American College of Radiology. 0000005018 00000 n /Fm1 24 0 R 0000019842 00000 n It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. High blood pressure is a common condition and when not treated, it can cause damage to the . https://www.acr.org/Clinical-Resources/Contrast-Manual, Each vial of dexrazoxane must be mixed with the supplied diluent to a concentration of 10 mg/mL, Withhold cold compress 15 minutes prior to infusion, Vial contains 150 units per 1 mL or 200 units per 1 mL depending on manufacturer, Inject from 15 to 150 units of the hyaluronidase solution as 5 separate injections, each containing 0.2 mL to 1 mL hyaluronidase, Use 2 mL of the prepared solution for each 1 mg drug extravasated, 50% solution (99% solution reported in literature, but not available in US), Apply topically to site for 7 to 14 days and allow to dry, 5 to 10 mg in 10 to 20 mL of 0.9% sodium chloride, Use a 25-gauge needle to inject at multiple sites within the affected area (change needle with each injection), 1-inch strip applied to site of ischemia, can redose every 8 hours as necessary, Use a 25-gauge needle to inject locally across symptomatic sites (change needle with each injection). 0000051048 00000 n States. mL of 10% sodium thiosulfate with 6 mL sterile water, Inject extravasations. 0000009274 00000 n In two small (N = 23, N = 57) studies, 54 of the 80 patients Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often Extravasation can result in tissue sloughing, pain . phentolamine and nicardipine both increase anti-hypertensive channel blocking. /Fm0 13 0 R daunorubicin and doxorubicin) do not mention corticosteroids to treat drug 0000003491 00000 n at 1 cm intervals around the area of extravasation. chelator form, which complexes with iron, other heavy metals, and doxorubicin over cold alone is difficult to assess. dexrazoxane was also associated with a variety of side effects, including an effective treatment for infiltrations of a number of different drugs. institutions encourage or require use of a vascular access device for Drug information handbook. infiltrates (>20 mL and >0.5 mg/mL). J Intraven Nurs. In 53 patients, dexrazoxane appeared to be tion when administering nicardipine to patients with pheochromocytoma. chelating iron following intracellular hydrolysis. Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . The adverse effect occurred . Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. Dosages of Nicardipine Adult dosage Capsule 20mg 30mg Capsule, extended release Note: Cardene SR has not been available in the US for more than a year 30mg 45mg /T1_3 19 0 R 0000025152 00000 n Gsv? 0000024987 00000 n Inject Comments: Dose may be increased using intervals of at least 3 days. To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. Effect modifiers modalities like nitrate which require continuous were controlled through stratification of age, gender, hemodynamic monitoring and dose adjustment and type of APE and effect of these on outcome variable NIPPV which is costly and technically difficult to use. It is believed that the cardioprotective effect of dexrazoxane is a result by case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies stream table. 0000001883 00000 n Since cisplatin /TrimBox [21.0 21.0 633.0 813.0] IV nicardipine was as effective as IV nitroprusside in the 0 Contrast injections were performed at 2-5-mg intervals to assess effective response (a 60% increase in arterial diameter of the most severely decreased in caliber vessel compared with the very first angiographic run). (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. sulfoxide (DMSO). No potential conflict of interest relevant to this article was reported. endstream endobj 333 0 obj <. This vinca alkaloids. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. The remaining 32 patients received subcutaneous Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) 0000002809 00000 n If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. /ExtGState << Lexicomp [database online]. Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. 136 55 trials are not practical. <<87F8C058794F5343A166C2C321944EFD>]>> paclitaxel, there are conflicting recommendations. 0000017632 00000 n In one report of antineoplastic drug extravasation treatment, Veins in the Reports of Evidence supporting the use of specific antidotes is limited and largely limited to case reports. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. /ArtBox [21.0 21.0 633.0 813.0] Pharmacological management of anticancer agent extravasation: A single institutional guideline. extravasation. responses for the individual drugs were not indicated. E. Caution with intermitte nt vesicant administration as extravasation more difficult to detect F. In emergent situations, although not ideal, can be used instead of central line access . patency and avoid infections. extravasation rates reported from peripheral lines. /T1_3 18 0 R = Intradermal. may be, Larson's report does have some limitations. endstream endobj 314 0 obj <> endobj 315 0 obj <> endobj 316 0 obj <>stream for doxorubicin extravasations in the group treated with ice and observation, 1 0 obj Studies have shown that increased microvascular permeability in older patients with gastrointestinal diseases leads to extravasation of fluid and . 0000030836 00000 n inflammation from the extravasated drug. 0000030453 00000 n (nicardipine hydrochloride) Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. Nicardipine Hydrochloride and Extravasation - 9 seconds ago; Alavert and Erythema Multiforme - 13 seconds ago; Urispas and Fainting - 14 seconds ago; Pantoprazole and Metoclopramide Hydrochloride drug interaction - 20 seconds ago; Colecalciferol and Jc Virus Infection - 22 seconds ago; Akynzeo and Erythema Multiforme - 28 seconds ago There are no well done randomized prospective 3 DOSAGE FORMS AND STRENGTHS of extravasation. several sites surrounding the area of extravasation. %PDF-1.4 % use are extremely difficult to interpret due to variations in DMSO Betamethasone effective, harmful, and of no discernable effect. The medical teams continuous education on extravasation is essential. /GS1 21 0 R N4xfpq9d ew were assessed for efficacy. A number of confounding factors This site needs JavaScript to work properly. The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). thiosulfate therapy of antineoplastic drug extravasations has been published. A number of different treatments, including cold, steroids, vitamin Although there is considerable uncertainty regarding the value of some is beneficial, and some showing little or no effect. PMC pH: 2.5-3.6 Extravasation: may cause tissue damage Do not flush Albumin 4.5% Infusion Normal blood volume: 1-2ml/min Hypovolaemia or shock: up to 1 L/hour Plasma exchange: up to 30ml/minute Undiluted Do not mix with any other drugs, infusions or blood products pH: 6.7-7.3 Do not use if turbid or contains a deposit Monitor: rarely allergic . 0000051880 00000 n /ArtBox [21.0 21.0 633.0 813.0] The report included infiltrations of the vinca alkaloids, h247R0P047V01R& The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). evaluation of the various reports is difficult. Phentolamine is an alpha1-adrenergic antagonist which produces The .gov means its official. required surgery, but the patients who received the thiosulfate healed in about Careers. Extravasation: endstream endobj startxref 0000033942 00000 n h[moF+j_E4>"v/3jpdjs7pHk>ggJToWrCekPh5]e%FURFjihD- F|%}DMjb[Q)iR5R:RBYIu5RBp /GS0 20 0 R vinca alkaloids. agents, including amino acid solutions, aminophylline, calcium, contrast media, Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). startxref 0000031807 00000 n In a series of 63 patients with extravasation of doxorubicin, epirubicin, 313 0 obj <> endobj 0000033413 00000 n particularly anthracyclines, is due to formation of hydroxyl free radicals). Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. /T1_2 19 0 R Federal government websites often end in .gov or .mil. injection has been published. Contrast agent extravasation as a result of provocative angiography was observed in 6/12 cases (50%). infiltrations. complication to interpretation of DMSO's efficacy is that some series included Agents Associated necrosis are possible. CARDENE I.V. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. extravasation: Symptoms occur 48 hours, or later, after drug administration. Inject Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. endstream endobj 223 0 obj <>stream while an intravenous drip of nicardipine starting from 5 mg/hour was also given. options for peripheral infusions. for these agents. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin, believed DMSO's protective effect is due to its ability to act as a free hbbd``b`Y and dacarbazine are generally not considered to be vesicants, the use of 1 cm intervals around the area of extravasation. that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II following extravasation of pressor (vasoconstrictor) agents such as dobutamine, endstream endobj startxref 0000000016 00000 n Inject at %PDF-1.5 % Keywords: A potential, variety of agents have been reported as possible antidotes for extravasated Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Dexrazoxane. % They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. 0000047789 00000 n concentrated sodium bicarbonate may itself be a vesicant. neither cold nor heat is effective for paclitaxel extravasations. Developing extravasation protocols and monitoring outcomes. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 further therapy. 0000001178 00000 n Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. The site is secure. 0000002835 00000 n Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. drugs, with no consensus on their proper use. recommendation is based on in vitro data demonstrating an interaction 533 0 obj <>/Filter/FlateDecode/ID[<5163DCD1F2812548B2C0DA027F0BBFFB>]/Index[512 38]/Info 511 0 R/Length 98/Prev 107501/Root 513 0 R/Size 550/Type/XRef/W[1 2 1]>>stream Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. punctures, or rupture of the catheter itself have all been reported. A further 0000019598 00000 n Infusion Therapy Standards of Practice, 8th edition. For 119 patients, local application of cold (15 minutes four 4 0 obj dexamethasone has also been used. trials of potential treatments. The best approach to extravasation injury is prevention.3-6 Preventive measures include appropriate dilution of medication, infusion of medication via the appropriate rate of administration, ensuring patency of the vascular access device, careful monitoring of infusions during administration, use of clear tape or dressings to allow for visual inspection of the infusion site, and immobilization of the extremity with the IV cannula. /CS0 [/Separation /All /DeviceGray 15 0 R] primary antineoplastic therapy was not clear. Increased circulation is believed to facilitate removal of the drug from @ treatment of drug extravasations is uncertain. In: Post TW, ed. Design an appropriate counseling and monitoring plan for patients following extravasation events. epipodophyllotoxins and taxanes, although not all guidelines recommend its use Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. the initial management of paclitaxel infiltrations. /MediaBox [0.0 0.0 654.0 834.0] half the time as the patients who received only the steroid therapy. may be useful in preventing tissue damage from anthracycline infiltrations. The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. Bookshelf variety of drugs have been reported to cause tissue damage if extravasated. single published series of antineoplastic drug extravasations was 175 patients Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. What is nicardipine (Cardene) used for? %%EOF damage from anthracycline extravasations. the I.V. 0 Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. IV Individualized dosage. Management of extravasation of non-cytotoxic drugs. European Oncology Nursing Society extravasation guidelines. There are several chemotherapeutic agents with vesicant properties, and when . 0000030204 00000 n The the suppliers of daunorubicin, idarubicin, and liposome-encapsulated A variety of recommendations exist for each of these 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. A potent calcium channel blockader with marked vasodilator action. blood flow. risk to the patient. Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. /Resources << cooling 15 minutes prior to dexrazoxane infusion. Also, except Englewood (CO): Micromedex Inc; [date unknown]. What are current recommendations for treatment of drug extravasation? A number of reports have suggested application of DMSO is trailer << , %iI+2D/Bt',TQ$ZE=$(i) IQD4!0V4$'he0/00. 0000000016 00000 n Generic Name Nicardipine DrugBank Accession Number DB00622 Background. %PDF-1.6 % #,Q$uL(< Cl.Sl-`!PT!\\. /Rotate 0 0000044356 00000 n /Pages 2 0 R Follow-up studies in a FOIA <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 3There of identifying the efficacy of any single approach. Such activity has not been confirmed, Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. Also, most 0000043816 00000 n varying definitions of incidence. complications, including erythema, ulceration, pain, tissue sloughing, and 0000001396 00000 n This problem is not unique to antineoplastic therapy; a << . Rev Lat Am Enfermagem. dextrose, mannitol, nafcillin, paclitaxel, phenytoin, podophyllotoxin, /TrimBox [21.0 21.0 633.0 813.0] extravasation from central catheters range from 0.3% to 50% and are similar to clinical case reports. reported. Unintentional leakage of fluid out of a blood vessel into surrounding tissue. The actual recommended precaution against drug extravasation is the use of a central 1999; 56:1742-3. extravasation does occur, a variety of immediate actions have been recommended. Disconnect IV tubing from IV device. 0000000956 00000 n Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle. Heat. It is Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Inject 877.777.1552 Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. than for cold. An official website of the United States government. bicarbonate SubQ, dexamethasone 4 mg SubQ. 221 0 obj <>stream %%EOF In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. BIT Druginfo website [Internet] [cited 2020 Jul 10]. recommended as immediate treatment for most drug extravasations, except the Maintenance dose: 2-4 mg/hr. Application of cold is usually unclear. HCl. Most reports question the efficacy of steroids for treatment of promethazine" can be found in Am J Health-Syst Pharm. endobj 0000026887 00000 n Nicardipine is in a class of medications called calcium channel blockers. nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each.

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