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. General recommendations for midline administration: A. PDF Guidelines on treatment of extravasation - Thames Valley Cancer Alliance 1995 Jan-Feb;22(1):57-67. The Independent Clinical Oncology Network's Chemotherapy Administration. References: 1. The procedure includes connecting the bag of saline to a long straight infusion set. 2016 Feb 10; 7(1): 8797. Special Considerations When Administering IV Chemotherapy - ONS Voice American College of Radiology. Generally, drugs that are vesicants or have extremes of pH or osmolarity should not be administered via midline catheters. 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. Minor updates to administration and patient education. The vinCRIStine is infused via gravity through the peripheral line. 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. 2. European Oncology Nursing Society extravasation guidelines. Unauthorized use of these marks is strictly prohibited. Use VADs for vesicant administration, continuous infusions of vesicants, anticipated long-term administration of chemotherapy, poor venous access, and for children or older adult patients.a,b Ensure clear visualization of the site throughout the infusion. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings. Extravasation is a known risk of vesicant administration. The site is secure. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. and transmitted securely. If cooling techniques are being used, withhold cooling 15 minutes before and after the infusion. Introduction Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. J Oncol Pharm Pract. Polovich M, Olsen M, LeFebvre KB, eds. 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. Vesicant Administration Guidelines 1. Answer:According to a publication by the Oncology Nursing Society, 1 the easiest way to check for a blood return is to use gravity by lowering the minibag below the IV site. References: 1. Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. Eur J Oncol Nurs. According to Trissels Handbook on Injectable Drugs 17th Edition, vinCRIStine is stable at a concentration of 20 mg/L in dextrose 5% in water, Lactated Ringers, and 0.9% sodium chloride for at least 24 hours and up to 21 days with little or no drug loss (under 10%) at 4C and 25C when in the dark. 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. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. All rights reserved. Flare reaction: A skin reaction to a medication which is an allergic response. The https:// ensures that you are connecting to the Infuse in an extremity or area other than the one affected by extravasation. stream 6. Rev. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . In general--aside from the exceptions listed below--keeping the extravasation cold is preferable to cause vasoconstriction, to prevent spread of the medication, and to decrease inflammation/pain. 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . Caution: excessive heat can cause tissue damage. 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. All rights reserved. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; Unable to load your collection due to an error, Unable to load your delegates due to an error. %PDF-1.6 % Rev.12/2/2014. Section V: Immediate Complications of cytotoxic therapy, p.105. Clinical exam may reveal warmth, erythema, or tenderness. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. 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. Updated July 2017. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. 2141 0 obj <>stream Copyright 2023 Oncology Nursing Society. 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. Accessibility Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org. Pittsburgh, PA 15275 Clin J Oncol Nurs. David V, Christou N, Etienne P, et al. %%EOF sharing sensitive information, make sure youre on a federal 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. 2021 Update: What are considerations for determining whether a drug may be administered via a midline catheter? Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. What do you recommend? ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. J Oncol Pharm Pract. 2012;18(suppl):16-7. Some medications are more likely to have vesicant properties in high concentrations or large volumes. 09/04/2019. Heat - 15 to 20 minutes at a time for at least four times per day for 24 to 48 hours. PMC 3. Midline catheters differ from other VADs with regard to their insertion and termination sites.1,3Midline catheters are inserted peripherally into the antecubital fossa or upper arm via the basilic, cephalic, or brachial vein, and extend from 8 to 20 cm centrally, where the catheter tip terminates at or below the axillary vein. 5-Safe administration of anti-cancer drugs | eviQ The following information is a compilation from the various resources listed below.[1][2][3][4][5][6][7][8]. 8600 Rockville Pike Careers. Gilbar PJ, Carrington CV. What are current recommendations for treatment of drug extravasation? These . The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. Rev. If an antidote is not going to be used, the venous access can be removed after aspiration of the extravasated fluid has been attempted. Front Oncol. 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. eCollection 2022. References: 1. Facebook - National Cancer Institute Pittsburg, PA: Oncology Nursing Society; 2014. 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. Potassium Chloride. Most importantly, organizations must weigh the risk of possible extravasation versus certain death from the accidental administration of vinCRIStine by the intrathecal route when making decisions about changing practice. Would you like email updates of new search results? 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. 2023 Institute for Safe Medication Practices. Rev. www.hospira.com/Images/434047_32-91799_1.pdf However, the INS Task Force identified limited literature describing extravasation of vancomycin. Note: Do not use an infusion pump when administering a vesicant via a peripheral intravenous. Accessibility Not a current ONS member or journal subscriber? Answer:Yes, the product is stable in a minibag. 125 Enterprise Drive <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Innovative Oncology Nurses Break Down Communication Barriers for Patients Who Are Deaf or Hard of Hearing, How I Practice Mindfulness as an Oncology Nurse, Clinical and Pharmaceutical Nurse Educators Collaborate to Bring Training to Nurses and Improve Patient Care, Oncology Nurse Uses Retirement to Help Patients and Healthcare Professionals Understand Pancreatic Cancer Biomarker Testing Results, The Life of Marie Curie and Her Contributions to Oncology, FDA Reports Efficacy Issue for Patients Taking Pembrolizumab or Atezolizumab as Monotherapy to Treat Urothelial Cancer with Low Expression of PD-L1, B. 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. Gilbar PJ, Carrington CV. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Developing extravasation protocols and monitoring outcomes. Centers for Disease Control and Prevention. 2012;18(1):155-7. 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. 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 . This site needs JavaScript to work properly. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 1,2 Recognize that when a vinca alkaloid is prepared in a minibag, it is likely more dilute than in a syringe, and thus the impact of tissue injury is even less if extravasation should occur. (K k0|hzv 6gN5UzVa+91C+yTOOcV^t^IjpiOROeutcI9GOqs'."XA*c2@GfK!rKP;{4?|h=,G _wyNdfSc#A]LHq#@Gtn[YWk%1o*Bbyk'82h6~IOvvi2`6 866-257-4ONS (866-257-4667). Trissel LA. Griffiths V. Midline catheters: indications, complications and maintenance. 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. Cold (different suggestions depending on reference): Heat (different suggestions depending on reference): Cold - for 6 to 12 hours after administration of sodium thiosulfate. Clinical Associate Professor, Drug Information Specialist, Updated by: The flush line can be used before, during, and after the infusion to verify line patency and blood return for a flush solution if the chemotherapy must be stopped because of an adverse reaction. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Bookshelf Polovich M, Olsen M, LeFebvre KB, eds. Another option is to aspirate with a syringe via the lowest Y-site and clamp off fluid from the minibag. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. Epub 2014 Jul 3. Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. Handbook of Injectable Drugs 17th Edition. Polovich M, Whitford JM, Olsen M. Chemotherapy and biotherapy guidelines and recommendations for practice, 3rd ed, Oncology Nursing Society, Pittsburgh, PA, 2009. 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. Click to reveal 2008 Sep;12(4):357-61. Please. 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. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. Vesicant & irritant chemotherapy - A Hematology Oncology Wiki Courtney Krueger, PharmD, BCPS Extravasation injury from chemotherapy and other non - UpToDate 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. 125 Enterprise Drive 3/26/2014, 4. J Intraven Nurs. 0 Before This page was last edited 14:24, 26 April 2023 by. This website is using a security service to protect itself from online attacks. 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. PDF Vesicant Chemotherapy Extravasation Antidotes and Treatments - ResearchGate Midline catheters have properties unique from those of peripheral and central VADs. % 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. e.YvIQ|!C2\@&;:8 h qF . uDX i! Unauthorized use of these marks is strictly prohibited. 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. Two important safety features are important here. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Question: Our pediatric department is reluctant to administer vinCRIStine via a minibag through a peripheral IV line since many of our patients do not have a peripherally inserted central catheter (PICC) or central venous access device. Bethesda, MD 20894, Web Policies The .gov means its official. 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. 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. Assessment of the risk of extravasation with the introduction of vincristine mini-bags to eliminate inadvertent intrathecal administration. What are other facilities doing to avoid excessive drug loss in the tubing? Exfoliants:An agent that is capable of causing inflammation and skin shedding, but less likely to cause tissue damage. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses. Reference 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. endstream endobj startxref 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. doi: 10.1097/GOX.0000000000001743. PDF Antineoplastic Drug Administration: Vesicant and Irritant Agents 8600 Rockville Pike 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. 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? If using a peripheral vein, allow the infusion to flow via gravity. J Oncol Pharm Pract. Nurses, Chemotherapy, and Pregnancy: What Do We Know? References: 1. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. This decision must be weighed in light of certain death if the drug is administered via the wrong route. Disclaimer. National Library of Medicine 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. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. The information presented is current as of August 2, 2021. Treatment of cutaneous injuries of neonates induced by drug extravasation with hyaluronidase and hirudoid. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. Oncology Nursing Society releases updated guidelines on - Healio Blood Rev. Manage conservatively as first line option with supportive non-pharmacologic strategies. Gorski LA, Hadaway L, Hagle ME, et al. 3 0 obj endstream endobj 2089 0 obj <. Sodium Chloride. Acknowledgement: MiKaela M.Olsen RN, MS, AOCNS, Oncology and Hematology Clinical Nurse Specialist; Johns Hopkins Hospital Hospira. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Management of Chemotherapy Extravasations - U.S. Pharmacist Preventing and Managing Vesicant Chemotherapy Extravasations Reduce dose by 50% for patients with creatinine clearance less than 40 mL/min. Intermountain Medical Center . ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. eCollection 2018 Apr. The safety of midline catheters for intravenous therapy at a large academic medical center. 2108 0 obj <>/Filter/FlateDecode/ID[<79BA663E75301A408346CF53CE9BCBB7><05BE28B3380661489955B8DFD5505C1D>]/Index[2088 54]/Info 2087 0 R/Length 102/Prev 343790/Root 2089 0 R/Size 2142/Type/XRef/W[1 3 1]>>stream $on8+i5BqlA/K>I,ELi{z292%4ImIK=EYG[tlX5l6XjVYU>WyAfb;%a@ There are non-chemo medications and solutions that have vesicant properties as well and can cause extravasation. Heat - Apply warm compresses to extravasation site for 1 hour. For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 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. Remove cold pack at least 15 minutes before dexrazoxane therapy. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. Oncologist. No current standard or scoring system exists for the . eCollection 2012 Jul 31. The 2008 European Oncology Nursing Society extravasation guidelines recommend this management for the following medications: From HemOnc.org - A Hematology Oncology Wiki, Chemotherapy vesicant & irritant properties and suggested management for extravasation, "Localize and neutralize" or "disperse and dilute". You can email the site owner to let them know you were blocked. 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. 8}-Fb}" "R5xPQ%Flm^%/jV Cloudflare Ray ID: 7c0b26d1e9b36bd5 Depending on treatment complexity, ONSs Chemotherapy and Biotherapy Guidelines and Recommendations for Practice state that chemotherapy agents being administered by infusion may be connected directly to the IV catheter or to a line of compatible maintenance solution. Therefore, critical and collaborative consideration of the components of each regimen and the clinical presentation of the patient should be part of the treatment planning process. A subsequent 2013 revision endobj Please enable it to take advantage of the complete set of features! 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. FOIA Current ASCO/ONS standards address the safety of all routes of chemotherapy administration to adult patients in the outpatient and inpatient settings. 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. Pediatr Rep. 2012 Aug 1;4(3):e28. Seo H, Altshuler D, Dubrovskaya Y, et al. Vesicant: An agent that has the potential to cause pain, inflammation, blistering and irreversible tissue damage, including necrosis and loss of limb function and mobility. Boulanger J, Ducharme A, Dufour A, et al. The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. The main consideration in determining whether a drug is appropriate for administration via midline catheter is its propensity for causing phlebitis.2Phlebitis is inflammation of a vein caused by damage to the tunica intima, which may be accompanied by erythema, swelling, pain, heat, and a palpable cord if thrombosis is present. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Controversial use of heat: EONS (European Oncology Nurses Society) suggests application of heat to encourage circulation and to dilute & diffuse the chemotherapy. Question:Is it just as safe to prepare vinCRIStine in a large volume (30-50 mL) syringe as in a minibag? endobj Extravasation: Leakage of a medication into tissue or extravascular space around the infusion site. Taxanes: vesicants, irritants, or just irritating? Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion. PDF BC Cancer Extravasation Hazard Table If not clearly defined in the literature. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. The venous access should not be removed immediately, since it can be used to attempt aspirating extravasated fluid and for administration of an antidote, if clinically appropriate.
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