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)
 Vasopressin
Warm
compress

VP-16 (etoposide)
Velban (vinblastine)
Oncovin (vincristine)
Eldisine (vindesine)
Navelbine (vinorelbine)

Cisplatin
Treatment is only indicated for
large extravasation (e.g. > ½ of
planned dose)

Calcium salts*
Dextrose 10%*
Magnesium sulfate*
Naficillin
Potassium salts*
Sodium bicarbonate*
* Treatment is only indicated for
large amount or concentrated
solution extravasated.
 Parental nutrition*
Dilantin (phenytoin)
Warm
compress

Dacarbazine (DTIC)

Actinomycin D (dactinomycin)
Mitomycin C (mutamycin)
Cerubidine (daunorubicin)
Adriamycin (doxorubicin)
Idamycin (idarubicin)
Ice
compress
Ice
compress
Ice
compress


Taxanes (docetaxel, paclitaxel)
Warm
compress


Phentolamine IV
or SQ
(administer w/in
12 hrs of
extravasation)
If not available,
omit.
Nitroglycerine
ointment 1 inch
topically q 8 hrs
prn x 3 doses
Hyaluronidase
SQ (administer
w/in 60 min of
extravasation)


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

Apply topically to affected area


Hyaluronidase (150 units/ml), draw up 1 ml and inject
0.2 ml SQ into the area x 5 separate injections.
Use 25 gauge needle, change with each injection
Ice
compress
None

N/A
Warm
compress
Hyaluronidase IV
or SQ
(administer w/in
60 min of
extravasation)


Hyaluronidase (150 units/ml), dilute 0.1 ml with 0.9 ml
NS in 1 ml syringe to make final concentration of 15
units/ml
If catheter is still in place, inject 1 ml of the 15 units/ml
solution into the IV catheter.
If catheter removed, inject 0.2 mls SQ into the area x
5 separate injections
Use 25 gauge needle, change with each injection
Nitroglycerine
ointment 1 inch
topically q 8 hrs
prn x 3 doses
None

Apply topically to affected area

N/A
None

N/A
Zinecard IV
(dexrazoxane)
Or if Zinecard not
available, use
DMSO
(dimethylsulfoxide) topically
Hyaluronidase
SQ (administer
w/in 60 min of
extravasation)

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.
Hyaluronidase (150 units/ml), draw up 1 ml and inject
0.2 ml SQ into the area x 5 separate injections.
Use 25 gauge needle, change with each injection


Warm
compress
Ice
compress
________ ________ _________________________
Date
Time
Nurse Signature



________________________
Physician Signature
___________
PID Number
Copy to pharmacy
*1-32634*
1
FORM 1-32634 REV. 10/2014
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