/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/delegationpractice-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/related/,

/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/related/name-97315-en.cckm

201605126

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UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Inpatient Delegation Protocols,Related

Oncology Chemotherapy Vesicant Extravasation

Oncology Chemotherapy Vesicant Extravasation - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols, Related


IP - Oncology Chemotherapy Vesicant Extravasation [3216]
UWHC Guidelines for the Management of
Extravasation of Antineoplastic Agents
URL: https://uconnect.wisc.edu/servlet/Satellite?
cid=1126664234984&pagename=B_EXTRANET_UWH_HOME%
2FFlexMemberFile%2FLoad_File&c=FlexMemberFile
Patient Care Orders


Contingency Parameters [97992]

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Vesicant extravasation
For Anthracycline Extravasation


Patient Care Orders [97989]

Extravasation Management [NURTRT0008] SEE COMMENTS, Starting today, Routine
Site:
Apply ice pack to affected site as instructed and protect site
from ultraviolet light by covering the area or using a sun block
cream (if skin surface is not open). Elevate affected arm and
report arm or hand swelling or stiffness. Monitor site and
notify provider of fever, chills, blistering or peeling skin or
worsening pain.
Dexrazoxane - For patients with creatinine clearance greater than 40 mL/minute [97984]

dexrazoxane (ZINECARD) in sodium chloride 0.9% bag
- Days 1 and 2 [700436]
1,000 mg/m2, Intravenous, EVERY 24 HOURS For 2 Doses
Administer into opposite extremity of extravasation. Remove
ice packs 15 minutes prior to infusion

dexrazoxane (ZINECARD) in sodium chloride 0.9% bag
- Day 3 [700436]
500 mg/m2, Intravenous, ONCE Starting 12/2/11 For 1 Doses
Administer over 2 hours into opposite extremity of
extravasation. Administer approximately 24 hours after Day 2
dose

Note: If patient discharged before therapy complete
apply Beacon Supportive Care Plan for extravasation
with appropriate dates [950018]
EVERY 24 HOURS For 3 Doses
Dexrazoxane - For patients with creatinine clearance 40 mL/minute or less [97985]

dexrazoxane (ZINECARD) in sodium chloride 0.9% bag
- Days 1 and 2 [700436]
500 mg/m2, Intravenous, EVERY 24 HOURS For 2 Doses
Administer into opposite extremity of extravasation. Remove
ice packs 15 minutes prior to infusion

dexrazoxane (ZINECARD) in sodium chloride 0.9% bag
- Day 3 [700436]
250 mg/m2, Intravenous, ONCE Starting 12/2/11 For 1 Doses
Administer over 2 hours into opposite extremity of
extravasation. Administer approximately 24 hours after Day 2
dose

Note: If patient discharged before therapy complete
apply Beacon Supportive Care Plan for extravasation
EVERY 24 HOURS For 3 Doses
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 11/30/2011 12:22:47 PM
Copyright © 2011 University of Wisconsin Hospitals and Clinics Authority


with appropriate dates [950018]
For Mechlorethamine (Nitrogen Mustard) Extravasation


Patient Care Orders [97990]

Extravasation Management [NURTRT0008] CONTINUOUS, Starting today For 6 Hours, Routine
Site:
Apply ice pack to affected site as instructed and protect site
from ultraviolet light by covering the area or using a sun block
cream (if skin surface is not open). Elevate affected arm and
report arm or hand swelling or stiffness. Monitor site and
notify provider of fever, chills, blistering or peeling skin or
worsening pain.
Sodium thiosulfate [97982]

sodium thiosulfate 4% injection [760311] 1-10 mL, Other, ONCE For 1 Doses
Administer intradermal or subcutaneous as 5-20 separate
injections 0.2 mL each into/around the site of extravasation
using 25-gauge or smaller needle. Change needle with each
injection
For Vinca Alkaloid Extravasation


Patient Care Orders [97991]

Extravasation Management [NURTRT0017] SEE COMMENTS, Starting today, Routine
Site:
Apply warm compress to affected site as instructed and
protect site from ultraviolet light by covering the area or using
a sun block cream (if skin surface is not open). Elevate
affected arm and report arm or hand swelling or stiffness.
Monitor site and notify provider of fever, chills, blistering or
peeling skin or worsening pain
Hyaluronidase [97979]

hyaluronidase (WYADASE) injection CUSTOM [760128] 150 units, Other, ONCE For 1 Doses
Administer intradermal or subcutaneous as 5 separate
injections 0.2 mL each into/around the site of extravasation
using 25-gauge or smaller needle. Change needle with each
injection
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 11/30/2011 12:22:47 PM
Copyright © 2011 University of Wisconsin Hospitals and Clinics Authority