Clinical Associate Professor, Drug Information Specialist, Updated by: For standardization, regimens with continuous daily dosing are represented using a 28-day cycle length. The Oncology Nursing Society4 recommends administering IV vinCRIStine and other vinca alkaloids via a minibag to prevent errors with intrathecal chemotherapy administration. 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. Question: We are trying to implement Best Practice #1 to dispense vinCRIStine (and other vinca alkaloids) in a minibag. Reviewed electronically by nursing reference committee. Introduction 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$. Package insert for vinCRIStine sulfate injection, USP (preservative-free) 1 mg/mL vial. Accessed August 2, 2021. https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html. Cloudflare Ray ID: 7c0b26d1e9b36bd5 Drug Safety and Administration - Cancer Care Ontario 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. David V, Christou N, Etienne P, et al. 2013;1(1):9- 16. By using this site, you agree to theTerms of Use, Privacy Policy, andTerms and Conditions for ONS Guidelines, as applicable. endstream endobj 2089 0 obj <. An official website of the United States government. There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. endobj Careers. References: 1. 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. The 2021 INS guidelines recommend against the use of midline catheters for continuous administration of vesicant therapy, parenteral nutrition, or other infusates with extremes of pH or osmolarity.6 Although the extremes are not further defined, the guidelines specifically recommend central lines for parenteral nutrition formulas with osmolarity exceeding 900 mOsm/L. The venous access should not be removed immediately, since it can be used to attempt aspirating extravasated fluid and for administration of an antidote, if clinically appropriate. Chemotherapy extravasation occurs when a vesicant medication leaks out of a vein into the surrounding soft tissues during an intravenous (IV) infusion. 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. Question:Will administering vinCRIStine in a minibag increase the risk of extravasation? Please refer to FAQ Question #1 and the ONS guidelines 1 for special considerations for vesicant administration through a peripheral IV site. No formal recommendation, but depending on clinical condition could consider extrapolating from management of other vinca alkaloids: Apply cold pack initially for 30 to 60 minutes, then repeat every 15 minutes on day 1 only. Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. The complexity of administration of antineoplastic agents and the potential safety issues involved are unique to oncology care and require careful consideration. When this complication occurs, or is suspected, be truthful and avoid minimizing the situationor worse, fabricating an explanation for the extravasation. Prevention is the most important approach to extravasation management. Copyright 2023 Oncology Nursing Society. Clipboard, Search History, and several other advanced features are temporarily unavailable. Errors have still been reported with the use of large volume syringes, although usually with 10 or 20 mL syringes. For pediatrics, if we dispense vinCRIStine in a minibag with 25 mL, losing 7 mL of the 25 mL dose is not acceptable either. Disclaimer. Pittsburg, PA: Oncology Nursing Society; 2014. 866-257-4ONS (866-257-4667). 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. Firas Y Kreidieh, Hiba A Moukadem, and Nagi S El Saghir. Email ONSs clinical inbox at clinical@ons.org to reach one of our oncology clinical specialists, who can advise on ONS recommendations, best practices, and evidence support. The following information is a compilation from the various resources listed below.[1][2][3][4][5][6][7][8]. Seo H, Altshuler D, Dubrovskaya Y, et al. 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.