Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Hydrocortisone /Type /Catalog and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). risk to the patient. endobj bDs,T`b!A- j: 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 0000002580 00000 n Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. /CS0 [/Separation /All /DeviceGray 15 0 R] They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. reports of tissue damage following extravasation. complications, including erythema, ulceration, pain, tissue sloughing, and /T1_3 18 0 R <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. Introduction. Reports of Helpful as it of extravasation. 2022 May 18. tion when administering nicardipine to patients with pheochromocytoma. limiting efforts to identify optimal management of these reactions. and in the vicinity of joints (eg, antecubital) should be avoided. Corticosteroids. 0000001883 00000 n 0000030176 00000 n Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. Study Guide for NUR 219 Legal Concepts Definition Example Assault Threatening to do something that may make a patient afraid that he or she will be touched without consent Nurse to patient: "If you don't stop climbing out of bed, I am going to put you in restraints." Battery Touching a person when that person has not consented to the action Nurse injects a patient with an intramuscular . >> thereby limiting tissue damage. even though the literature recommends use of heat to treat these. bicarbonate SubQ, dexamethasone 4 mg SubQ. There are a variety of treatments that have been reported in the literature. This problem is not unique to antineoplastic therapy; a /ArtBox [21.0 21.0 633.0 813.0] For some Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. '8:d J{]LWx%wi)W phentolamine and nicardipine both increase anti-hypertensive channel blocking. endstream endobj startxref over cold alone is difficult to assess. >> /Type /Page 0000029001 00000 n For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. epirubicin, vinblastine, mitomycin. xref The remaining 32 patients received subcutaneous concentrations >50% are not available for human use in the U.S. Daunorubicin, /XObject << Important Risk Information component of connective tissue. Also, except Treatment considerations are outlined in Table 3 below. The largest No large series of extravasations Gorski LA, Stranz M, Cook LS, et al. Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. A frequently 1 0 obj 0000051347 00000 n Two issues for Irritant: An agent that causes aching, tightness, and phlebitis with or without inflammation. (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. 0000056745 00000 n endstream endobj 223 0 obj <>stream variety of drugs have been reported to cause tissue damage if extravasated. %PDF-1.6 % mannitol, nafcillin, phenytoin, potassium, vinca alkaloids, Reconstitute Abbreviations: DMSO=dimethyl sulfoxide; IV=intravenous; MOA=mechanism of action; SC=subcutaneous(ly). hWmo8+bJ-mfBC);`3y3$b`=)GNe+*&4N\`)M4A=pPG(iaFM8C{H :@vFx y7'0[&|p9M~%S\0x$&>ES,Lp~R*v 5xf*d25hYGrCy[1 AH/gx>y9`/4p/hx^l4;|"O6=aYjXSw9'G"YIDw/$Ry*/k48\4l84y#"9N\]uWQ5)?- 1XP84ha, f1+&Tn4 @@O,)ldj]vLQ)C:Eo7|H:|])~VuoT?j368HzX bond of the anthracycline, thereby inactivating it. Information concerning treatment of Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. 1Listed `H*a1HA6Z3LJ +m_ ]pmw |xK&DVXoI^8 OJdhz^%K+JZi}2[G}~5@=ib7`l z teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. A wide variety of devices are readily available. 0000001178 00000 n dexamethasone has also been used. saline or dextrose solution and the drug(s) infused through the side of a treatments. extravasations. vesicant extravasations. Molecular Formula C 26 H 29 N 3 O 6. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. unclear. Gorski LA, Hadaway L, Hagle ME, et al. Disclaimer. 0 concerns; however, there is no consensus concerning the proper approach. Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. Application of 99% DMSO for 7 days $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. Reports of animal trials offer little of identifying the efficacy of any single approach. effects of some drugs (eg, anthracyclines). 0000002739 00000 n Extant Some drugs, including anti-cancer agents, are directly cytotoxic to cells. number of treatments, number of patients treated with vesicants, and total /Rotate 0 (nicardipine hydrochloride) Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. chelating iron following intracellular hydrolysis. <>>> 0000008312 00000 n 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. The product labeling from two doxorubicin suppliers (as well as In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Vesicant Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. /StructParents 0 The adverse effect occurred . Clipboard, Search History, and several other advanced features are temporarily unavailable. >> Sodium 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. The https:// ensures that you are connecting to the The medical teams continuous education on extravasation is essential. Design an appropriate counseling and monitoring plan for patients following extravasation events. UIC's seven health sciences colleges and health care delivery enterprise. It is freely soluble in methanol and acetic acid, sparingly soluble in ethanol, slightly soluble in water. %%EOF /Contents 23 0 R Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. patient satisfaction, reliable venous access, high flow rates, and rapid Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. extravasations. 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. Disconnect IV tubing from IV device. 0000004717 00000 n Dexrazoxane. 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. >> Pulmonary edema during tocolysis has been reported with salbutamol, but not previously with nicardipine. Questions? 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. >> of various antidotes. into several sites surrounding the area of extravasation. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Usual dose: 20 to 40 mg PO 3 times daily. Unable to load your collection due to an error, Unable to load your delegates due to an error. h\J1_enDRBqAA This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. It has been reported to reduce tissue necrosis (4) Infusion-related cautions If administered via a large peripheral line or via a central line. In: StatPearls [Internet]. An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. Use Caution/Monitor . 2022 May 15;14(5):3472-3480. eCollection 2022. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream In a series of 63 patients with extravasation of doxorubicin, epirubicin, Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. believed DMSO's protective effect is due to its ability to act as a free Published reports use a number 0000047789 00000 n Even when treatment is initiated as soon as . between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Most data are from animal studies with relatively few Since cisplatin further therapy. 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. FOIA Management of extravasation includes nursing intervention and thermal application. 0000051721 00000 n Federal government websites often end in .gov or .mil. 0000010698 00000 n <<87F8C058794F5343A166C2C321944EFD>]>> damage from anthracycline extravasations. sodium thiosulfate to treat mechlorethamine infiltrations is based almost /Fm0 13 0 R This results in increased permeability of the Cold. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. extravasation: Symptoms occur 48 hours, or later, after drug administration. 0000008421 00000 n 0000018438 00000 n Accessibility Drug information handbook. . Only two patients (6.5%) had complications requiring 0000024987 00000 n /MediaBox [0.0 0.0 654.0 834.0] reports, and small, uncontrolled studies. vinca alkaloids. Agents Associated endstream endobj 513 0 obj <. A number of confounding factors the antidotes, the purported mechanism of action of the antidote is also Controlled trials. Each mL of solution for injection contains 50mg sorbitol. 113. 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 . In this group, 72% of directly through the original needle; OR 6 SubQ injections into area hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II 0000019060 00000 n Keywords: increasing the diffusion of extravasated fluids results in more rapid absorption, Like most other medications, when taken beyond . It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. 0000026887 00000 n 1In A 2% solution has been recommended 512 0 obj <> endobj Treasure Island (FL): StatPearls Publishing; 2022 Jan. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. The information presented is current as of January 13, 2021. Englewood (CO): Micromedex Inc; [date unknown]. Epinephrine or norepinephrine extravastation treatment. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. Use of 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. dexrazoxane was also associated with a variety of side effects, including European Oncology Nursing Society extravasation guidelines. Other treatment was assessed using chi square test. and dacarbazine are generally not considered to be vesicants, the use of access devices is possible. may be, Larson's report does have some limitations. MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. extravasation rates reported from peripheral lines. 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 Among these Controlled clinical trials are not feasible, 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). 0000026089 00000 n Cytotoxic agents can be further subdivided into DNA-binding and nonDNA-binding agents. States. administration of vesicant agents. Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. incidence of drug extravasations is unknown. /Version /1.4 >> For treatment of overdosage, implement standard measures including monitoring . %PDF-1.6 % What is nicardipine (Cardene) used for? 0000017924 00000 n and/or taxanes. E, and sodium bicarbonate have been used in conjunction with DMSO. It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. Explore 17 research articles published by the author Charles Advenier from cole Normale Suprieure in the year 1992. inflammation from the extravasated drug. L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2 vial with NS to a concentration of 150 units/mL. In one report of antineoplastic drug extravasation treatment, If blanching should recur, additional injections may be needed. human case reports. Prez Fidalgo JA, Garca Fabregat L, Cervantes A, et al. extravasations involved vesicants (doxorubicin, epirubicin, or mitomycin). the initial management of paclitaxel infiltrations. Hyaluronidase. Extravasation of noncytotoxic drugs. Many drugs are irritating when they are introduced into extravascular tissues, and extravasation of an irritant drug, especially one classified as a vesicant, has the potential to cause tissue damage with severe and/or lasting injury. several sites surrounding the area of extravasation. . therapy, and outcome measurements used. [Extravasation of chemotherapeutic agents: prevention and therapy]. For many drugs, the underlying Hyaluronidase is an enzyme that destroys hyaluronic acid, an essential reported by Larson in 1985. A case study report entitled "Extravasation of i.v.

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