PLACE LABEL HERE

EXTRAVASATION ANTIDOTE

STANDING ORDERS

Nurse initiated standing order based on medical staff approved criteria when extravasated drug is ordered by provider.

Orders with a “” are indicator choices and are NOT implemented unless checked.

Nurse: Notify provider of extravasation
Extravasated Drug / Apply: / Antidote / Method of Administration
 / Dobutrex (DOBUTamine)
DOPamine
EPInephrine
Inocor (inamrinone)
Isuprel (isoproterenol)
Levophed (norepinephrine)
NeoSynephrine (phenylephrine) / Warm compress / Phentolamine IV or SQ (administer w/in 12 hrs of extravasation)
If not available, omit. /
  • Dilute Phentolamine 10 mg in 10 ml of NS.
  • Inject 5 mg through IV catheter, then
Inject remaining 5 mg SQ in 0.5-1 ml increments.
  • If can’t administer IV, administer entire volume SQ.
  • Use 25 gauge needle, change with each injection

 / Vasopressin / Warm compress / Nitroglycerine ointment 1 inch topically q 8 hrs prn x 3 doses /
  • Apply topically to affected area

 / VP-16 (etoposide)
Velban (vinblastine)
Oncovin (vincristine)
Eldisine (vindesine)
Navelbine (vinorelbine) / Warm compress / Hyaluronidase SQ (administer w/in 60 min of extravasation) /
  • Hyaluronidase (150 units/ml), draw up 1 mland inject 0.2 ml SQ into the area x 5 separate injections.
  • Use 25 gauge needle, change with each injection

 / Cisplatin
Treatment is only indicated for large extravasation (e.g. > ½ of planned dose) / Ice compress / None /
  • N/A

 / Calcium salts*
Dextrose 10%*
Magnesium sulfate*
Naficillin
Potassium salts*
Sodium bicarbonate*
* Treatment indicated for large or concentrated solution extravasated. / Warm compress / Hyaluronidase IV or SQ
(administer w/in 60 min of extravasation) /
  • Hyaluronidase(150 units/ml), dilute0.1 ml with 0.9 ml NS in 1 ml syringe to make final concentration of 15 units/ml
  • If catheter is still in place, inject1ml of the 15units/ml solution into the IV catheter.
  • If catheter removed, inject 0.2mls SQ into the area x 5 separate injections
  • Use 25 gauge needle, change with each injection

 / Parental nutrition*
Dilantin (phenytoin) / Warm compress / Nitroglycerine ointment 1 inch topically q 8 hrs prn x 3 doses /
  • Apply topically to affected area

 / Dacarbazine (DTIC) / Ice compress / None /
  • N/A

 / Actinomycin D (dactinomycin)
Mitomycin C (mutamycin) / Ice compress / None /
  • N/A

 / Cerubidine (daunorubicin)
Adriamycin (doxorubicin)
Idamycin (idarubicin) / Icecompress / Zinecard IV
(dexrazoxane)
Or if Zinecard not available, use DMSO (dimethylsulf- oxide) topically /
  • Zinecard IV:
1000 mg/m2 within 6 hrs of extravasation, then
1000 mg/ m2 on Day 2 then, 500 mg/ m2 on Day 3
  • DMSO: apply a few drops of 50% DMSO to the site using a sterile guaze pad q 8 hrs. Allow to air dry, do not cover site.

 / Taxanes (docetaxel, paclitaxel) / Icecompress / Hyaluronidase SQ (administer w/in 60 min of extravasation) /
  • Hyaluronidase (150 units/ml), draw up 1 mland inject 0.2 ml SQ into area x 5 separate injections.
  • Use 25 gauge needle, change with each injection

 / Phenergan (promethazine) / Ice compress / None /
  • Leave cannula/needle in place; gently aspirate extravasated solution (do NOT flush the line);
  • Remove needle/cannula; elevate extremity.

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Date TimeNurse SignaturePhysician Signature PID Number

Copy to pharmacy

*1-32634* FORM 1-32634 REV. 10/2016 Page 1 of 1