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Vesicant Extravasation: Management and Prevention Guide, Exams of Nursing

Southern New Hampshire University (SNHU)Nursing

A comprehensive overview of infiltration and extravasation, focusing on the leakage of iv administered drugs into tissues and the associated risks. It details various types of reactions, including irritation, flare reactions, and infusion reactions, along with specific drugs and their potential effects. The document also covers factors affecting tissue damage severity, risk factors for peripheral and central vad extravasations, and possible etiologies. Furthermore, it outlines signs, symptoms, consequences, and initial management steps for extravasation, including grading for adverse events and specific treatments for different vesicants. This information is crucial for healthcare professionals to understand and manage extravasation effectively, minimizing patient harm and ensuring proper treatment protocols are followed. A valuable resource for understanding the complexities of vesicant extravasation and its management.

Typology: Exams

2024/2025

Available from 06/04/2025

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infiltration - CORRECT ANSWER passage or escape of IV administered drugs into
the tissue
extravasation - CORRECT ANSWER leakage of drugs capable of causing tissue
damage into the subcutaneous or subdermal tissue or other unintended sites.
irritation - CORRECT ANSWER a localized inflammatory reaction at the infusion or
injection site
flare reaction - CORRECT ANSWER a local allergic reaction along a vein caused by
irritating drugs.
infusion reactions - CORRECT ANSWER reactions mediated by the immune system
(hypersensitivity, anaphylaxis, cytokine release syndrome)
DNA-binding vesicants - CORRECT ANSWER vesicant binds to nucleic acids in the
DNA of healthy cells in the tissue, causing cell death. the dead cells then release
complexes, which are taken up by adjacent healthy cells. this process causes a
continuing cycle of tissue damage as the vesicant is retained in the tissue for a
long period of time.
NON-DNA binding vesicants - CORRECT ANSWER the vesicant has an indirects
effect on healthy cells. it does not bind to cellular DNA. it is metabolized in the
tissue and is more easily neutralized.
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Download Vesicant Extravasation: Management and Prevention Guide and more Exams Nursing in PDF only on Docsity!

infiltration - CORRECT ANSWER passage or escape of IV administered drugs into the tissue extravasation - CORRECT ANSWER leakage of drugs capable of causing tissue damage into the subcutaneous or subdermal tissue or other unintended sites. irritation - CORRECT ANSWER a localized inflammatory reaction at the infusion or injection site flare reaction - CORRECT ANSWER a local allergic reaction along a vein caused by irritating drugs. infusion reactions - CORRECT ANSWER reactions mediated by the immune system (hypersensitivity, anaphylaxis, cytokine release syndrome) DNA-binding vesicants - CORRECT ANSWER vesicant binds to nucleic acids in the DNA of healthy cells in the tissue, causing cell death. the dead cells then release complexes, which are taken up by adjacent healthy cells. this process causes a continuing cycle of tissue damage as the vesicant is retained in the tissue for a long period of time. NON-DNA binding vesicants - CORRECT ANSWER the vesicant has an indirects effect on healthy cells. it does not bind to cellular DNA. it is metabolized in the tissue and is more easily neutralized.

cabazitaxel (jevtana) - CORRECT ANSWER a taxane where infiltration has not caused skin or tissue impairment Docetaxel (taxotere) - CORRECT ANSWER extravasation may cause hyperpigmentation, erythema and tenderness. paclitaxel (taxol) - CORRECT ANSWER injection site reactions, including reactions secondary to extravasation, usually mild and consist of erythema, tenderness, skin hyperpigmentation or swelling at injection site. seen more often with 24 hour infusions than with 3 hour infusions. severe reactions such as phlebitis, cellulitis, induration, skin exfoliation, necrosis and fibrosis have been reported. onset has been delayed by a week to 10 days. recall reactions - CORRECT ANSWER recurrence of skin reactions at the site of previous extravasation following paclitaxel injection at a different site. docetaxel and paclitaxel - CORRECT ANSWER classified as exfoliants or drugs that may cause inflammation and peeling of skin without causing underlying tissue death. factors affecting tissue damage severity following a vesicant extravasation - CORRECT ANSWER 1. DNA binding vesicants cause greater tissue damage than non-dna binding vesicants

  1. the higher the concentration and greater amount of a vesicant the more damaged caused.
  2. location of the extravasation such as those with little subcutaneous tissue and overlying veins, arteries and nerves are likely to have more damage.

Risk factors for extravasation from central VADs - CORRECT ANSWER 1. difficulty encountered during device insertion

  1. inadvertent slicing, piercing or nicking of catheter prior to insertion
  2. device misplacement with catheter tip outside of the venous system.
  3. insufficient length of non coring needle (implanted port)
  4. presence of a fibrin sheath or thrombus at the catheter tip. 6.catheter migration
  5. long dwell time of catheters inserted using a subclavian approach, in which the catheter is placed between the clavicle and first rib possible etiologies of extravasations from central VADs - CORRECT ANSWER 1. inadvertent misplacement of catheter tip outside of the venous system during insertion procedure.
  6. vein perforation during insertion
  7. post insertion vein erosion, catheter leakage, rupture or fracture.
  8. separation of the catheter from a portal body.
  9. incomplete insertion of a non coring needle into an implanted port
  10. non coring needle dislodgement from an implanted port.
  11. backflow of vesicant along the catheter to the venotomy site secondary to fibrin sheath or thrombus at the catheter tip. signs and symptoms of vesicant extravasation - CORRECT ANSWER 1. vein irritation and flare reactions may mimic signs of vesicant extravasation.
  12. vein irritation and flare reactions only occur in peripheral chemo administration
  1. if it happens in CAD it is d/t catheter tip placement outside of the venous access device or erosion of the vein wall.
  2. this may cause SOB and shock to secondary blood loss. additional signs and symptoms of vesicant extravasation - CORRECT ANSWER 1. IV flow rate that slows or stops
  3. resistance during IV bolus vesicant administration
  4. leaking around the IV catheter or implanted port needle. consequences of untreated vesicant extreavasation - CORRECT ANSWER 1. blistering (usually happens within 3 to 5 days.
  5. peeling and sloughing of skin (usually begins 2 weeks after extravasation)
  6. tissue necrosis (usually evident two or three weeks after extravasation.
  7. DNA binding vesicants stay in the tissue for a long time, the area of necrosis becomes larger and deeper over time.
  8. non-dna binding vesicants are more easily metabolized in the tissue. it is localized and improves over time.
  9. damage to tendons, nerves and joints
  10. functional and sensory impairment of the affected area.
  11. disfigurement
  12. loss of limb. Flare reaction - CORRECT ANSWER 1. itchy blotches or hives; pain and burning uncommon

steps to take when a vesicant extravasation occurs or is suspected. - CORRECT ANSWER 1. immediately stop administering the vesicant and IV fluids

  1. disconnect the IV tubing from the IV device. do not remove the IV device or non coring port needle
  2. attempt to aspirate residual vesicant from the IV device or port needle using a small ( 1-3 ml) syringe.
  3. remove the peripheral IV device or port needle.
  4. initiate appropriate management measures according to policy. Grading for adverse event of infusion site extravasation - CORRECT ANSWER grade 1: painless edema grade 2: erythema with associated symptoms ( edema, pain, induration, phlebitis) grade 3: ulceration or necrosis, severe tissue damage; operative intervention indicated. grade 4: life-threatening consequences; urgent intervention indicated grade 5: death. mechlorethamine hydrochloride (nitrogen mustard, Mustargen) - CORRECT ANSWER 1. alkylating agent
  5. apply cold pack for 6-12 hours following sodium thiosulfate antidote injection
  6. sodium thiosulfate neutralizes mechlorethamine to form non toxic thioesters that are excreted in the urine.
  7. to prepare 1/6 (4.14 g) molar solution of sodium thiosulfate per 100 ml of sterile water for injection
  1. inject 2 ml of the sodium thiosulfate solution for each milligram of mechlorethamine suspected to have extravasated. inject the solution SC into the extravasation site using a 25 gauge or smaller needle. dose may be divided into 3- 4 syringes to inject around the site of extravasation. the needle should be changed with each new injection.
  2. assess the extravasation area for pain, blister formation and skin sloughing periodically.
  3. instruct patients to monitor extravasation site and ot report fever, chills, blistering skin sloughing and worsening pain.
  4. instruct patient to report arm or hand swelling and stiffness. Trabectedin (Yondelis) - CORRECT ANSWER 1. apply cold pack for 15-20 minutes at least 4 times/ day for the first 24 hours.
  5. no known antidote or treatment exists.
  6. assess the extravasation area for pain, blister formation and skin sloughing periodically. Anthracenedione (Mitoxantrone, Novantrone) - CORRECT ANSWER 1. apply cold pack for 15-20 minutes at least 4 times/day for the first 24 hours.
  7. no known antidote or treatment exists.
  8. extravasation typically causes blue discoloration of the infusion site area and may require debridement and skin grafting.
  9. assess the extravasation area for pain, blister formation, and skin sloughing periodically as needed

antitumor antibiotics ex. dactinomycin (actinomycin D, cismegen) Daunorubicin and cytarabine (cyxeos), doxorubicin hydrochloride liposome (doxil), Mitomycin (mutamycin) - CORRECT ANSWER 1. apply cold pack for 15-20 minutes at least 4 times/day for the first 24 hours.

  1. no known antidotes or treatment exists.
  2. assess the extravasation area for pain, blister formation and skin sloughing. plant alkaloids and microtubule inhibitors. ex. Vinblastine( velban), vincristine (oncovin) - CORRECT ANSWER 1. apply warm pack for 15-20 minutes at least 4 times/day for the first 24-48 hours. elevate extremity. (peripheral extravasations)
  3. antidote: hyaluronidase. it degrades hyaluronic acid and promotes drug dispersion and absorption
  4. prepare per package insert. do not dilute. use solution provided. store at room temperature.
  5. administer 150 units of hyaluronidase solution as 5 separate injections, each containing 0.2 ml of hyaluronidase, subcutaneously into the extravasation site using a 25 gauge or smaller needle.
  6. assess the extravasation area for pain, blister formation and skin sloughing.
  7. instruct patients to monitor the extravasation site and to report fever, chills, blistering, skin sloughing and worsening pain.
  8. instruct patients w/ peripheral extravasation to report arm or hand swelling or stiffness. Taxanes Ex. cabazitaxel (jevtana), docetaxel (taxotere), paclitaxel (taxol), paclitaxel protein-bound particles for injectable suspension (abraxane) - CORRECT ANSWER 1. apply cold pack for 15-20 minutes at least 4 times/day for the first 24 hours.
  1. no known antidotes or treatment exists.
  2. assess the extravasation area for pain, blister formation, and skin sloughing. instruct patients to monitor for extravasation site and to report fever, chills, blistering, skin sloughing and worsening pain.
  3. instruct patients w/ peripheral extravasation to report arm or hand swelling and stiffness. key elements of vesicant extravasation documentation - CORRECT ANSWER 1. date and time of extravasation
  4. type and size of peripheral venous access device or type of CVAD.
  5. number and locations of venipuncture attempts.
  6. description and quality of blood return before and during vesicant administration.
  7. vesicant administration technique
  8. concentration and estimated amt of extravasated vesicant.
  9. symptoms reported by patient.
  10. description of administration site that include date and time
  11. assessment of extremity for range of motion and discomfort with movement
  12. immediate nursing interventions
  13. extravasation antidote or treatment administered.
  14. follow up recommendations
  15. patient teaching.
  1. assess the administration site and monitor for pain, redness, and swelling in patients receiving irritating agents. Bendamustine hydrochloride (bendeka, treanda) - CORRECT ANSWER 1. irritant (usually), vesicant rarely
  2. infiltration may cause painful erythema
  3. infiltration include hospitalization for erythema, marked swelling and pain.
  4. precautions should be taken to avoid extravasation.
  5. apply cold pack for 15-20 minutes at least 4 times/day for 24 hours.
  6. assess infiltrated area for pain, blister formation and skin sloughing.
  7. instruct patients to monitor the infiltration site and to report fever, chills, blistering, skin sloughing and worsening pain. Irinotecan (Camptosar) - CORRECT ANSWER 1. irritant (usually)
  8. exfoliative dermatitis may occur
  9. flush skin with sterile water and apply cold pack for 15-20 minutes at least 4 times/day for the first 24 hours.
  10. assess the infiltrated area for pain, blister formation and skin sloughing
  11. instruct pt to monitor for infiltration site and to report fever, chills, blistering, skin sloughing and worsening pain
  12. topical flushing of the skin with sterile water and application of ice Melphalan (Alkeran0 - CORRECT ANSWER 1. irritant usually, vesicant rarely
  1. infiltration may cause local tissue damage
  2. apply cold pack for 15-20 minutes 4 times/day for 24 hours.
  3. assess for pain, blister formation, skin sloughing
  4. instruct pt to monitor the infiltration site and to report fever, chills, blistering, skin sloughing and worsening pain.
  5. administer over 15-20 minutes into a fast running IV solution into an injection port on the IV tubing. do not administer by direct injection into a peripheral veing. Oxaliplatin (Eloxatin) - CORRECT ANSWER 1. irritant usually, vesicant rarely
  6. infiltration can lead to redness, swelling, pain and necrosis.
  7. a warm pack may reduce local pain and inflammation
  8. apply warm pack for 15-20 minutes at least 4 times/day for the first 24 hours.
  9. elevate extremity for peripheral extravasation
  10. high dose dexamethasone (8 mg twice daily for up to 14 days)
  11. assess the infiltrated area for pain, blister formation and skin sloughing.
  12. instruct patients to monitor the infiltration site and to report fever, chills, blistering, skin sloughing and worsening pain.
  13. instruct patients to report arm or hand swelling and stiffness.
  14. reports describe induration, edema, red-brown skin discoloration, hyperpigmentation and rare cases of tissue necrosis. Vinorelbine (Navelbine) - CORRECT ANSWER 1. irritant usually, vesicant rarely
  15. extravasation may cause local tissue extravasation
  1. ibritumomab tiuxetan
  2. tositumomab
  3. brentuximab
  4. cetuximab
  5. rituximab
  6. alemtuzumab
  7. bevacizumab
  8. gemtuzumab ozogamicin
  9. trastuzumab
  10. ipilimumab
  11. ofatumumab
  12. panitumumab Anaphylaxis - CORRECT ANSWER 1.hypersensitivity reaction that is a systemic allergic reaction. can be life threatening.
    1. reported with rituximab, trastuzumab and cetuximab.
    2. flushing, itching, angioedema, cough, nasal congestion, SOB, wheezing sensation of choking, change in voice quality, tachycardia, fainting, hypo or hypertension, loss of consciousness, N/V. cramping/diarrhea, impending sense of doom, tunnel vision and back/chest or pelvic pain. risk factors for hypersensitivity and anaphylaxis - CORRECT ANSWER 1. administration of chemotherapy or immunotherapy agent
  1. pre existing allergies to food, drugs and bee stings.
  2. premedicate with fosaprepitant
  3. previous exposure to the agent with mild symptoms of allergy
  4. failure to administer known effective prophylactic medication
  5. first 5 to 15 minutes from the start of the infusion. cytokine release syndome - CORRECT ANSWER 1. life threatening systemic inflammatory reaction after infusion of agents targeting the immune system
  6. develops after cells are damaged and complement pathways are activated which results in an increase in systemic inflammatory cytokines and interleukins.
  7. occurs with chimeric antigen receptor T cell therapy and agents such as rituximab and flinatumomab and may result in organ failure or death. S/S of CRS - CORRECT ANSWER 1. mild: fevers (days to weeks), tachycardia, chills, nausea, anorexia, myalgia, and headaches.
  8. life threatening: capillaries leak fluid, which results in third spacing into the lungs and interstitial tissue, leading to intravascular depletion. can occur as late as 7 days after completion of the infusion. can result in thrombocytopenia and increased risk of thrombosis. AKI can occur w/ CRS as a result of changes d/t decrease in renal blood flow. CAR T cell therapy - CORRECT ANSWER 1. form of immunotherapy using genetically modified CD19 positive T cells to produce receptors called chimeric antigens in the tx. of B cell malignancies.
  1. monitor VS every 12 minutes until pt is stable, then every 5 minutes for 30 minutes, then every 15 minutes.
  2. maintain airway, assessing the patient for increasing respiratory tract edema. give oxygen if needed.
  3. administer emergency meds
  4. provide emotional support
  5. document all treatments and the patient's response.
  6. symptoms of anaphylaxis may recur hours after initial intervention so pt should remain in hospital and monitored. clinical management of CRS - CORRECT ANSWER 1. stop infusion and observe the patient until symptoms resolve, usually within 30 minutes.
  7. administer corticosteroid
  8. resume infusion at a slower rate after resolution of symptoms and titrate the rate slowly.
  9. for severe reactions, administer emergency meds. clinical management of localized hypersensitivity reaction - CORRECT ANSWER 1. observe and evaluate symptoms
  10. administer diphenhydramine, ranitidine or corticosteroids,
  11. monitor VS at least every 15 minutes for 1 hr.
  12. document the episode and pt. response. protection - CORRECT ANSWER defense against foreign pathogens

Homeostatisis - CORRECT ANSWER elimination of damaged or dead cells and initiation of tissue repair surveillance - CORRECT ANSWER inhibition of tumor growth innate immunity - CORRECT ANSWER 1. first line of defense

  1. does not generate immunologic memory.
  2. components include: physical barriers, mechanical barriers, chemical barriers, inflammatory barriers and complement activation
  3. acute-phase protein production-recruit phagocytes to site of infection or tissue injury.
  4. production of large granular lymphocytes (kill and digest pathogens) Adaptive or Acquired Immunity - CORRECT ANSWER 1. secondary line of defense
  5. involves immunologic memory, specificity and collaboration of B cells and T cells
  6. three types: cell mediated, regulatory T cells and humoral immunity humoral immunity - CORRECT ANSWER B cells produce antibodies after exposure to specific antigens; type of adaptive immunity, the result if the production of immunoglobulins or antibodies.