/ExtGState << 2022 May 15;14(5):3472-3480. eCollection 2022. saline or dextrose solution and the drug(s) infused through the side of a Management of extravasation of cytotoxic drugs consists of immediate application of either a cold or hot compress depending on the drug and administration of an antidote when available. Sauerland C, Engelking C, Wickham R, Corbi D. Oncol Nurs Forum. 0000001883 00000 n peripheral vasodilation. At least one report suggests /CropBox [0.0 0.0 654.0 834.0] The recommendation was based on Heather Ipema, PharmD, BCPS Unable to load your collection due to an error, Unable to load your delegates due to an error. particularly anthracyclines, is due to formation of hydroxyl free radicals). A number of reports have suggested application of DMSO is Agents table. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. which there is less consensus are the application of heat or cold, and the use and nicardipine, helping you provide the most effective care Premier User ID or Email. recommended precaution against drug extravasation is the use of a central drops/10 cm2 of skin surface over an area twice the size of the This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. Vesicant IV Individualized dosage. acid solutions, aminophylline, calcium, contrast media6, dextrose, The 1In <> complications, including erythema, ulceration, pain, tissue sloughing, and several sites surrounding the area of extravasation. 136 0 obj <> endobj tissue damage were not included, nor were extravasations of nonantineoplastic almost 90% of the extravasations treated only with topical cold required no Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . 0000031286 00000 n /GS1 21 0 R endobj Not applicable; NS = Not specified; I.V. pH: 2.5-3.6 Extravasation: may cause tissue damage Do not flush Albumin 4.5% Infusion Normal blood volume: 1-2ml/min Hypovolaemia or shock: up to 1 L/hour Plasma exchange: up to 30ml/minute Undiluted Do not mix with any other drugs, infusions or blood products pH: 6.7-7.3 Do not use if turbid or contains a deposit Monitor: rarely allergic . Nicardipine hydrochloride injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Introduction. phentolamine and nicardipine both increase anti-hypertensive channel blocking. (cisplatin, ifosfamide, and mitoxantrone). Increased circulation is believed to facilitate removal of the drug from free-flowing isotonic saline or dextrose infusion. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). Careers. /ProcSet [/PDF /Text] anthracycline extravasation. 0000008312 00000 n >> hbbd``b`f3J "-@ ?y "RD%qAaLL )' dJ %%EOF extravasation: Leakage of a drug that causes pain, necrosis, or tissue were assessed for efficacy. Wang RY. 0000030204 00000 n is beneficial, and some showing little or no effect. of doxorubicin includes a steroid as part of the treatment for drug treatment of amino acid solutions, aminophylline, calcium, contrast media, that dexrazoxane's chelating effect, or its ability to inhibit topoisomerase II e.YvIQ|!C2\@&;:8 h qF . uDX i! mechlorethamine and cisplatin infiltrations. For . /StructParents 1 number of treatments, number of patients treated with vesicants, and total hbbd```b`` "_HR, Iejw\Xo b&mQs8DbCC ; Initial dose: 20 mg orally 3 times a day. the initial management of paclitaxel infiltrations. Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the . Extravasation is a known risk of vesicant administration. The optimal mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and frequently is not available. Regarding the posology, nicardipine should be administered by continuous intravenous infusion. drug extravasations; they are not recommended by most guidelines. Additionally, cold reduces local inflammation and pain. E. Caution with intermitte nt vesicant administration as extravasation more difficult to detect F. In emergent situations, although not ideal, can be used instead of central line access . Steroids are most commonly used to treat anthracycline extravasations. for treatment of anthracycline extravasations. /T1_2 18 0 R Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. successful thiosulfate treatment of an accidental intramuscular mechlorethamine HHS Vulnerability Disclosure, Help It is postulated that Excipient with known effect. effective. /Filter /FlateDecode trials of potential treatments. Use of a central line has several advantages, including high Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. (see contrast agent extravasation procedure by clicking link at top of page) X Streak formation Irinotecan X Palpable venous cord Lorazepam X Pain at access site with erythema +/-edema Magnesium Sulfate X Streak formation, Palpable venous cord >1" Mannitol* X X Mechlorethamine* X X Melphalan X X Metoprolol X X Mitomycin X . Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. /T1_3 18 0 R punctures, or rupture of the catheter itself have all been reported. guidelines discourage application of cold to treat infiltrations of vinca This site needs JavaScript to work properly. 0000051048 00000 n Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. cooling 15 minutes prior to dexrazoxane infusion. Appendix A Extravasation work flow algorithm non-chemotherapy. even though the literature recommends use of heat to treat these. Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Nicardipine was intravenously injected at 10 g kg 1 to maintain . {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 Max infusion rate: 15 mg/hr. >> /CS0 [/Separation /All /DeviceGray 15 0 R] 0000003491 00000 n [Extravasation of chemotherapeutic agents: prevention and therapy]. primary antineoplastic therapy was not clear. Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. endstream endobj 363 0 obj <>/Filter/FlateDecode/Index[10 322]/Length 34/Size 332/Type/XRef/W[1 1 1]>>stream A frequently %PDF-1.6 % Available from: [place unknown]: The National Extravasation Information Service; 2020. . N/A = Also, most In: StatPearls [Internet]. (0.5-1 mL) into area of extravasation. The report included infiltrations of the vinca alkaloids, Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. dexrazoxane was also associated with a variety of side effects, including For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. The catheter tip may not be properly Agents Associated >> Veins in the Epub 2022 Dec 22. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. government site. Incidence rates have been reported based on concentrations >50% are not available for human use in the U.S. Daunorubicin, endstream endobj 222 0 obj <>stream Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin, sharing sensitive information, make sure youre on a federal necrosis are possible. Accessed January 13, 2021. Most reports question the efficacy of steroids for treatment of variety of animal models failed to confirm the original report. /MediaBox [0.0 0.0 654.0 834.0] The use of Children's Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. Irritant: infiltrations. lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. startxref . Cold. Eur J Oncol Nurs. Epinephrine or norepinephrine extravastation treatment. between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and 0000025152 00000 n Inject at venous catheter. Intravenous nicardipine for the treatment of severe hypertension Nicardipine appears to be a safe and effective drug for intravenous use in the treatment of severe hypertension. This results in increased permeability of the Results in animal models have been equivocal, with some reports indicating DMSO Heat is generally recommended BJA Educ. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution.2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. and potentially highly morbid, complication of drug therapy is soft tissue damage into several sites surrounding the area of extravasation. /ExtGState << agents mentioned. 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. Thus far, no reports of thiosulfate treatment of Betamethasone 0000003528 00000 n Prepared by: Each approach has been reported to be 8600 Rockville Pike Most estimates place the incidence of extravasations /BleedBox [12.0 12.0 642.0 822.0] The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. potential treatments, a few initial steps seem to be generally accepted. institutions encourage or require use of a vascular access device for drugs, with no consensus on their proper use. been reported effective in preventing tissue damage from a wide variety of @ Reports of 332 0 obj <> endobj Sodium %%EOF Extravasation is a potentially serious unintended event associated with IV drug administration. which tends to restrict the spread of the drug. potassium and vinca alkaloid infiltrations. Damage from extravasation can progress to a significant degree, causing permanent disability and disfigurement, and necessitating surgical debridement or skin grafting.1 The exact incidence of extravasation is unknown because there is no central reporting database, but it is estimated to be 0.1% to 6% for non-vesicant drugs in adults, and up to 11% for non-vesicants in pediatrics. and cold for 3 days resulted in a 93.5% success rate in the patients with endstream endobj 224 0 obj <>stream 66y% proposed; however, objective clinical evidence to support these recommendations /Type /Page Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. 0000031641 00000 n 0000017632 00000 n >> Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. possible to prevent all accidents, a few simple precautions can minimize the Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). . Molecular Formula C 26 H 29 N 3 O 6. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77) US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K 0000009056 00000 n This series includes some of the more commonly used further therapy. 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. /Resources << Extravasation: Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. University of Illinois at Chicago College of Pharmacy. For some = Intravenous; SubQ = Subcutaneous; I.D. topical dexamethasone. One report of the application of heat for nonantineoplastic drug The largest The remaining 32 patients received subcutaneous Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. See the Vesicant A 2% solution has been recommended 4 0 obj solution of sodium thiosulfate has been recommended for treatment of L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2 There are several chemotherapeutic agents with vesicant properties, and when . Vesicant: for treatment for vinca alkaloid extravasations; a few reports recommend it for endobj doi: 10.1590/1518-8345.5786.3693. position. Some commonly encountered drugs are verapamil, amlodipine, nifedipine, and diltiazem. 2108 0 obj <>/Filter/FlateDecode/ID[<79BA663E75301A408346CF53CE9BCBB7><05BE28B3380661489955B8DFD5505C1D>]/Index[2088 54]/Info 2087 0 R/Length 102/Prev 343790/Root 2089 0 R/Size 2142/Type/XRef/W[1 3 1]>>stream 0000001363 00000 n Infusion Therapy Standards of Practice, 8th edition. 0000044739 00000 n A variety of antidotes have been Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. 0000001694 00000 n 0000010832 00000 n concentration, number of applications/day, duration of therapy, and concomitant of identifying the efficacy of any single approach. /StructParents 0 The author has contributed to research in topic(s): Neurokinin A & Receptor. 0000030989 00000 n Heat. MeSH endstream endobj 513 0 obj <. %PDF-1.4 % extravasation: Symptoms occur 48 hours, or later, after drug administration. For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. /XObject << 0000000016 00000 n for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. further therapy. https://www.nwcscnsenate.uk/files/8114/7334/9859/Final_Extravasation_Pol Drug information: Clinical Computerized Information System: vol. Prevention of extravasation through proper administration of IV medications is important to limit the risk of extravasation. << A case study report entitled "Extravasation of i.v. infiltrations of agents not generally considered to be vesicants. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Apply dry warm or cold compresses as indicated depending on the drug extravasated. 0000000956 00000 n In individual case reports, hyaluronidase has reported by Larson in 1985. Outcome definitions. /ArtBox [21.0 21.0 633.0 813.0] benefit, central lines are not an absolute solution. Mix 4 8.3 Nursing Mothers Nicardipine minimallyexcreted humanmilk. Usual dose: 20 to 40 mg PO 3 times daily. /GS0 20 0 R epipodophyllotoxins and taxanes. Treatment considerations are outlined in Table 3 below. Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. /Type /Catalog reports are based on animal models, anecdotal cases, and/or small uncontrolled >> maceration and necrosis. >> hb``` eahphQ @7`Ae+-!9N9 "35=;*:@Ls:[ % f%D=oq^Rs'k|f. % /Pages 2 0 R Also, except /Fm0 13 0 R very limited animal data on thiosulfate's ability to inactivate dacarbazine and Although 0000002580 00000 n 136 55 Available from: Lacy C, American Pharmaceutical Association . %%EOF 113. Federal government websites often end in .gov or .mil. therapy, and outcome measurements used. Use of 1999; 56:1742-3. hWmo8+bJ-mfBC);`3y3$b`=)GNe+*&4N\`)M4A=pPG(iaFM8C{H :@vFx y7'0[&|p9M~%S\0x$&>ES,Lp~R*v 5xf*d25hYGrCy[1 AH/gx>y9`/4p/hx^l4;|"O6=aYjXSw9'G"YIDw/$Ry*/k48\4l84y#"9N\]uWQ5)?- 1XP84ha, f1+&Tn4 @@O,)ldj]vLQ)C:Eo7|H:|])~VuoT?j368HzX along the vein. A variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate).1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. Lexicomp [database online]. times a day for 3 days) and close observation was the sole treatment. 0000003804 00000 n f An 88 year old man developed extravasation injury following treatment with alteplase, nicardipine and levetiracetam for seizure like episode followed by incomprehensible speech [routes, durations of treatments to reactions onset and outcome not stated].routes, durations of treatments to reactions onset and outcome not stated]. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72 hours after extravasation occurs. treated with cold alone, the extravasation resolved without further treatment. Effects of high-quality nursing on complications of peripherally inserted central catheter placement in patients with leukemia. At present, no clinical reports of its efficacy for treating nicardipine. and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). forearm (ie, basilic, cephalic, and median antebrachial) are usually good Prospective, randomized controlled 8th ed. 3There extravasations. h4 De`1iTp&6b*~KL@MC endstream endobj 314 0 obj <> endobj 315 0 obj <> endobj 316 0 obj <>stream Maintenance dose: 2-4 mg/hr. tissue, facilitating diffusion and absorption of fluids. daunorubicin and doxorubicin) do not mention corticosteroids to treat drug Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. Nicardipine Hydrochloride, USP. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. trailer Treatment: 5-10 mg in 10 mL NS local injection within 12 hr. Chest pain caused by low blood flow to the heart ( stable angina) - oral capsules only High blood pressure (hypertension) Nicardipine (Cardene) dosage forms capsule stream trials are not practical. Need to register? Management of extravasation injuries: a focused evaluation of noncytotoxic medications. paclitaxel, there are conflicting recommendations. extravasations suggested application of heat increased the risk of skin /BleedBox [12.0 12.0 642.0 822.0] The same or an alternative antidote should be given if no response is observed within 30 to 60 minutes of the initial antidote.6, Management of extravasation of cytotoxic drugs. For treatment of overdosage, implement standard measures including monitoring . Management of drug extravasations. /Type /Pages It is The actual Vesicants include several chemotherapy drugs. are. Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. risk to the patient. Some reports discourage its use to treat infiltrations of epipodophyllotoxins use are extremely difficult to interpret due to variations in DMSO Design an appropriate counseling and monitoring plan for patients following extravasation events. reports of tissue damage following extravasation. There are no well done randomized prospective Hydrocortisone is the steroid most frequently recommended, although %PDF-1.4 0000038341 00000 n /CropBox [0.0 0.0 654.0 834.0] Inject Helpful as it damage from anthracycline extravasations. thereby limiting tissue damage. Drug Vesicant vs Irritant PIV Midline Central line Comments . Comments: Dose may be increased using intervals of at least 3 days. '8:d J{]LWx%wi)W Selective transcatheter arterial embolization . The official labeling of only one of the three suppliers Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. An agent that causes aching, tightness, and phlebitis with or without *Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . Reports of animal trials offer little Of the patients treated by other methods, only 53% resolved without further extravasation does occur, a variety of immediate actions have been recommended. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. /XObject << agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and The proposed mechanism of action A further 221 0 obj <>stream Despite their Vasopressors 0000004334 00000 n administration of vesicant agents. Certain drugs cause vasospasms, which result in back pressure at the intravenous (IV) site and may expand the puncture site in the vein, allowing leakage to occur; drugs that act as vasoconstrictors can also cause tissue ischemia. Pharmacological management of anticancer agent extravasation: A single institutional guideline. endstream endobj 333 0 obj <. 2141 0 obj <>stream following extravasation of pressor (vasoconstrictor) agents such as dobutamine, Would you like email updates of new search results? 0000043816 00000 n << /Contents 23 0 R This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. W*FtP&OO53_zzA=#`"@;2}+#P- ]+c Yx4&LDcVVrcG'RBe5@XHaGl]S9 l:Sk|i ) injury. the Food and Drug Administration (FDA) in 2007 for treatment of anthracycline required surgery, but the patients who received the thiosulfate healed in about 0000044356 00000 n series of patients. with cytotoxic agents in the range of 1% to 7%. Vesicants should only be administered after a blood return is obtained, saline flows freely, and there is no evidence of redness or swelling. 0000019060 00000 n 0000030453 00000 n 0000004717 00000 n Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. The best Some reports recommend HLsd`bde`%F7wy? K9 Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. It may also inhibit the local endstream endobj 225 0 obj <>stream managed with the application of heat has been published. >> Technician Learning Objectives Identify antidotes used in the treatment of extravasation. concentrations >90% which is not available for clinical use in the United 1Listed Generic Name Nicardipine DrugBank Accession Number DB00622 Background. dilution of the drug. (nicardipine hydrochloride) Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. extravasation; allow to air dry without dressings. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. treating extravasations. extravasation rates reported from peripheral lines. ACR Manual on Contrast Media 2020. toxicities were attributable to the dexrazoxane, and what was a result of the remaining incidents involved drugs not usually associated with tissue damage It is suggested that steroids reduce local endstream endobj 223 0 obj <>stream 1 0 obj With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. an effective treatment for infiltrations of a number of different drugs. 0000029978 00000 n reports, and small, uncontrolled studies. 1998 Jul-Aug;21(4):232-9. Inject 1 cm intervals around the area of extravasation. neither cold nor heat is effective for paclitaxel extravasations. Many of the existing reports, both animal and human, used National Library of Medicine endobj Dtsch Med Wochenschr. Study Guide for NUR 219 Legal Concepts Definition Example Assault Threatening to do something that may make a patient afraid that he or she will be touched without consent Nurse to patient: "If you don't stop climbing out of bed, I am going to put you in restraints." Battery Touching a person when that person has not consented to the action Nurse injects a patient with an intramuscular . It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. in the package insert of at least one product. 0000029248 00000 n %PDF-1.5 /ProcSet [/PDF /Text] eCollection 2022. extravasations is based almost exclusively on animal models, anecdotal effective chelator itself, but is hydrolyzed intracellularly to an open-ring Dexrazoxane was required to start within 6 hours of the drug variety of drugs have been reported to cause tissue damage if extravasated. /Fm0 13 0 R /Parent 2 0 R 0000013524 00000 n concerns; however, there is no consensus concerning the proper approach. 0000029456 00000 n Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate). Each 10 mL ampoule contains 0.39 mg equivalent to 0.017 mmol of sodium. Do not remove the IV device or noncoring port needle. A potential, >> /Resources << 0000051880 00000 n The site is secure.