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The pharmacology of anti-neoplastics, focusing on the potential for extravasation and its damaging effects on tissues. Indications of extravasation, medications classified as vesicants, and ways to minimize extravasation are covered. Instructions for handling suspected extravasation are also provided.
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Vesicants are agents that, if deposited into the subcutaneous tissue (extravasation), cause tissue necrosis and damage to underlying tendons, nerves, and blood vessels. The full extent of tissue damage may take several weeks to become apparent. Indications of extravasation include: Absence of blood return from IV catheter Resistance to flow of IV fluid Swelling, pain, and/or redness to IV site Some medications classified as vesicants: Vinca Alkaloids and Antitumor Antibiotics Daunorubicin, Doxorubicin (Adriamycin), Vincristine, Vinblastine, Nitrogen Mustard If extravasation is suspected, stop drug administration immediately and administer protocol according to institution’s policy. (Ex- aspiration of infiltrated drug and inject neutralizing solution such as Hyaluronidase.) Ways to minimize extravasation: Check for blood return prior to drug administration Good IV access or Implanted vascular access device Slow administration of chemotherapeutic agent Monitor IV access closely during administration Have client report any s/s of swelling, pain, redness or burning to IV site If you have to administer a combination of chemotherapeutic agents that consist of vesicants and non-vesicants (such as irritants), you need to administer the non-vesicants first. These are less likely to cause tissue destruction.