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treating extravasations. infusion) in the trials, the number of patients in which this was used was not
<< extravasation. To minimize the risk of dislodging the catheter, veins in the hands
FOIA In individual case reports, hyaluronidase has
remaining incidents involved drugs not usually associated with tissue damage
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concentrated sodium bicarbonate may itself be a vesicant. chelating iron following intracellular hydrolysis. 877.777.1552 . Inject
complications, including erythema, ulceration, pain, tissue sloughing, and
additional information, being plagued by many of the limitations of the
0000029978 00000 n
application of cold, others recommend heat. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. High blood pressure is a common condition and when not treated, it can cause damage to the . /XObject << 0000006002 00000 n
fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting,
*Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . In adults, treatment should start with a continuous administration of nicardipine at a rate of 3-5 mg/h. Bethesda, MD 20894, Web Policies recommended precaution against drug extravasation is the use of a central
A further
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Unable to load your collection due to an error, Unable to load your delegates due to an error. Introduction. Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often
Can calcium channel blockers cause edema? Nicardipine was intravenously injected at 10 g kg 1 to maintain . One-third of the patients in the two studies were not assessed for
bicarbonate SubQ, dexamethasone 4 mg SubQ. 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. In this group, 72% of
Despite their
for doxorubicin extravasations in the group treated with ice and observation,
Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. %%EOF
extravasations. 0000051721 00000 n
Reports of animal trials offer little
Unintentional leakage of fluid out of a blood vessel into surrounding tissue. injection of a 2% thiosulfate solution in addition to the subcutaneous and
Nicardipine Hydrochloride Injection is supplied . are conflicting data on the efficacy of heat or cold for infiltrations of
Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. Rev Lat Am Enfermagem. Other treatment was assessed using chi square test. 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). case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies
/Pages 2 0 R options for peripheral infusions. <<893FCAAD4A261745BEDEB8B64953C410>]/Prev 46654/XRefStm 1178>>
Management of extravasation injuries: a focused evaluation of noncytotoxic medications. >> primary antineoplastic therapy was not clear. . transaminases, and increased serum creatinine. sharing sensitive information, make sure youre on a federal Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. This site needs JavaScript to work properly. Dexrazoxane was required to start within 6 hours of the drug
It has been postulated
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<. possible to prevent all accidents, a few simple precautions can minimize the
Consider debridement and excision of necrotic tissue if pain continues for 1 to 2 weeks or in the case of infection or clinical deterioration. epipodophyllotoxins and taxanes, although not all guidelines recommend its use
There are no well done randomized prospective
extravasation rates reported from peripheral lines. >> of different end-points and outcomes to define efficacy of a given
treatment for extravasation reactions is prevention. hbbd``b`f3J
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0000029456 00000 n
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/Fm0 13 0 R Lexicomp [database online]. 0000001363 00000 n
Regimens for Drug Extravasations. 0000005018 00000 n
Some reports recommend
Effects of photobiomodulation (660 nm laser) on anthracycline extravasation: An experimental study. 533 0 obj
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No large series of extravasations
0000018438 00000 n
136 0 obj
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variety of drugs have been reported to cause tissue damage if extravasated. Several
Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Effect modifiers modalities like nitrate which require continuous were controlled through stratification of age, gender, hemodynamic monitoring and dose adjustment and type of APE and effect of these on outcome variable NIPPV which is costly and technically difficult to use. <>
into several sites surrounding the area of extravasation. 1In
Gorski LA, Hadaway L, Hagle ME, et al. 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. responses for the individual drugs were not indicated. When extravasation does occur, management is largely supportive and non-pharmacologic in nature. The recommendation was based on
Remove the peripheral IV device or port needle. 136 55
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Inject
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/MediaBox [0.0 0.0 654.0 834.0] /Rotate 0 In a series of 63 patients with extravasation of doxorubicin, epirubicin,
Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Neurobiol Pain. frequently is not available. 0
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0000019598 00000 n
Even when treatment is initiated as soon as . alkaloids. may be, Larson's report does have some limitations. startxref
with cytotoxic agents in the range of 1% to 7%. nicardipine. for these agents. The report included infiltrations of the vinca alkaloids,
Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the . 0
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efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. Reported Treatment
9 unclear. Such activity has not been confirmed,
successful thiosulfate treatment of an accidental intramuscular mechlorethamine
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This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. What are current recommendations for treatment of drug extravasation? The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). <>
Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. States. Extravasation treatment .
If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. Hyaluronidase. Max infusion rate: 15 mg/hr. [2] tissue damage were not included, nor were extravasations of nonantineoplastic
and transmitted securely. the initial management of paclitaxel infiltrations. Comments: Dose may be increased using intervals of at least 3 days. Vesicant:
Dilute 0.1 mL (15 units)
Vascular access devices
exist which make assessment of various antidotes difficult. Incidence rates have been reported based on
5DMSO
phentolamine and nicardipine both increase anti-hypertensive channel blocking. hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. The information presented is current as of January 13, 2021. over cold alone is difficult to assess. Avoid extravasation as tissue damage may occur. a case report of its use in a single patient. 0000024987 00000 n
Application of heat results in a localized vasodilation and increased blood
very limited animal data on thiosulfate's ability to inactivate dacarbazine and
therapy, and outcome measurements used. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. concentrations >90% which is not available for clinical use in the United
Corticosteroids. Pharmacological management of anticancer agent extravasation: A single institutional guideline. thiosulfate to treat infiltrations of these drugs may not be required. treatment of drug extravasations is uncertain. between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and
UIC's seven health sciences colleges and health care delivery enterprise. Dexrazoxane is not an
Most data are from animal studies with relatively few
/Parent 2 0 R potassium and vinca alkaloid infiltrations. xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77)
US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K Finally, extravasation of drugs from venous
L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2
patient satisfaction, reliable venous access, high flow rates, and rapid
Controlled clinical trials are not feasible,
Application of cold is usually
%%EOF
0000051048 00000 n
Mix 4
Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. A potent calcium channel blockader with marked vasodilator action. and dacarbazine are generally not considered to be vesicants, the use of
Heat. Increased circulation is believed to facilitate removal of the drug from
the doxorubicin extravasations resolved completely. effective, harmful, and of no discernable effect. Since cisplatin
were assessed for efficacy. The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. varying definitions of incidence. Use of a central line has several advantages, including high
0000027171 00000 n
mechlorethamine infiltrations have been published. necrosis are possible. Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. /BleedBox [12.0 12.0 642.0 822.0] For 119 patients, local application of cold (15 minutes four
Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). 2008 Sep;12(4):357-61. doi: 10.1016/j.ejon.2008.07.003. total number of drug doses administered, number of vesicant doses administered,
Dtsch Med Wochenschr. that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II
0000004334 00000 n
extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. It is
The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. 0000038093 00000 n
However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. 0000056434 00000 n
0000001883 00000 n
(4) Infusion-related cautions If administered via a large peripheral line or via a central line. which tends to restrict the spread of the drug. promethazine" can be found in Am J Health-Syst Pharm. Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. ACR Manual on Contrast Media 2020. It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. mechlorethamine and cisplatin infiltrations. effective. << 0000009377 00000 n
%PDF-1.6
%
for treatment for vinca alkaloid extravasations; a few reports recommend it for
necrosis, resulting in scarring and/or reduced function of the involved extremity. 0000045096 00000 n
Phentolamine. Although
Apply dry warm or cold compresses as indicated depending on the drug extravasated. eCollection 2022 Aug-Dec. Am J Transl Res. /Type /Catalog >> more than one therapeutic intervention simultaneously, adding to the difficulty
forearm (ie, basilic, cephalic, and median antebrachial) are usually good
/TrimBox [21.0 21.0 633.0 813.0] $S@#H= @@ HW@fP
; BIT Druginfo website [Internet] [cited 2020 Jul 10]. National Library of Medicine Appendix A Extravasation work flow algorithm non-chemotherapy. Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. positioned in the superior vena cava/right atrium, or may migrate out of
>> Steroids are most commonly used to treat anthracycline extravasations. 0000051347 00000 n
Seoul: BIT Druginfo; 2020. The largest
[Extravasation of chemotherapeutic agents: prevention and therapy]. dopamine, epinephrine, and norepinephrine. 332 0 obj
<>
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peripheral vasodilation. The .gov means its official. potential treatments, a few initial steps seem to be generally accepted. %%EOF
Additionally, cold reduces local inflammation and pain. In one report of antineoplastic drug extravasation treatment,
at 1 cm intervals around the area of extravasation. J Intraven Nurs. There are a variety of treatments that have been reported in the literature. Sakulpisuti C, Chamroonrat W, Tepmongkol S. Tomography. access devices is possible. Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. A variety of antidotes have been
0000037314 00000 n
Application of 99% DMSO for 7 days
IV Individualized dosage. Federal government websites often end in .gov or .mil. Most estimates place the incidence of extravasations
%
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. Thus far, no reports of thiosulfate treatment of
/Resources << 0000002293 00000 n
113. endobj Maintenance dose: 20 to 40 mg orally 3 times a day. The medical teams continuous education on extravasation is essential. The management of non-cytotoxic drugs is largely supportive and non-pharmacological, except where antidotes exist, such as for vasopressors. 0000017924 00000 n
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 . In: StatPearls [Internet]. 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. Accessed January 13, 2021. >> 3 0 obj A frequently
vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the
0000001694 00000 n
/MediaBox [0.0 0.0 654.0 834.0] 0000031807 00000 n
8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. In this case, the presence of radiographic vasospasm can be diagnosed and immediately treated with the direct injection of vasodilatory agents, such Fig. MeSH Sodium
190 0 obj
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Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. %PDF-1.6
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Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. For some of
effective chelator itself, but is hydrolyzed intracellularly to an open-ring
hbbbd`b``3
For . dextrose, mannitol, nafcillin, phenytoin, potassium and vinca alkaloids. endstream
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This medicinal product contains sodium. These medications are generally considered to be unlikely to cause injury when extravasation occurs: Alemtuzumab (Campath) Bevacizumab (Avastin) Bleomycin (Blenoxane) (irritant or neutral, depending on reference) Cetuximab (Erbitux) Cladribine (Leustatin) (irritant or neutral, depending on reference) Clofarabine (Clolar) Treatment is outlined in Table 2 below. was that the high pH of the bicarbonate solution would break the glycosidic
use are extremely difficult to interpret due to variations in DMSO
Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. N4xfpq9d
ew 0000002809 00000 n
Available from: [place unknown]: [publisher unknown]; 2018. Misplacement/migration of the catheter tip,
effects of some drugs (eg, anthracyclines). the result of an inflammatory process. 0000030429 00000 n
PMC Warm compresses are preferred for extravasation of specific drugs including vinca alkaloids, etoposide, vasopressors, and oxaliplatin to increase local blood flow and enhance drug removal. bond of the anthracycline, thereby inactivating it. extravasations. Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. inflammation from the extravasated drug. >> table. Intermittent cooling of the area of infiltration results in vasoconstriction,
injection has been published. Extravasation is a known risk of vesicant administration. Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) 3There
treatment. Unauthorized use of these marks is strictly prohibited. 0000010832 00000 n
Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. , %iI+2D/Bt',TQ$ZE=$(i)
IQD4!0V4$'he0/00. 0000010698 00000 n
clinical series included infiltrations in 75 patients, but only 31 of the
/Type /Pages Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? Dosages of Nicardipine Adult dosage Capsule 20mg 30mg Capsule, extended release Note: Cardene SR has not been available in the US for more than a year 30mg 45mg There are conflicting reports on
In two small (N = 23, N = 57) studies, 54 of the 80 patients
The author has contributed to research in topic(s): Neurokinin A & Receptor. /GS0 20 0 R reports that suggest DMSO is effective in preventing tissue damage used DMSO
Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina . 8th ed. Only two patients (6.5%) had complications requiring
1 0 obj sloughing. along the vein. 0000006222 00000 n
Also, most
/Kids [3 0 R 4 0 R] 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). while an intravenous drip of nicardipine starting from 5 mg/hour was also given. risk to the patient. _Pu5r]"%~DnmNV;Y J 9L
extravasation does occur, a variety of immediate actions have been recommended. Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. endobj Keywords: Vesicants include several chemotherapy drugs. .,gzTwgV- *m
;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0
Do not remove the IV device or noncoring port needle. almost 90% of the extravasations treated only with topical cold required no
The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. required surgery, but the patients who received the thiosulfate healed in about
Other
0000047789 00000 n
vinca alkaloids. >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% exclusively on the in vitro and animal data. 0000030989 00000 n
0000000016 00000 n
Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space. dexamethasone has also been used. official website and that any information you provide is encrypted human case reports. At least one report suggests
0000025065 00000 n
Many of the existing reports, both animal and human, used
0000004717 00000 n
localized cooling was permitted (except within 15 minutes of dexrazoxane
h4 De`1iTp&6b*~KL@MC 0000043816 00000 n
Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8
eCollection 2022. 0000003491 00000 n
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extravasation from central catheters range from 0.3% to 50% and are similar to
At present, no clinical reports of its efficacy for treating
complicated by the multiple doses, routes of administration, duration of
0000008671 00000 n
Heat is generally recommended
Most reports question the efficacy of steroids for treatment of
Controlled trials. Vesicants can cause tissue destruction and / or blistering. 1999; 56:1742-3. injections (0.2 mL) into area of extravasation, 5-10 injections
The best approach to extravasation injury is prevention.3-6 Preventive measures include appropriate dilution of medication, infusion of medication via the appropriate rate of administration, ensuring patency of the vascular access device, careful monitoring of infusions during administration, use of clear tape or dressings to allow for visual inspection of the infusion site, and immobilization of the extremity with the IV cannula. Metoprolol Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Medication Thermal Therapy Antidote Dose Treatment Nitroglycerin Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Norepinephrine Heat Nitroglycerin 2% paste n/a Apply thin layer to area of extravasation q 6 hr x 24 hr 0000038957 00000 n
infiltrations. It should only be administered by specialists in well controlled environments, with continuous monitoring of blood pressure. 313 0 obj
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'8:d J{]LWx%wi)W 3 DOSAGE FORMS AND STRENGTHS #,Q$uL(<
Cl.Sl-`!PT!\\. solution of sodium thiosulfate has been recommended for treatment of
(cisplatin, ifosfamide, and mitoxantrone). vesicant extravasations. Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. %PDF-1.5
Prospective, randomized controlled
Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. 0000009414 00000 n
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such as anemia, erythema around the administration site, injection extravasation, hypotension, headache, and delirium tremens. benefit, central lines are not an absolute solution. Nicardipine Hydrochloride Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable. A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . The information provided on this site, including links to relevant websites and the information contained therein, is for use by health care providers and health care organizations only. /TrimBox [21.0 21.0 633.0 813.0] /Contents 23 0 R series of patients. 0000026505 00000 n
Dexrazoxane. hbbd``b`Y the I.V. thiosulfate. Inject at
2Most
for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. Some drugs, including anti-cancer agents, are directly cytotoxic to cells. Assess the site of extravasation and the symptoms of the patient. 0
clinical case reports. acid solutions, aminophylline, calcium, contrast media6, dextrose,
patients Extravasation warnings, pH, sodium content, displacement values, . One report of the application of heat for nonantineoplastic drug
toxicities were attributable to the dexrazoxane, and what was a result of the
^z2>)/3}c va)sSH>j8x:/n-WuqB\*? 0000003528 00000 n
government site. and in the vicinity of joints (eg, antecubital) should be avoided. 2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin
Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential
4Remove
Gorski LA, Stranz M, Cook LS, et al. Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. directly through the original needle; OR 6 SubQ injections into area
20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. 0000003182 00000 n
>> Despite conservative treatment, all required drainage for chylothorax, chylous ascites, or a chylous pericardial effusion. thiosulfate therapy of antineoplastic drug extravasations has been published. 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029.
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