MD 20894, Web Policies Developing extravasation protocols and monitoring outcomes. Drug Safety and Administration - Cancer Care Ontario No current standard or scoring system exists for the . 5-Safe administration of anti-cancer drugs | eviQ Clinical exam may reveal warmth, erythema, or tenderness. %%EOF <>/Metadata 1012 0 R/ViewerPreferences 1013 0 R>> 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. Midline catheters have properties that differ from both those of traditional peripheral IV catheters and central venous catheters (CVCs). Bethesda, MD 20894, Web Policies Extravasation of antineoplastic agents: prevention and treatments. government site. Polovich M, Olsen M, LeFebvre KB, eds. endobj