Recently we have been revising our extravsation policy and are interested in what others are doing. We have been considering seeking MED approval for the pharmacist manage the orders fro extravasations much as they do antibiotic drug dosing (ex. vancomycin). We were hoping to get orders for antidotes quicker in the community hospital setting and treat sooner. We would still be notifying the attendings when it occurs so they can further examine the site when they see the patient.
What are others doing in regards to this? do you have a treatment policy that includes antidotes.... not just for chemo but other irritant and vesicant drugs?
Jose
I recently updated our extravasation policy for chemotherapy and we did not go with any protocol algorithms as this is not a recommended practice. For many of the chemo/biotherapy meds there needs to be an evaluation by a physician. We found that there were no "recommended" treatment protocols. When it comes to extravasation there is not alot of documented evidence to support a certain antidote as protocol, physician consult is recommended. Also Totect is about 16,000 so you really want to be sure before you give it. Best practice for extravastion is localize, neutralize. Are you using an extravasation kit? We aggressively look at prevention techniques. Have you looked at the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice? I can send you are chemo extravasation policy if that would help.
Tahitia
I strongly disagree with the second message and would strongly recommend that each hospital assess the literture and create their protocols for treating both infiltration and extravasation. This is the national standard of practice from INS. When these events occur, there is no time to do this research and decision making. Most physicians have no knowledge of this treatment. We will never have a large database of evidence of treatments due to ethical reasons. All evidence is limited to case reports and animal studies. I see the horrible outcomes from these events in legal cases and think that proper management immediately after it is discovered could radically change these outcomes. I am in the process of updating my online course on this issue and will provide the recommendations from the literature. Sorry it is not updated yet, but it is currently available on my website. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I am looking at not just chemotherapy agents but also some of the vesitcant irritant meds other than chemo. I am sure toltect is expensive but with appropriate training and IV team can make that assessment and collaberate with the staff nurse on treatment. Waiting and not treating can result in much worse outcomes and be hard to explain in court when you end up there.
Jose
Jose Delp RN BSN VA-BC