Vincristine and Vesicant Safety

Vincristine sulfate is a vesicant. Therefore it is extremely critical that the intravenous needle or catheter is properly inserted prior to the vincristine injection or infusion. Any leakage into surround tissues during the infusion may cause substantial injury.

It is crucial that extravasation precautions are employed when administering this drug. These include:

  1. Verifying the presence of a blood return before, during, and after administration.
  2. Continuous observation and monitoring of the patient throughout the infusion for signs and symptoms of extravasation. These include pain, redness, swelling, lack of blood return, and/or ulceration. Note that pain may not necessarily be present for an extravasation to have occurred (Polovich, et al., 2009). If blood return is not present in a peripheral or midline catheter, a new site should be inserted. If no blood return is present in a central catheter or port, placement verification should be done using x-ray or dye studies (Camp-Sorrell, 2004).
  3. Avoiding the use of infusion pumps for vesicant administration via short infusion using a peripheral vein (Polovich et al., 2009).

If an extravasation should occur:

  1. Stop the IV and the medication immediately.
  2. Disconnect the IV tubing from the IV device. Do not remove the IV device or the needle.
  3. Attempt to aspirate the residual drug from the IV device or port needle using a 1-3cc syringe.
  4. Remove the peripheral IV needle or port needle.
  5. Assess the IV site and the symptoms that the patient is experiencing.
  6. Notify the physician or advanced practice nurse.
  7. Administer antidote per protocol. Hyaluronidase is the antidote for vincristine sulfate. Apply warm packs for 15-20 minutes at a time, at least four times a day, for the first 24-48 hours, and elevate the affected extremity if extravasation is a peripheral one (Polovich, et al., 2009)

References:

Camp-Sorrell, D. (2004). Access Device Guidelines. Pittsburgh, PA: Oncology Nursing Society.

Oncovin® package insert. At http://www.kiessig.com/drugs/druginfo.aspx?id=1554.

Polovich, M. , Whitford, J. M., & Olsen, M. (Eds). (2009). Chemotherapy and biotherapy Guidelines and Recommendations for Practice. Pittsburgh, PA: Oncology Nursing Society.
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