Extravasation management reference sheet medication thermal therapy antidote dose treatment amino acids 4. If any issues, notify iv therapy and document infiltration and phlebitis scale. Approved by pharmacy, therapeutics, and diagnostics committee june 2016. Amiodarone hydrochloride injection drug information.
Therefore, caution is advised when using this drug in children. Objectives to determine the incidence and factors contributing to the development of amiodarone induced phlebitis in the coronary care unit in an academic. A focused evaluation of noncytotoxic medications paul m. Apply cold compress for 1520 minutes at least four times a day. Wrap a plastic bag around the moist compress to keep it warm longer and elevate the limb only slightly. Guide to extravasation management in adult patients. Cordarone amiodarone hcl is a member of a class of antiarrhythmic drugs with predominantly class iii vaughan williams classification effects, available for oral administration as pink, scored tablets containing 200 mg of. This products label may have been revised after this insert was used in production. Chemical phlebitis a chemical irritation affecting the innermost layer of the vein, called the tunica intima. Treatment of anthracycline extravasation with savene dexrazoxane. Some references suggest cold compresses as a therapeutic alternative for oxaliplatin extravasation.
How to avoid complications an article of the ejournal of the esc council for cardiology practice vol. Location of the device the most appropriate site for the location of a peripheral cannula is considered to be the forearm schrijvers 2003. Request pdf management of amiodarone extravasation with. A warm or cool compress may be applied, depending on the infiltrated solution.
Oxaliplatin administration is associated with sensory neuropathies that may be exacerbated or precipitated by cold temperatures or objects. When pumps continue to alarm, the possibility of an extravasation should be investigated. Infiltration extravasation treatment table nonchemotherapy. Apply cold compress for 15 to 20 minutes at least four times a day.
Oxaliplatin administration is associated with sensory neuropathies that may be exacerbated or precipitated by cold temperatures or. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Amiodarone hydrochloride is highly proteinbound approximately 96%. Amiodarone hydrochloride is intended for use only in patients with the indicated lifethreatening arrhythmias because its use is accompanied by substantial toxicity. Extravasation is a potential complication associated with intravenous therapy administration. Amiodarone is widely prescribed, largely due to its efficacy in the management of. Amiodarone injection fda prescribing information, side. Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhyth mias and atrial fibrillation. Microsoft word extravasation treatment table nonchemo june 2016. Chemical phlebitis can result in cell destruction, infiltration and inflammation.
Further information may be obtained from the bnf british national formulary, ucl injectable. For further product information and current package insert, please visit. Management of amiodarone extravasation with intradermal hyaluronidase. There was a weak correlation between blood levels of amiodarone, the daily dose, and the cumulative dose r 0. Prescribing of amiodarone for atrial fibrillation and.
Oct 26, 2018 cordarone iv amiodarone hydrochloride intravenous. The related drug information index provides comprehensive access to all drug information related to a specific drug types of content include full prescribing information, drug summaries, full prescribing information continuing medication education full pi cme, medication guides, risk evaluation and mitigation strategies rems summaries, rems continuing medication education rems cme, and. Iv infiltration treatment infusion intravenous nursing. Side effects and complications of amiodarone therapy. Amiodarone hcl injection is a sterile clear, paleyellow micellular solution visually free from particulates. Assess the iv site prior to infusion assess for pain, redness, and assure an adequate flush with 10 ml normal saline. Amiodarone hydrochloride injection is a sterile clear, paleyellow micellar solution visually free from particulates. Objectives to determine the incidence and factors contributing to the development of amiodaroneinduced phlebitis in the coronary care unit in an academic. Amiodarone injection cordarone side effects, medical. An amiodarone infusion guideline was developed by a multidisciplinary group which included pharmacy, iv therapy, cardiology, and nursing. Amiodarone, a vaughanwilliams class iii antiarrhythmic, is commonly used for the treatment of ventricular arrhythmias. Extravasation of contrast media frequency the reported incidence of intravenous iv contrast media extravasation related to power injection for ct has ranged from 0. Cold compress for extravasation of nafcillin sympathomimetics dobutamine dopamine epinephrine metaraminol norepinephrine vasopressin phenylephrine phentolamine 5mg in 10ml of 0.
Drug levels were higher in symptomatic patients p less than 0. Amiodarone interacts with many other drugs anyone prescribing medication for a patient taking amiodarone is responsible for checking for interactions. After completion of a riskbenefit analysis, the qas authorises the administration of sodium chloride 0. Special administration guidelines should be followed e. Prescribing of amiodarone for atrial fibrillation and atrial flutter in wales.
Amiodarone is a class iii antiarrhythmic drug vaughnwilliams classification that reduces the incidence of arrhythmias by increasing the duration and refractory period of the cardiac action potential prolonging the qt interval. Change the compress as needed, until the edema has gone down. Complications of peripheral intravenous therapy infiltration. Guidelines for the administration of iv amiodarone register.
The attending dermatologist diagnosed skin necrosis secondary to amiodarone extravasation. Guidelines for the administration of iv amiodarone. Intravenous amiodarone is an important treatment for arrhythmias, but peripheral infusion is associated with direct irritation of vessel walls and phlebitis rates of 8% to 55%. A literature search was carried out using pubmed with the following key words. In clinical studies of 2 to 7 days, clearance of amiodarone after intravenous administration in patients with vt and vf ranged between 220 and 440 mlhrkg. Paramedic pharmacology manual 3 infiltration precautions before administering any iv medication or solution, the paramedic must check the iv site for patency and signs of infiltration andor phlebitis. Amiodarone hcl is 2butyl3benzofuranyl42diethylaminoethoxy3,5diiodophenylmethanone hydrochloride. Inadvertent leakage of medications with vesicant properties can cause severe tissue necrosis, which can lead to devastating longterm consequences. Data collection included amiodarone concentration, visual inspection of the infusion site, and phlebitis grading. Route of administration, location, concentration, and duration of amiodarone therapy and factors associated with occurrence of phlebitis were examined. One for the amiodarone and one for other medications the patient may need.
Amiodarone hcl is a white to slightly yellow crystalline powder, and is very slightly soluble in water. Prescribing of amiodarone for atrial fibrillation and atrial. Amiodarone can cause this chemical to leach out of the tubing. Dailymed amiodarone hydrochloride injection, solution. Management of amiodarone extravasation with intradermal. Acr manual on contrast media version 8, 2012 extravasation of contrast media 17 extravasation of contrast media frequency the reported incidence of intravenous iv contrast media extravasation related to power injection for ct has ranged from 0. Recommendations for conversion to intravenous amiodarone after oral administration. Qt interval from excess amiodarone administration, magnesium sulphate administration is to be considered. Oct 01, 2017 amiodarone, a vaughanwilliams class iii antiarrhythmic, is commonly used for the treatment of ventricular arrhythmias.
This guidance endeavours to deliver care in such a way as to treat patients fairly and respectfully regardless of age, gender, race, ethnicity, religionbelief, sexual. Cordarone amiodarone hcl is a member of a new class of antiarrhythmic drugs with predominantly class iii vaughan williams classification effects, available for oral administration as pink, scored tablets containing 200 mg of amiodarone hydrochloride. Etomidate, lorazepam, diazepam, nitroglycerin, digoxin, phenytoin. The nursing staff was instructed to treat the patient for the amiodarone extravasation with traditional nonpharmacologic measures, including warm compresses and elevation of the extremity. The amiodarone drip was discontinued, and amiodarone 400 mg orally twice daily was started. It exhibits all four of the classic vaughan williams mechanisms of action, namely sodium and potassium channel blockade, a mild antisympathetic action and some calcium channel blockade, but it is usually classified as a class iii antiarrhythmic drug see table 1. The drug prevents the recurrence of lifethreatening ventricular arrhythmias and. The frequency of extravasation is not related to the injection flow rate. Amiodarone fda prescribing information, side effects and uses. After extravasation, the patient reported severe pain at the site. Age, sex, renal disease, and hepatic disease cirrhosis do not have marked effects on the disposition of amiodarone or dea. It also slows heart rate and cardiac action potential conduction through inhibition of beta receptors and ion. Amiodarone can be used to treat tachyarrhythmias, including atrial fibrillation, ventricular tachycardia and patients at high risk. Amiodarone hydrochloride has several potentially fatal toxicities, the most important of which.
Kiser1,2, 1department of clinical pharmacy university of colorado skaggs school of pharmacy and pharmaceutical sciences, aurora, colorado. If infiltration occurs, stop the drug but do not remove the iv device. Damage caused by chemical phlebitis can occur proximally or. Replacement therapy may not be necessary in such patients if. In august, 2012, irb approval was obtained and data collected postguideline implementation. The incidence of extravasation injury depends on both the patient and the medication, with nonvesicant extravasations occurring in 0. Infiltration refers to the leaking of iv fluid or medication into the tissue surrounding a vascular.
Each milliliter of the amiodarone hcl injection formulation contains 50 mg of amiodarone hcl, 20. Treatment resulted in conversion to sinus rhythm, but the patient. The drug prevents the recurrence of lifethreatening ven. In most countries including australia, amiodarone is the most commonly prescribed antiarrhythmic apart from drugs such as digoxin and beta blockers.
Amiodarone x amphotericin b x arginine hcl x x arsenic trioxide x x bleomycin x infiltration grading scale busulfan x x grade clinical criteria calcium chloride x x 0 no symptoms calcium gluconate x x 1 skin blanched carboplatin x with or without pain carmustine x cool to touch cisplatin x x edema amiodarone and one for other medications the patient may need. Amiodarone is the most effective antiarrhythmic drug available. Management of amiodarone extravasation with intradermal ncbi. Amiodarone hcl injection is a sterile clear, paleyellow micellar solution visually free from particulates. Amiodarone is an iodinated benzofuran derivative that was synthesized and tested as an antianginal agent in the 1960s but was later discovered to have antiarrhythmic properties. Jan, 2014 extravasation injuries are a major cause of iatrogenic morbidity to the hospitalized patient. Metoprolol cold hydrocortisone 50200 mg give via 510 sq or td injections into area of extravasation medication thermal therapy antidote dose treatment nitroglycerin cold hydrocortisone 50200 mg give via 510 sq or td injections into area of extravasation norepinephrine heat nitroglycerin 2% paste na apply thin layer to area of extravasation q 6 hr x 24 hr. Amiodarone extravasation can lead to tissue injury due to the drugs acidic ph 3. Due to increased risk of adverse effects over time, it is sensible to ask from time to time whether amiodarone is still indicated and whether the dose can be reduced. May, 2020 amiodarone hcl injection is a sterile clear, paleyellow micellar solution visually free from particulates. Amiodarone hydrochloride has a very large but variable volume of distribution, averaging about 60 lkg, because of extensive accumulation in various sites, especially adipose tissue and highly perfused organs, such as the liver, lung, and spleen.
With an infiltration, i have used a warm moist compress around the affected limb. Extravasation injuries are a major cause of iatrogenic morbidity to the hospitalized patient. Extravasation site, size, and color description may delineate infiltrated area on patients skin with felttip marker patient complaints or statements at the time of vesicant or irritant infusion. Cordarone amiodarone hcl is a member of a class of antiarrhythmic drugs with predominantly class iii vaughan williams classification effects, available for oral administration as pink, scored tablets containing 200 mg of amiodarone hydrochloride. Usually charting about the infiltration is sufficient. Amiodarone is widely prescribed, largely due to its efficacy in the management of both supraventricular and ventricular arrhythmias.
Amiodarone x amphotericin b x arginine hcl x x arsenic trioxide x x bleomycin x infiltration grading scale busulfan x x grade clinical criteria calcium chloride x x 0 no symptoms calcium gluconate x x 1 skin blanched carboplatin x with or without pain carmustine x cool to touch cisplatin x x edema compress for extravasation of nafcillin sympathomimetics dobutamine dopamine epinephrine metaraminol norepinephrine vasopressin phenylephrine phentolamine 5mg in 10ml of 0. Management of extravasation policy document version. Amiodarone hydrochloride is a white to slightly yellow crystalline powder, and is very slightly soluble in water. Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. Please refer to upmc presbyterian shadyside nursing policy, management of antineoplastic infiltration, extravasation and anthracycline flare reaction policy number p. Amiodarone hcl has the following structural formula. The etiology of extravasation and infiltration injuries can be separated into two different categories.
The infiltration of a drug into the subcutaneous tissue that may lead. Amiodarone is an antiarrhythmic drug with structural similarities to thyroxine. The mild side effects included corneal microdeposits, skin rashes, and gastrointestinal symptoms. Infiltration of hypertonic solutions can result in nerve damage or compartment syndrome.