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. Reference: 1. The Oncology Nursing Society4 recommends administering IV vinCRIStine and other vinca alkaloids via a minibag to prevent errors with intrathecal chemotherapy administration. National Library of Medicine 2009 Aug;13(4):395-8. doi: 10.1188/09.CJON.395-398. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. Polovich M, Olsen M, LeFebvre KB, eds. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Gorski LA, Stranz M, Cook LS, et al. David V, Christou N, Etienne P, et al. eCollection 2022. 2088 0 obj <> endobj The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. Polovich M, Olsen M, LeFebvre KB, eds. (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 Reference Section V: Immediate Complications of cytotoxic therapy, p.105. 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. 2014 Aug;24(4):352-8. Developing extravasation protocols and monitoring outcomes. 1 0 obj 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. Introduction Please. 3. Properties of midline catheters VinCRIStine administration and the back flushing method are done by gravity when administered through a peripheral line. Due to some references not using this classification, the only drugs listed in this section are ones which were unclassified by some resources, yet classified by others as inflammitants. Please enable it to take advantage of the complete set of features! Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. Midline catheters have properties unique from those of peripheral and central VADs. Centers for Disease Control and Prevention. %%EOF The procedure includes connecting the bag of saline to a long straight infusion set. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. 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. Copyright 2023 Oncology Nursing Society. The action you just performed triggered the security solution. 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. This site needs JavaScript to work properly. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, sel 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. Answer:ISMP does not recommend the use of large volume syringes as an acceptable alternative to the minibag. 2.13.2 Vesicant chemotherapy administered through a peripheral intravenous must be infused IV push as ordered or via a short-term gravity intravenous line. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. 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. Extravasation of noncytotoxic drugs. 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 . Gilbar PJ, Carrington CV. The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations. J Oncol Pharm Pract. Bethesda, MD 20894, Web Policies The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 125 Enterprise Drive References: 1. Epub 2014 Jul 3. Vesicant & irritant chemotherapy - A Hematology Oncology Wiki 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . Sodium Chloride. PDF Chemotherapy Drugs for Cancer Treatment: Administration, Safe Handling 5-Safe administration of anti-cancer drugs | eviQ Pittsburgh, PA 15275 Vesicant Administration Guidelines 1. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Rev. 2,23 Documentation of Events Each incident of extravasation must be thoroughly documented and reported. Seo H, Altshuler D, Dubrovskaya Y, et al. 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. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and . 866-257-4ONS (866-257-4667). Vesicants: not just chemo agents! | Infusion Nurse Blog Vesicant chemotherapy extravasation antidotes and treatments 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. Federal government websites often end in .gov or .mil. $on8+i5BqlA/K>I,ELi{z292%4ImIK=EYG[tlX5l6XjVYU>WyAfb;%a@ Version number changed to v.5. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. National Library of Medicine Not a current ONS member or journal subscriber? The site is secure. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) stream Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment information, and advocated for patient care, all in an effort to improve the quality of life and outcomes for patients with cancer and their families. Disclaimer. government site. x][8~Gi"K6$Yd cG_")X=@zdbXb"f]FyMQrt2i[Fl')o:{pO^}~[~9>aP,p"yKxb}t+~{x:?OA9?tvK:0+M*7y wg|[]okN(6cw1gQX$|6x5Q^Xn{~(8klFaL8?k|9}YjO"?}M8OC?}T-Qezi^D1@olKSw8E[D7:z,eQ,rY!'HT|9,}O$. Chemical phlebitis may be caused by drugs that irritate the vasculature, usually because of extremes of pH or osmolarity.3Infusates with an osmolarity over 600 mOsm/L are associated with symptoms when extravasation occurs, and those over 800 mOsm/L are usually recommended to be given via a CVAD.9 Infusates with a pH between below 5.5 or above 8.5 can cause tissue damage, with alkaline agents generally producing worse toxicity than acidic agents. Unable to load your collection due to an error, Unable to load your delegates due to an error. Current ASCO/ONS standards address the safety of all routes of chemotherapy administration to adult patients in the outpatient and inpatient settings. The tubing contains 7 mL of volume and that is more than 10% of the 50 mL for an adult dose. 2017 Jan-Mar;4(1):61-68. doi: 10.4103/2347-5625.199081. Bookshelf The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta-analysis [published online ahead of print, 2021 May 15]. Secondary infusions are safest administered with the use of secondary tubing attached with a Luer lock connector to the primary line containing a compatible IV solution. Use of an infusion pump is discouraged because it increases the amount of pressure on the vein, which raises the risk of extravasation. Additionally, patient mobility is greater with midline catheters because of the location of their insertion site.2 Lastly, compared with drug administration via peripheral IV catheter, the risk of phlebitis may be reduced with administration via midline catheter because of its termination in an area with a higher rate of blood flow.2The rates of CRBSI have also been reported to be lower with midline versus peripheral catheters (0 to 0.2 versus 0.5 per 1,000 catheter days).1, Overall, the properties of midline catheters may make them preferable for specific durations of therapy. It is also important to note that some medications are classified differently by different references. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment . UIC's seven health sciences colleges and health care delivery enterprise. 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. Polovich M, Olsen M, LeFebvre KB, eds. All rights reserved. World J Clin Oncol. 139.59.111.99 Calcium Chloride. 2. Please refer to FAQ Question #1 and the ONS guidelines1 for special considerations for vesicant administration through a peripheral IV site. Vesicant extravasation: myths and realities. Extravasation is a known risk of vesicant administration. Hospira. 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. Based on the range of pH values generally considered appropriate for midline administration, vancomycin would be excluded because of its pH of 4. 2. 8600 Rockville Pike This information is intended as an educational piece and should not be used as the sole source for clinical decision making. 4. In 2021 the Infusion Nurses Society (INS) updated their 2016 guidelines and recommended consideration of midline catheters when the anticipated duration of therapy was 5 to 14 days with a preference for peripheral catheters for shorter durations of therapy and CVCs when longer durations of therapy are required.6 A recent study supports use of midline catheters for prolonged courses of therapy up to 14 days, but there remains limited data for use of midline catheters beyond 2 weeks.7 Currently, the CDC recommends consideration of midline catheters when the duration of IV therapy is likely to exceed 6 days.1,8, Considerations for drugs administered via midline catheter 3 0 obj In addition, whenever an extravasation occurs or is suspected, vesicant administration must immediately cease, and the appropriate antidote or treatment needs to be promptly administered. Blood Rev. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. PDF Vesicant Chemotherapy Extravasation Antidotes and Treatments - ResearchGate All rights reserved. Clipboard, Search History, and several other advanced features are temporarily unavailable. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. 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. Watch for signs of extravasation; stay with the patient and verify blood return every 5 to 10 minutes. The .gov means its official. Extravasation injury from chemotherapy and other non - UpToDate A central line is always required for vesicant or any chemotherapy in the home. May be due to direct leakage from the venous access device or from elsewhere in the vessel (such as from previous phlebotomy). Available antidote and treatment formulations and their preparation and administration also are discussed. 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 Trissel LA. 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.
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