Appendix B: Vesicant/Irritant and Extravasation Management ...

NIH Clinical Center Vesicant/Irritant and Extravasation Management Guidelines

Drug (Brand Name) Acyclovir (Zovirax?)

Ado-trastuzumab emtansine (Kadcyla?) Amiodarone (Nextarone?)

Amsacrine (Not commercially available in U.S.)

Bendamustine (Bendeka?, Treanda?)

Cabazetaxel (Jevtana?)

Classification Irritant

Irritant

Irritant

Vesicant

Irritant with Vesicant Properties

Irritant with Vesicant Properties Classification extrapolated from other agents in the taxane family

Extravasation Management 1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen None

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 4. Elevate extremity 1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 4. Consider plastic surgery consult 5. Apply dry, cold compress for 20 minutes four times daily for 1-2 days 1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 4. Consider plastic surgery consult 5. Apply dry, cold compress for 20 minutes four times daily for 1-2 days

Reference(s)

34-36 1,2 36,37 2,3

2-4

2,5

Revised 05/2017

Page 1 of 19

Drug (Brand Name) Calcium chloride

Calcium gluconate

Carboplatin (Paraplatin?) Carmustine (BiCNU?) Ciprofloxacin (Cipro?) Cisplatin (Platinol?)

Classification Vesicant

Vesicant

Irritant Irritant Irritant Irritant

Extravasation Management

Reference(s)

1. Immediately stop drug administration, disconnect drug from patient

38-49

2. Aspirate back through VAD to remove any accessible extravasated drug

3. Outline area of extravasation with a skin markingpen

4. Apply dry, warm or cold compress for 20 minutes four times daily for 1-2days

5. Plastic surgery consult stronglyrecommended

Consider hyaluronidase injections (see dosing guidelines at end of document for details)

1. Immediately stop drug administration, disconnect drug from patient

38-49

2. Aspirate back through VAD to remove any accessible extravasated drug

3. Outline area of extravasation with a skin markingpen

4. Apply dry, warm or cold compress for 20 minutes four times daily for 1-2days

5. Plastic surgery consult stronglyrecommended

Consider hyaluronidase injections (see dosing guidelines at end of document for details)

1. Immediately stop drug administration, disconnect drug from patient

2,3

2. Aspirate back through VAD to remove any accessible extravasated drug

3. Outline area of extravasation with a skin markingpen

4. Apply dry, cold compress for 20 minutes four times daily for 1-2days

1. Immediately stop drug administration, disconnect drug from patient

2,3

2. Aspirate back through VAD to remove any accessible extravasated drug

3. Outline area of extravasation with a skin markingpen

4. Apply dry, cold compress for 20 minutes four times daily for 1-2 days

1. Immediately stop drug administration, disconnect drug from patient

50

2. Aspirate back through VAD to remove any accessible extravasated drug

3. Outline area of extravasation with a skin markingpen

Apply dry, cold compress for 20 minutes four times daily for 1-2 days

1. Immediately stop drug administration, disconnect drug from patient

2,3,6-9

2. Aspirate back through VAD to remove any accessible extravasated drug

3. Outline area of extravasation with a skin markingpen

4. Apply dry, cold compress for 20 minutes four times daily for 1-2 days

5. Consider injecting sodium thiosulfate through IV if line is still in place; if IV line has been

removed, consider local infiltration of affected area with sodium thiosulfate. Sodium thiosulfate

may be beneficial for large volume extravasations (see dosing guidelines at end of document for

details)

Revised 05/2017

Page 2 of 19

Drug (Brand Name)

Dacarbazine (DTIC?, DTIC-Dome?)

Classification Irritant

Dactinomycin, Actinomycin-D (Cosmegen?)

Vesicant

Darubicin (Idamycin?)

Vesicant

Daunorubicin (Cerubidine?)

Vesicant

Extravasation Management

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 4. Apply dry, cold compress for 20 minutes four times daily for 1-2 days

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 4. Consider plastic surgery consult 5. Apply dry, cold compress for 20 minutes four times daily for 1-2 days 1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through the VAD to remove any accessible extravasated drug 3. Apply dry, cold compress for 20 minutes four times daily for 1-2 days 4. If extravasation is noted within 6 hours of idarubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)* 5. If extravasation is noted more than 6 hours after idarubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)* 6. Avoid applying pressure to the extravasationsite 7. Elevate the extremity 8. Consider plastic surgery consult

*Concurrent use of dexrazoxane and DMSO is NOT recommended.

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through the VAD to remove any accessible extravasated drug 3. Apply dry, cold compress for 20 minutes four times daily for 1-2 days 4. If extravasation is noted within 6 hours of daunorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)* 5. If extravasation is noted more than 6 hours after daunorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)* 6. Avoid applying pressure to the extravasationsite 7. Elevate the extremity 8. Consider plastic surgery consult *Concurrent use of dexrazoxane and DMSO is NOT recommended.

Reference(s)

2,3,10 2,3 2,3,11-14

2,3,11-14

Revised 05/2017

Page 3 of 19

Drug (Brand Name) Classification

Daunorubicin Liposomal Vesicant (DaunoXome?)

Dextrose (> 10%)

Vesicant

Diazepam (Valium?)

Dobutamine (Dobutrex?)

Vesicant Vesicant

Revised 05/2017

Extravasation Management

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through the VAD to remove any accessible extravasated drug 3. Apply dry, cold compress for 20 minutes four times daily for 1-2 days 4. If extravasation is noted within 6 hours of daunorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)* 5. If extravasation is noted more than 6 hours after daunorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)* 6. Avoid applying pressure to the extravasationsite 7. Elevate the extremity 8. Consider plastic surgery consult

Reference(s)

2,3,11-14

*Concurrent use of dexrazoxane and DMSO is NOT recommended.

Extrapolated from standard daunorubicin information due to lack of significant data on

liposomal daunorubicin extravasation management 1. Immediately stop drug administration, disconnect drug from patient

36,38,49,51-53

2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 4. Apply dry, cold compress for 20 minutes four times daily for 1-2 days 5. Consider plastic surgery consult

Consider hyaluronidase injections (see dosing guidelines at end of document for details)

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen

38,49,54

4. Apply dry, cold compress for 20 minutes four times daily for 1-2 days 1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug

38,49,55-60

3. Outline area of extravasation with a skin markingpen

4. Apply dry, warm compress for 20 minutes four times daily for 1-2 days 5. Consider local infiltration with phentolamine (see dosing guidelines at end of document for details)

6. (Alternative to 5) Apply topical nitroglycerin ointment (see dosing guidelines at end of document for details)

Page 4 of 19

Drug (Brand Name) Docetaxel (Taxotere?)

Dopamine (Intropin?)

Doxorubicin (Adriamycin?)

Classification Irritant with Vesicant Properties

Vesicant

Vesicant

Extravasation Management

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 4. Consider plastic surgery consult 5. Apply dry, cold compress for 20 minutes four times daily for 1-2 days

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through VAD to remove any accessible extravasated drug 3. Outline area of extravasation with a skin markingpen 4. Apply dry, warm compress for 20 minutes four times daily for 1-2 days 5. Consider local infiltration with phentolamine (see dosing guidelines at end of document for

1. Immediately stop drug administration, disconnect drug from patient 2. Aspirate back through the VAD to remove any accessible extravasated drug 3. Apply dry, cold compress for 20 minutes four times daily for 1-2 days 4. If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)* 5. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)* 6. Avoid applying pressure to the extravasationsite 7. Elevate the extremity 8. Consider plastic surgery consult *Concurrent use of dexrazoxane and DMSO is NOT recommended.

Reference(s)

2,3

36,38,49,57-61

2,3,11-15

Revised 05/2017

Page 5 of 19

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