Vesicant extravasation

Peripheral neuropathy primary dose-limiting toxicity motor sensory, autonomic, and cranial nerves may all be affected (paresthesias, ileus, urinary retention, facial palsies) may be irreversible mild emetogen SIADH vesicant extravasation injury... 

St Germain B, Houlihan N, D Amato S. Dimethyl sulfoxide therapy in the treatment of vesicant extravasation two case presentations. J Intraven Nurs 1994 17(5) 261-6. 

Myelosuppression mucositis moderately emetogenic vesicant extravasation alopecia cardiac toxicities acute and chronic, as with daunorubicin and doxorubicin (total cumulative dose not well established >150 mg/m reported to be associated with decreased LVEF Myelosuppression low... 

Myelosuppression highly emetogenic rapid onset, within 1-2 hours of dose vesicant extravasation injury secondary malignancies sterility and infertility... 

If a vesicant is prescribed as an infusion, it is given through a central line only and checked every 1 to 2 hours. The nurse keeps an extravasation kit containing all materials necessary to manage an extravasation available, along with the extravasation policy and procedure guidelines. 

When file patient is receiving a vesicant, file nurse monitors file IV site continuously and checks for blood return frequently (every 1-2 mL). Extravasation may occur without warning, or signs may be detected by an alert nurse The earlier file extravasation is detected, file less likely soft-tissue damage will occur. 

Myelosuppression (dose-related) mucositis (worse with continuous infusion) moderate emetogenic potential alopecia vesicant severe extravasation injury cardiac toxicities acute—not related to cumulative dose arrhythmias, pericarditis chronic— cumulative injury to myocardium (total dose greater than 550 mg/m2 lower total cumulative doses cause damage to myocardium in children (e.g., 350 mg/m2)... 

Vesicants given via peripheral vein should be given by intravenous push rather than by infusion to enable immediate cessation and withdrawal of fluids if extravasation occurs. 

Extravasation Movement of fluid from inside a blood vessel into the surrounding tissues for example, leakage or infiltration of a vesicant chemotherapy agent into local tissue. 

Vincristine—vesicant-avoid extravasation cumulative neurotoxicity—may produce severe constipation -maximum 2 mg per administration... 

Doxorubicin—monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy) vesicant—avoid extravasation use 50% for bilirubin 1.5-3.0 use 25% for bilirubin > 3.0... 

Epirubicin-monitor cumulative dose for cardiac toxicity (not to exceed 1000 mg/M2) vesicant—avoid extravasation... 

Vinblastine-use 50% of dose for bilirubin > 3.0 vesicant-avoid extravasation watch for neurotoxicity... 

Vinorelbine-vesicant avoid extravasation can cause peripheral neuropathy ... 

Streptozocin—vesicant-avoid extravasation have 50% dextrose available in case of sudden hypoglycemia monitor closely for renal impairment... 

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