official website and that any information you provide is encrypted Updated January 2021. Always double check information at the primary references linked below. Please. sharing sensitive information, make sure youre on a federal 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. Developing extravasation protocols and monitoring outcomes. 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. Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Question:Will administering vinCRIStine in a minibag increase the risk of extravasation? 2006;12(2):113-8. Updated July 2017. endobj 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. Use a central venous catheter or implanted device for continuous vesicant infusions or for any vesicant infusion lasting longer than 30 minutes. Treatment of cutaneous injuries of neonates induced by drug extravasation with hyaluronidase and hirudoid. 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. %%EOF Chemotherapeutics can be classified into three categories: vesicants, irritants, and non-irritants. General recommendations for midline administration: A. 866-257-4ONS (866-257-4667). 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. Vesicant: Medication that may causes severe and/or irreversible tissue injury and necrosis. These include engaging patients in extravasation-prevention efforts, thoroughly assessing patients receiving vesicants, sel %PDF-1.7 References: 1. All rights reserved. Pediatr Rep. 2012 Aug 1;4(3):e28. In regard to the risk of extravasation: There have been studies comparing extravasation rates between these two administration techniques, which have similar results. David V, Christou N, Etienne P, et al. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. 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. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. A central line is always required for vesicant or any chemotherapy in the home. Clinimix 4.25/5 Vesicant Yes Yes Yes Guidelines allow if 10% dextrose, Peripheral PN (PPN) Vesicant . Listed below are a few non-chemo agents: Vancomycin. Pediatr Rep. 2012 Aug 1;4(3):e28. Gilbar PJ. doi: 10.4081/pr.2012.e28. 2. Prior to initiation of a vesicant, the VAD tip must be verified &checked for blood Gorski LA, Hadaway L, Hagle ME, et al. 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. Please enable it to take advantage of the complete set of features! Vesicant Administration Guidelines 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. ACR Committee on Drugs and Contrast Media. World J Clin Oncol. Gilbar P, Chambers CR, Larizza M. Medication safety and the administration of intravenous vincristine: International survey of oncology patients. 2014 Aug;24(4):352-8. Pittsburg, PA: Oncology Nursing Society; 2014. 2 0 obj It is also important to note that some medications are classified differently by different references. (Closed system devices are also utilized to ensure the vinCRIStine does not leak out of the system.) government site. Unauthorized use of these marks is strictly prohibited. Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. e.YvIQ|!C2\@&;:8 h qF . uDX i! This decision must be weighed in light of certain death if the drug is administered via the wrong route. ONS is committed to promoting excellence in oncology nursing and the transformation of cancer care. Vesicants and irritants with vesicant . Nurgat Z, Smythe MP, Aljedai A. Reference Vesicant extravasation: myths and realities. http://opp.sagepub.com/content/early/2014/01/13/1078155213517729. Gorski LA, Stranz M, Cook LS, et al. 2018 Apr 19;6(4):e1743. Heat - 15 to 20 minutes at a time for at least four times per day for 24 to 48 hours. Cold (different suggestions depending on reference): Heat (different suggestions depending on reference): Cold - for 6 to 12 hours after administration of sodium thiosulfate. 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. However, we have concerns about the excessive loss of drug that remains in the IV tubing after administration. hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; The organization also recommends a multidisciplinary review of the process regarding the preparation and administration of vinCRIStine in each practice setting. Question:How do you recommend that we verify blood return when administering vinCRIStine in a minibag? and transmitted securely. 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. 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]. 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. 1990 Mar;4(1):41-60. doi: 10.1016/0268-960x(90)90015-k. Wang Y, Tian H, Chen X, Zhang J, Wang L, Fan H, Zhang Y, Qi X, Hu S, Yang Y. Please enable it to take advantage of the complete set of features! Reviewed electronically by nursing reference committee. Rev. Another option is to aspirate with a syringe via the lowest Y-site and clamp off fluid from the minibag. Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. This section focuses on drug administration, including cycle definition (which contains the cycle length, number of cycles, and other schedule-related information), dosing, frequency, and routes of administration. Pittsburgh, PA 15275 If chemical phlebitis occurs, consideration should be given to the need for alternative vascular access, an alternative medication, a slower infusion rate, or further dilution of the medication.6. 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. Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. 2141 0 obj <>stream eCollection 2012 Jul 31. J Oncol Pharm Pract. Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. 1 Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta-analysis [published online ahead of print, 2020 Dec 29]. However, data suggests that the risk of extravasation is low, regardless of the method used to administer the drug. Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. Copyright 2023 Oncology Nursing Society. Nurses, Chemotherapy, and Pregnancy: What Do We Know? 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. Some medications are more likely to have vesicant properties in high concentrations or large volumes. Federal government websites often end in .gov or .mil. PMC Handbook of Injectable Drugs 17th Edition. Griffiths V. Midline catheters: indications, complications and maintenance. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment . Bethesda, MD 20894, Web Policies Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Lu H, Hou Y, Chen J, et al. Apply ice to the area for 15 to 20 minutes each hour for 4 hours. Having practitioners spend a few additional minutes during the administration step using a minibag is the only safe choice to be made. J Oncol Pharm Pract. Disclaimer. 6 Although the "extremes" are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas . doi: 10.1097/GOX.0000000000001743. 5200 Butler Pike Irritant: Medication that can cause local inflammatory reactions at the infusion site, which may include: burning, swelling, pain, inflammation, tightness, or phlebitis. If using a peripheral vein, allow the infusion to flow via gravity. Calcium Gluconate. Unauthorized use of these marks is strictly prohibited. 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$. Epub 2014 Jul 3. Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. Cold - Apply cold packs for 15 to 20 minutes four times per day for 1 to 2 days. Reference: 1. 125 Enterprise Drive Seo H, Altshuler D, Dubrovskaya Y, et al. 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? Potassium Chloride. Centers for Disease Control and Prevention. Would you like email updates of new search results? 3/26/2014 5. All rights reserved. stream Not a current ONS member or journal subscriber? Your institution can use them to inform practice policies and procedures, internal quality assessment, and external quality monitoring. Adams DZ, Little A, Vinsant C, Khandelwal S. The midline catheter: A clinical review. 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.