At the first sign of extravasation, the following steps are recommended: (1) stop administration of IV fluids immediately, (2) disconnect the IV tube from the cannula, (3) aspirate any residual drug from the cannula, (4) administer a drug-specific antidote, and (5) notify the physician (Fig. 1).

Is valproate a Vesicant?

Of the remaining 14 indeterminate vesicants, another 8 met our first inclusion criteria (aminophylline, amphotericin, ampicillin, doxycycline, lorazepam, metronidazole, penicillin, and valproate).

Is vancomycin an extravasation?

Vancomycin is acidic (pH 2.5–4.0) and hyperosmolar (328 mOsm/L), which may make it a vesicant when administered through a peripheral line. Bohm and Wong describe bullous dermatitis as a result of vancomycin extravasation.

How is Levophed infiltration treated?

Depending on the size of the extravasation, bring 5 to 10 mg of phentolamine to the bedside. This will need to be reconstituted, and further diluted to 0.5 mg/mL in normal saline. Treatment of the extravasation will involve the nurse administering the phentolamine intradermally around the site of the extravasation.

What drugs cause extravasation?

Examples of medications that can cause extravasation include: cytotoxic medications such as certain drugs used in chemotherapy; dyopamine; phenytoin (Dilantin); norepinephrine (Levophed) and phenylephrine (Neo-Synephrine).

What is vancomycin extravasation?

Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.

Is vancomycin a vesicant or irritant?

How is valproate (valproic acid) toxicity treated?

Treatment of patients with valproate (valproic acid [VPA]) toxicity is mainly supportive, commonly including the following: However, respiratory depression and cardiopulmonary arrest have been documented. Proceed with resuscitative maneuvers (eg, intubation or defibrillation) if appropriate.

What is the molecular weight of valproate sodium?

Valproate sodium has a molecular weight of 166.2. It occurs as an essentially white and odorless, crystalline, deliquescent powder. DEPACON solution is available in 5 mL single-dose vials for intravenous injection. Each mL contains valproate sodium equivalent to 100 mg valproic acid, edetate disodium 0.40 mg, and water for injection to volume.

How does valproate interact with other medications?

Protein binding of valproate is reduced in the elderly, in patients with chronic hepatic diseases, in patients with renal impairment, and in the presence of other drugs (e.g., aspirin). Conversely, valproate may displace certain protein-bound drugs (e.g., phenytoin, carbamazepine, warfarin, and tolbutamide).

What is the concentration of valproate in CSF?

Valproate concentrations in cerebrospinal fluid (CSF) approximate unbound concentrations in plasma (about 10% of total concentration). Metabolism Valproate is metabolized almost entirely by the liver. In adult patients on monotherapy, 30-50% of an administered dose appears in urine as a glucuronide conjugate.