Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. 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. 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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. Bethesda, MD 20894, Web Policies official website and that any information you provide is encrypted Except as expressly stated on this site or as otherwise permitted by applicable law, no content on this site may be used or reproduced without the permission of the copyright holder. All rights reserved. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. stream Would you like email updates of new search results? Rev. 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. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. Unauthorized use of these marks is strictly prohibited. In, For more information on nurses, chemotherapy, and pregnancy, watch. Midline catheters have properties unique from those of peripheral and central VADs. Careers. 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. For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. Rev.12/2/2014. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy link and reference updated to new version. Clinical exam may reveal warmth, erythema, or tenderness. Overview, prevention and management of chemotherapy extravasation. For every 1 mg of mechlorethamine suspected to have extravasated, inject 2 mL of the 1/6 molar sodium thiosulfate solution subcutaneously into the extravasation site using a 25 gauge or smaller needle. This page was last edited 14:24, 26 April 2023 by. 3/26/2014, 4. National Library of Medicine Heat - 15 to 20 minutes at a time for at least four times per day for 24 to 48 hours. Vesicants and irritants with vesicant . 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. Eur J Oncol Nurs. 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. This decision must be weighed in light of certain death if the drug is administered via the wrong route. Do not pinch the IV administration tubing because this can cause the vein to rupture. 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. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. 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. However, the INS Task Force identified limited literature describing extravasation of vancomycin. National Library of Medicine Clipboard, Search History, and several other advanced features are temporarily unavailable. Some references primarily classify drugs as vesicants or irritants, so those categories will preferentially be used below over classifying as inflammitants and exfoliants. ACR manual on contrast media. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Plymouth Meeting, PA 19462. Extravasation of antineoplastic agents: prevention and treatments. 4. In some regimens, enough data support sequencing of agents, but in others, data are lacking. 2012;18(suppl):16-7. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. Polovich M, Olsen M, LeFebvre KB, eds. 2023 Institute for Safe Medication Practices. **Some case reports of extravasation and injection site reactions or inflammation have been reported. Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. eCollection 2012 Jul 31. 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 Developing extravasation protocols and monitoring outcomes. Cold (different suggestions depending on reference): Heat (different suggestions depending on reference): Cold - for 6 to 12 hours after administration of sodium thiosulfate. Clinical Assistant Professor, Drug Information Specialist Two important safety features are important here. endobj Administration of chemotherapy in patients requires the proper training of staff and education of patients and administrative support through the implementation of policy. Epub 2014 Jul 3. 1990 Mar-Apr;13(2):111-4. Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. Please enable it to take advantage of the complete set of features! However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. Midline catheters represent a unique vascular access device (VAD) for patients requiring intravenous (IV) administration of drugs or other infusates.1,2After their introduction in the 1950s, hypersensitivity and phlebitis reactions to the manufacturing materials led to a temporary decline in the use of midline catheters through the 1990s; however, a redesign of these products in recent years has led to their renewed adoption. Nonetheless, a review of literature of known vesicants and drugs reported to cause vascular injury or extravasation indicates some drugs that may present higher risk when administered via midline catheter. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. A central line is always required for vesicant or any chemotherapy in the home. Introduction. To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Therefore, questions often arise regarding the appropriateness of administering specific drugs via midline catheter. 3. 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$. Management of the extravasation of anti-neoplastic agents. Yan YM, Fan QL, Li AQ, Chen JL, Dong FF, Gong M. Iran J Pediatr. World J Clin Oncol. Rev. Ensure the best possible outcomes with ONS standards. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; Copyright 2023 Oncology Nursing Society. %%EOF Section V: Immediate Complications of cytotoxic therapy, p.105. Gilbar PJ, Carrington CV. Table 7 in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice discusses special features required for administration, but package inserts should be referred to for the most up-to-date information. 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. 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. sharing sensitive information, make sure youre on a federal 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 . Blood Rev. 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. Institutional policies and procedures used in hospitals, clinics, and office settings should be written in accordance with these . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2088 0 obj <> endobj Bethesda, MD: American Society of Healthsystem Pharmacists; 2012:1104-5. Introduction Hyaluronidase may be used in extreme scenarios such as large volume extravasation or severe irritation. Version number changed to v.5. Answer:For those patients who do not have a PICC or central venous access device, a peripheral IV line can still be used to administer vinCRIStine in a minibag. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. In order from most likely to least likely to cause damage when extravasation occurs: vesicants (most likely), exfoliants, irritants, inflammitants, and neutrals (least likely). %PDF-1.7 Federal government websites often end in .gov or .mil. Irritants and Vesicants Guide to Intravenous Administration via Midline Catheters . Pittsburg, PA: Oncology Nursing Society; 2014. www.hospira.com/Images/434047_32-91799_1.pdf, http://opp.sagepub.com/content/early/2014/01/13/1078155213517729, Medication Safety Officers Society (MSOS). If using a peripheral vein, allow the infusion to flow via gravity. 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. Nurses, Chemotherapy, and Pregnancy: What Do We Know? Lastly, they recommend avoidance of midline catheters in patients with a history of thrombosis, hypercoagulability, venous stasis, or with a need to preserve vein integrity, such as in patients with end-stage renal disease. For definitions of different categories of extravasation hazard and the details on management of extravasation, see BC Cancer Systemic Therapy Policy III-20 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. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were rst published in 2009 and updated in 2011 to include inpatient settings. eCollection 2012 Jul 31. Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis.
