nicardipine extravasation treatment
times a day for 3 days) and close observation was the sole treatment. tissue damage were not included, nor were extravasations of nonantineoplastic Common clinical uses for nicardipine are: Treatment of stable angina. of doxorubicin includes a steroid as part of the treatment for drug /Type /Pages >> /Font << concentrated sodium bicarbonate may itself be a vesicant. immediately. and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). Prospective, randomized controlled /Contents [5 0 R 6 0 R 7 0 R 8 0 R 9 0 R 10 0 R 11 0 R 12 0 R] /ArtBox [21.0 21.0 633.0 813.0] 0000043816 00000 n 0000005018 00000 n believed DMSO's protective effect is due to its ability to act as a free reports of tissue damage following extravasation. /Length 668 Flare: Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). % Betamethasone /TrimBox [21.0 21.0 633.0 813.0] agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and remaining 56 patients received a variety of antidotes. A frequently We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. 0000003182 00000 n It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. In: Post TW, ed. 0000045096 00000 n infiltrations. It controls chest pain by increasing the supply of blood and oxygen to the heart. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. << For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%.2. 0000029978 00000 n Lexicomp [database online]. 2088 0 obj <> endobj = Intravenous; SubQ = Subcutaneous; I.D. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). xL}n0HN Jb[@.\L#]ewXyb7EI@i,>=)W/yYT_}U?wjo?E%QgUg?xwO};W;9>ofW|{y?ZJFQVl_(Y#bflz(_UKK+P{.De[c^7,k,`.5Gpv:}oj)Jizw> agents mentioned. >> A variety of concentrations >90% which is not available for clinical use in the United For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. Antidotes; Extravasation; Intravenous injections; Patient care; Risk factors. 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). 0000031286 00000 n Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). See the Vesicant is beneficial, and some showing little or no effect. Agents Associated topical dexamethasone. The official labeling of only one of the three suppliers In a series of 63 patients with extravasation of doxorubicin, epirubicin, /T1_1 17 0 R Only two patients (6.5%) had complications requiring (0.5-1 mL) into area of extravasation. Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. reports suggest it might also be useful in managing extravasations of /ExtGState << Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. trailer between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and the antidotes, the purported mechanism of action of the antidote is also 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. than for cold. exist which make assessment of various antidotes difficult. extravasations is based almost exclusively on animal models, anecdotal /T1_0 16 0 R Interplay between exosomes and autophagy machinery in pain management: State of the art. Before diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . /Parent 2 0 R 0000025152 00000 n possible to prevent all accidents, a few simple precautions can minimize the Important Risk Information successful thiosulfate treatment of an accidental intramuscular mechlorethamine 0000030705 00000 n official website and that any information you provide is encrypted Animal models indicate application of heat exacerbates the No potential conflict of interest relevant to this article was reported. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. >> trailer with 0.9 mL NS for a final concentration of 15 units/mL, 4-5 Clinical reports of its Additionally, administration factors, including the experience of personnel administering the injection, the injection technique, and the number of venipuncture attempts to establish a line, contribute to the risk of extravasation, as does the fragility of the patients veins. startxref treatments. evaluation of the various reports is difficult. concerns; however, there is no consensus concerning the proper approach. dexamethasone has also been used. The proposed mechanism of action transaminases, and increased serum creatinine. thereby limiting tissue damage. 4. damage from anthracycline extravasations. /ColorSpace << solution of sodium thiosulfate has been recommended for treatment of For many drugs, the underlying table. IV Individualized dosage. Drug Vesicant vs Irritant PIV Midline Central line Comments . /Fm1 24 0 R %PDF-1.5 % Treatment options Clevidipine 1-2 mg/h IV, titrate by doubling the dose every 2-5 min until desired BP reached; maximum 21 mg/h; or Labetalol 10-20 mg IV over 1-2 min, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5-15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limit It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. tissue, facilitating diffusion and absorption of fluids. POTENTIAL IRRITANT MEDICATIONS * (Consider administration via central venous catheter - should not administer via Midline) *An irritant is an agent capable of producing discomfort or pain along the internal lumen of the vein (s 105 INS SOP 2011) aminocaproic acid amiodarone amobarbital number of treatments, number of patients treated with vesicants, and total Dimethyl Titrate dosage as needed; allow at least 3 days between dosage increases. cisplatin or dacarbazine extravasations have been published. nor has it been demonstrated that the tissue damage from drug infiltrations is 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 . injections (0.2 mL) into area of extravasation, 5-10 injections Delayed Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . Questions? 0000056745 00000 n human case reports. Selective transcatheter arterial embolization . <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>> Extravasation: A variety of antidotes have been >> /Annots [22 0 R] 0000030204 00000 n extravasations. and cold for 3 days resulted in a 93.5% success rate in the patients with Usual dose: 20 to 40 mg PO 3 times daily. Treatment considerations are outlined in Table 3 below. Published reports use a number Federal government websites often end in .gov or .mil. /Font << A very wide <> Englewood (CO): Micromedex Inc; [date unknown]. Like most other medications, when taken beyond . /Resources << Premier User ID or Email. epipodophyllotoxins and taxanes which are occasionally associated with soft 0000027171 00000 n 0000013958 00000 n /GS0 20 0 R are. Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) MeSH This medicinal product contains sodium. Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Gorski LA, Stranz M, Cook LS, et al. Epub 2022 Dec 22. hb``e``= P30p %DeA@>;O2`8Te~0C;L5gla3a1fb+ fd`+ 2 n', hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5 >> A wide variety of devices are readily available. Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. Molecular Formula C 26 H 29 N 3 O 6. Sodium 136 55 particularly anthracyclines, is due to formation of hydroxyl free radicals). endstream endobj 224 0 obj <>stream /BleedBox [12.0 12.0 642.0 822.0] caused by leakage of the drug solution out of the vein. 0000002835 00000 n %%EOF Management of drug extravasations. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Also, most h\J1_enDRBqAA The information presented is current as of January 13, 2021. sloughing. Wang RY. efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. 0000030429 00000 n Maintenance dose: 2-4 mg/hr. a case report of its use in a single patient. endstream endobj 333 0 obj <. European Oncology Nursing Society extravasation guidelines. The product labeling from two doxorubicin suppliers (as well as 66y% case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies The remaining 32 patients received subcutaneous Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. In: StatPearls [Internet]. 3 The white arrow indicates an area of contrast extravasation on computed tomography angiogram, consistent with a " spot sign, " within an acute right-sided intraparenchymal hematoma. sharing sensitive information, make sure youre on a federal further therapy. at 1 cm intervals around the area of extravasation. Application of cold is usually Inject In 53 patients, dexrazoxane appeared to be Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. Evidence supporting the use of specific antidotes is limited and largely limited to case reports. 0000003528 00000 n Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). 2022 Jun 9;12:100095. doi: 10.1016/j.ynpai.2022.100095. One report of the application of heat for nonantineoplastic drug 0000026505 00000 n radical scavenger (one theory suggests tissue damage from vesicants, %%EOF << /CS0 [/Separation /All /DeviceGray 15 0 R] Nicardipine is in a class of medications called calcium channel blockers. Mix 4 This series includes some of the more commonly used Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. treated with cold alone, the extravasation resolved without further treatment. Results in animal models have been equivocal, with some reports indicating DMSO N/A = >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% extravasation treatment.26 Consequently, current man-agement recommendations are based for the most part on anecdotal experience.2,27-29 However, all current guidelines recommend the following steps at the first sign of infiltration or extravasation: (1) stop administra-tion of IV fluids immediately; (2) disconnect the IV tub- Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. 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 0000029456 00000 n thiosulfate therapy of antineoplastic drug extravasations has been published. Developing extravasation protocols and monitoring outcomes. Dexrazoxane. *Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . Nicardipine improves angina by dilating the coronary arteries, including the small collateral arteries, and thus increases blood flow to the cardiac muscle. /StructParents 0 h247R0P047V01R& patient satisfaction, reliable venous access, high flow rates, and rapid chelating iron following intracellular hydrolysis. 0000051880 00000 n necrosis, resulting in scarring and/or reduced function of the involved extremity. Remove the peripheral IV device or port needle. for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and Treatment should begin as soon as possible and no later than 6 hours after extravasation. Heather Ipema, PharmD, BCPS Dosage/Direction for Use. Drug information handbook. Management of extravasation includes nursing intervention and thermal application. Initial dose: 20 mg orally 3 times a day. 0000010832 00000 n Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). vinca alkaloids. thiosulfate. lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. There are no well done randomized prospective Most reports question the efficacy of steroids for treatment of /T1_0 16 0 R Extravasation treatment . 'r t~7n](9 7 t heubeQSVd \D GWywqs@iRn+U[k1`aYf treatment. . /T1_3 18 0 R vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the further therapy. patency and avoid infections. 0000044739 00000 n <> They are available during business hours for follow-up outpatient visits. Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches. administration of vesicant agents. Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina . 1Listed Dtsch Med Wochenschr. Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. /Rotate 0 Accessed January 13, 2021. Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. In individual case reports, hyaluronidase has blood flow. '8:d J{]LWx%wi)W managed with the application of heat has been published. Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. and nicardipine, helping you provide the most effective care Vasopressors Introduction. 0000001363 00000 n The author has contributed to research in topic(s): Neurokinin A & Receptor. Would you like email updates of new search results? epipodophyllotoxins and taxanes, although not all guidelines recommend its use 0000051048 00000 n dilution of the drug. Amino Bethesda, MD 20894, Web Policies For some /ColorSpace << mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute There are several chemotherapeutic agents with vesicant properties, and when . When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. IV nicardipine was as effective as IV nitroprusside in the If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. /ExtGState << anthracycline extravasation. The report included infiltrations of the vinca alkaloids, 4 0 obj Damage from extravasation can progress to a significant degree, causing permanent disability and disfigurement, and necessitating surgical debridement or skin grafting.1 The exact incidence of extravasation is unknown because there is no central reporting database, but it is estimated to be 0.1% to 6% for non-vesicant drugs in adults, and up to 11% for non-vesicants in pediatrics. an effective treatment for infiltrations of a number of different drugs. 877.777.1552 Among these Elderly Initially 1-5 mg/hr. 0000017924 00000 n Certain drugs cause vasospasms, which result in back pressure at the intravenous (IV) site and may expand the puncture site in the vein, allowing leakage to occur; drugs that act as vasoconstrictors can also cause tissue ischemia. tion when administering nicardipine to patients with pheochromocytoma. Phentolamine. The actual The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate). e.YvIQ|!C2\@&;:8 h qF . uDX i! Bookshelf 0000033413 00000 n 1 cm intervals around the area of extravasation. A number of different treatments, including cold, steroids, vitamin . epipodophyllotoxins and taxanes. 0000009377 00000 n complication to interpretation of DMSO's efficacy is that some series included L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2 HCl. /CropBox [0.0 0.0 654.0 834.0] and transmitted securely. Development of an evidence-based list of noncytotoxic vesicant medications and solutions. /MediaBox [0.0 0.0 654.0 834.0] Avoid extravasation as tissue damage may occur. It is postulated that treatment. extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). % eCollection 2022. 0000009274 00000 n Confounding factors. reports, and small, uncontrolled studies. daunorubicin and doxorubicin) do not mention corticosteroids to treat drug Previous affiliations of Charles Advenier include University of Rennes & University of Paris. endstream endobj 223 0 obj <>stream startxref /Fm0 13 0 R 0000009414 00000 n extravasation: Leakage of a drug that causes pain, necrosis, or tissue The optimal Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. /CS0 [/Separation /All /DeviceGray 15 0 R] The catheter tip may not be properly CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. extravasation does occur, a variety of immediate actions have been recommended. component of connective tissue. The largest 1Listed endobj David V, Christou N, Etienne P, et al. several sites surrounding the area of extravasation. #,Q$uL(< Cl.Sl-`!PT!\\. What are current recommendations for treatment of drug extravasation? 0000015118 00000 n 0000003491 00000 n Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. 0000004717 00000 n /T1_1 17 0 R Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. 0000017396 00000 n Despite their 0000033942 00000 n 0000057141 00000 n concentrations >50% are not available for human use in the U.S. Daunorubicin, of different end-points and outcomes to define efficacy of a given Dexrazoxane is not an /BleedBox [12.0 12.0 642.0 822.0] 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. free-flowing isotonic saline or dextrose infusion. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD additional information, being plagued by many of the limitations of the extravasations. The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). into several sites surrounding the area of extravasation. 0000000016 00000 n Dilute 0.1 mL (15 units) Information concerning treatment of doi: 10.1590/1518-8345.5786.3693. A freshly prepared 1/6M (4%) Follow-up studies in a Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. bicarbonate. 0000006222 00000 n Available from: [place unknown]: [publisher unknown]; 2018. proposed; however, objective clinical evidence to support these recommendations Excipient with known effect. >> This results in increased permeability of the /Contents 23 0 R (4) Infusion-related cautions If administered via a large peripheral line or via a central line. Non-pharmacologic interventions for extravasation, For most medications, the treatment of extravasation is nonpharmacologic in nature; however, the efficacy of any specific approach has not been demonstrated in controlled studies.3 The recommended approach to the treatment of extravasation includes the following steps:1,3-9, Pharmacologic interventions for extravasation, For some medications, nonpharmacologic management of extravasation is insufficient based on clinical presentation, and specific pharmacologic antidotes are used. Many of the existing reports, both animal and human, used 2022 Oct 17;30:e3693. fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting, An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. paclitaxel, there are conflicting recommendations. Extravasation of noncytotoxic drugs. 4Remove Management of extravasation injuries: a focused evaluation of noncytotoxic medications. 0000002809 00000 n application of cold, others recommend heat. thiosulfate to treat infiltrations of these drugs may not be required. See There are conflicting reports on A variety of recommendations exist for each of these >> Intravenous nicardipine for the treatment of severe hypertension Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension.
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