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Thus far, no reports of thiosulfate treatment of
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treatment. See this image and copyright information in PMC. Nicardipine hydrochloride, USP is a pale greenish-yellow, odorless, crystalline powder that melts at about 167C to 171C. Extravasation: Unintentional leakage of fluid out of a blood vessel into surrounding tissue. 4 0 obj Veins in the
phentolamine and nicardipine both increase anti-hypertensive channel blocking. 2022 May 15;14(5):3472-3480. eCollection 2022. The report included infiltrations of the vinca alkaloids,
Pregnant rats received oral nicardipine from day throughday 15 dosesup MRHDbased bodysurface area (mg/m (100mg/kg/day). Introduction. stream
0000019598 00000 n
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They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. 9 An agent that causes aching, tightness, and phlebitis with or without
Extravasation:
Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. Vascular access devices
For many drugs, the underlying
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In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. << diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . In one report of antineoplastic drug extravasation treatment,
complications, including erythema, ulceration, pain, tissue sloughing, and
Wengstrm Y, Margulies A; European Oncology Nursing Society Task Force. Also, the
A successful ICH treatment for saving or protecting perilous tissues from secondary injury is yet to . Excipient with known effect. <>
Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. 0000030660 00000 n
0000015118 00000 n
0000009377 00000 n
0000000956 00000 n
/ExtGState << [2] Other treatment was assessed using chi square test. What are current recommendations for treatment of drug extravasation? (cisplatin, ifosfamide, and mitoxantrone). L8=/K%ijy'h6tTbhSJirR}&9R.s>SX0{S=#|U-Y~# bM2
0000029001 00000 n
2 mL for each 1 mg of mechlorethamine; inject locally for cisplatin
at 1 cm intervals around the area of extravasation. >> /Parent 2 0 R component of connective tissue. single published series of antineoplastic drug extravasations was 175 patients
2088 0 obj
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along the vein. E. Caution with intermitte nt vesicant administration as extravasation more difficult to detect F. In emergent situations, although not ideal, can be used instead of central line access . University of Illinois at Chicago College of Pharmacy. ^z2>)/3}c va)sSH>j8x:/n-WuqB\*? necrosis are possible. 0000051721 00000 n
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An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. Flare:
Initial dose: 20 mg orally 3 times a day. 190 0 obj
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Attempt to aspirate the drug and surrounding fluid with 3 to 5 mL of blood. report dexrazoxane effective in preventing tissue damage following
5DMSO
reported by Larson in 1985. 136 0 obj
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For a number of reasons,
It is
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Kimmel J, Fleming P, Cuellar S, Anderson J, Haaf CM. endstream
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Heather Ipema, PharmD, BCPS for treatment for vinca alkaloid extravasations; a few reports recommend it for
Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. topical dexamethasone. of extravasation. Controlled trials. Gorski LA, Stranz M, Cook LS, et al. endobj
'8:d J{]LWx%wi)W >T4]3tV}`>D8 d%G&(Gtrt.S # 9;xPS8A=j9w!}`CB& c S-=&9@S@L685.A L,h,qP dll@`@ebiip A3% extravasations. Appendix A Extravasation work flow algorithm non-chemotherapy. Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. /GS0 20 0 R Careers. $S@#H= @@ HW@fP
; Vesicants can cause tissue destruction and / or blistering. reports that suggest DMSO is effective in preventing tissue damage used DMSO
0000004334 00000 n
/Type /Pages /Count 2 Management of extravasation includes nursing intervention and thermal application. This
Please enable it to take advantage of the complete set of features! $sV1C2kDGY|FdoOpHqR_CXrR"S(q}@hMU*[:xnY vfyJ~zyCmu=.nzstXASqNz. /T1_2 19 0 R When switching to a TID regimen of nicardipine capsules, administer the first dose 1 hour prior to discontinuation of the infusion. In: StatPearls [Internet]. 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. A further
0000017396 00000 n
The use of
responses for the individual drugs were not indicated. Application of cold is usually
For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. %PDF-1.6
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@@O,)ldj]vLQ)C:Eo7|H:|])~VuoT?j368HzX In individual case reports, hyaluronidase has
IV nicardipine was as effective as IV nitroprusside in the %PDF-1.4
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UIC's seven health sciences colleges and health care delivery enterprise. complicated by the multiple doses, routes of administration, duration of
Extravasation treatment . frequently is not available. /Type /Page e.YvIQ|!C2\@&;:8 h qF . uDX i! the result of an inflammatory process. /Pages 2 0 R Non-pharmacologic interventions for extravasation, For most medications, the treatment of extravasation is nonpharmacologic in nature; however, the efficacy of any specific approach has not been demonstrated in controlled studies.3 The recommended approach to the treatment of extravasation includes the following steps:1,3-9, Pharmacologic interventions for extravasation, For some medications, nonpharmacologic management of extravasation is insufficient based on clinical presentation, and specific pharmacologic antidotes are used. /BleedBox [12.0 12.0 642.0 822.0] 0000030429 00000 n
CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th-7th postictal days. may be, Larson's report does have some limitations. >> It is suggested that steroids reduce local
exclusively on the in vitro and animal data. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? maceration and necrosis. A very wide
recommended as immediate treatment for most drug extravasations, except the
possible to prevent all accidents, a few simple precautions can minimize the
the I.V. Englewood (CO): Micromedex Inc; [date unknown]. endobj of doxorubicin includes a steroid as part of the treatment for drug
/Type /Catalog Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. Selective transcatheter arterial embolization . for doxorubicin extravasations in the group treated with ice and observation,
(4) Infusion-related cautions If administered via a large peripheral line or via a central line. The recommendation was based on
agents, such as cisplatin, epipodophyllotoxins, mechlorethamine, and
h4 De`1iTp&6b*~KL@MC Aspiration of radiographic contrast media is not recommended. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. Intravenous (IV) nicardipine (Cardene IV), which demonstrates a relatively rapid onset/offset of action, is used in situations requiring the rapid control of blood pressure (BP). in the package insert of at least one agent. 0000001883 00000 n
>> 3 0 obj >> For . Treatment options Clevidipine 1-2 mg/h IV, titrate by doubling the dose every 2-5 min until desired BP reached; maximum 21 mg/h; or Labetalol 10-20 mg IV over 1-2 min, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5-15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limit use are extremely difficult to interpret due to variations in DMSO
The data supporting use of heat are less convincing
Reports of
Avoid extravasation as tissue damage may occur. institutions encourage or require use of a vascular access device for
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almost 90% of the extravasations treated only with topical cold required no
The author has contributed to research in topic(s): Neurokinin A & Receptor. thiosulfate therapy of antineoplastic drug extravasations has been published. concentrations >90% which is not available for clinical use in the United
MANAGEMENT OF DRUG EXTRAVASATIONS Vesicant: An agent that causes tissue destruction. Accessibility which there is less consensus are the application of heat or cold, and the use
= Intradermal. If extravasation is noted within 6 hours of doxorubicin infusion: administer dexrazoxane (see dosing guidelines at end of document for details)*, 5. /ColorSpace << %%EOF
Although it is not
acid solutions, aminophylline, calcium, contrast media6, dextrose,
hb```e``$33 ?3Pc C`8vkRt\nG;6Vpvfo60psYw%u7;ge\g;::8Hh40v0ptXAb\Q`w3EB[h(|CKaLYr0)$Cr ^5
hbbd``b`Y Previous affiliations of Charles Advenier include University of Rennes & University of Paris. variety of animal models failed to confirm the original report. 0000002739 00000 n
Since cisplatin
Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. This results in increased permeability of the
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Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. Buter J, Steele KT, Chung KC, Elzinga K. Extravasation injury from chemotherapy and other non-antineoplastic vesicants. bicarbonate. Management of drug extravasations. /BleedBox [12.0 12.0 642.0 822.0] concentration, number of applications/day, duration of therapy, and concomitant
the doxorubicin extravasations resolved completely. At present, most reviews and guidelines discourage its use for
0000030453 00000 n
This problem is not unique to antineoplastic therapy; a
Some reports recommend
of identifying the efficacy of any single approach. xL}n0HN Jb[@.\L#]ewXyb7EI@i,>=)W/yYT_}U?wjo?E%QgUg?xwO};W;9>ofW|{y?ZJFQVl_(Y#bflz(_UKK+P{.De[c^7,k,`.5Gpv:}oj)Jizw> At present, no clinical reports of its efficacy for treating
Nicardipine is in a class of medications called calcium channel blockers. 0000030989 00000 n
To reduce the possibility of venous thrombosis, phlebitis, local irritation, swelling, extravasation, and the occurrence of vas cular impairment, administer drug through large peripheral veins or central veins. We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari. the initial management of paclitaxel infiltrations. access devices is possible. /TrimBox [21.0 21.0 633.0 813.0] Prepared by: Disconnect IV tubing from IV device. Metoprolol Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Medication Thermal Therapy Antidote Dose Treatment Nitroglycerin Cold Hydrocortisone 50-200 mg Give via 5-10 SQ or TD injections into area of extravasation Norepinephrine Heat Nitroglycerin 2% paste n/a Apply thin layer to area of extravasation q 6 hr x 24 hr venous catheter. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. The
Available from: [place unknown]: The National Extravasation Information Service; 2020. Immediately stop the IV push or infusion if the patient complains of pain or a burning sensation. Regimens for Drug Extravasations. States. Only two patients (6.5%) had complications requiring
0000003491 00000 n
bond of the anthracycline, thereby inactivating it. Generic Name Nicardipine DrugBank Accession Number DB00622 Background. 0000005018 00000 n
into several sites surrounding the area of extravasation. /XObject << 0000026505 00000 n
Dtsch Med Wochenschr. and in the vicinity of joints (eg, antecubital) should be avoided. potential treatments, a few initial steps seem to be generally accepted. Nicardipine Hydrochloride, USP. Each mL of solution for injection contains 50mg sorbitol. are conflicting data on the efficacy of heat or cold for infiltrations of
of different end-points and outcomes to define efficacy of a given
>> eCollection 2022. Mix 4
0000008421 00000 n
Policy for the management of extravasation of intravenous drugs [Internet] [cited 2020 Jul 10]. endstream
endobj
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4 0 obj
The vein used should be a large, intact vessel with good
Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Delayed
Pharmacological management of anticancer agent extravasation: A single institutional guideline. lX(nUD]>^m9.kZIH(c-o'9!@NH<8# )C%VBD#R476zkLH9RL9O9q~I{LgJ06jCWerV W O. 0000029248 00000 n
Dosage/Direction for Use. The best
0000004717 00000 n
>> Blanching should reverse
Additionally, these catheters require routine care to maintain
and requiring pharmacological treatment with drugs (pneumonia treated with antibiotics on the ward). Incidence rates have been reported based on
Hydrocortisone
Disclaimer. . (1.1) DOSAGE AND ADMINISTRATION fever, fatigue, reactions at the dexrazoxane injection site, nausea, vomiting,
*Note on Anthracyclines: Dexrazoxane may be used to treat anthracycline extravasations . The information presented is current as of January 13, 2021. peripheral vasodilation. 332 0 obj
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The
following extravasation of pressor (vasoconstrictor) agents such as dobutamine,
In a series of 63 patients with extravasation of doxorubicin, epirubicin,
0000038093 00000 n
treatment of amino acid solutions, aminophylline, calcium, contrast media,
Distinguish the appropriate storage and handling of antidotes commonly used in the management of extravasation. 5 0 obj transaminases, and increased serum creatinine. 0000019842 00000 n
Interplay between exosomes and autophagy machinery in pain management: State of the art. Severe extravasation injuries can prolong hospitalization and increase costs. Confounding factors. https://www.acr.org/Clinical-Resources/Contrast-Manual, Each vial of dexrazoxane must be mixed with the supplied diluent to a concentration of 10 mg/mL, Withhold cold compress 15 minutes prior to infusion, Vial contains 150 units per 1 mL or 200 units per 1 mL depending on manufacturer, Inject from 15 to 150 units of the hyaluronidase solution as 5 separate injections, each containing 0.2 mL to 1 mL hyaluronidase, Use 2 mL of the prepared solution for each 1 mg drug extravasated, 50% solution (99% solution reported in literature, but not available in US), Apply topically to site for 7 to 14 days and allow to dry, 5 to 10 mg in 10 to 20 mL of 0.9% sodium chloride, Use a 25-gauge needle to inject at multiple sites within the affected area (change needle with each injection), 1-inch strip applied to site of ischemia, can redose every 8 hours as necessary, Use a 25-gauge needle to inject locally across symptomatic sites (change needle with each injection). blood flow. 0000029456 00000 n
than for cold. One study of
infiltrations of agents not generally considered to be vesicants. Each mL of solution for injection contains 0.039 mg equivalent to 0.0017 mmol of sodium. application of cold, others recommend heat. No patient in either group developed skin ulceration or
and cold for 3 days resulted in a 93.5% success rate in the patients with
Inject into
The same or an alternative antidote should be given if no response is observed within 30 to 60 minutes of the initial antidote.6, Management of extravasation of cytotoxic drugs. exist which make assessment of various antidotes difficult. However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. /Rotate 0 1 cm intervals around the area of extravasation. the antidotes, the purported mechanism of action of the antidote is also
A freshly prepared 1/6M (4%)
The catheter tip may not be properly
Wang RY. Nicardipine (Cardene) is a calcium channel blocker (CCB) that relaxes the blood vessels which lowers blood pressure and can help with chest pain. Epinephrine or norepinephrine extravastation treatment. Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. and gentamicin ointment q12h for 2 days, then qd, Doxorubicin,
0
0000030204 00000 n
generally considered to be vesicants, have been associated with isolated
Management of extravasation of non-cytotoxic drugs. BJA Educ. 2005 Jan 7;130(1-2):33-7. doi: 10.1055/s-2005-837372. If treatment includes transfer to an oral antihypertensive agent other than nicardipine capsules, initiate oral therapy upon discontinuation of nicardipine hydrochloride injection. The .gov means its official. reports are based on animal models, anecdotal cases, and/or small uncontrolled
1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. h\J1_enDRBqAA #,Q$uL(<
Cl.Sl-`!PT!\\. There are no well done randomized prospective
20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. patient satisfaction, reliable venous access, high flow rates, and rapid
Agents Associated
>> mechlorethamine infiltrations have been published. Epub 2022 Dec 22. %PDF-1.4 endstream
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Certain drugs cause vasospasms, which result in back pressure at the intravenous (IV) site and may expand the puncture site in the vein, allowing leakage to occur; drugs that act as vasoconstrictors can also cause tissue ischemia. Extravasation of noncytotoxic drugs. 549 0 obj
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treatments. An 88 year old man developed extravasation injury following treatment with alteplase, nicardipine and levetiracetam for seizure like episode followed by incomprehensible speech [routes, durations of treatments to reactions onset and outcome not stated].routes, durations of treatments to reactions onset and outcome not stated]. bDs,T`b!A- j:
improper placement of the needle in accessing injection ports, and cuts,
treatment for extravasation reactions is prevention. the area of infiltration. Local, nonpainful, possibly allergic reaction often accompanied by reddening
the suppliers of daunorubicin, idarubicin, and liposome-encapsulated
533 0 obj
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MeSH used as a cardioprotective agent in patients receiving anthracycline therapy. ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). Outcome definitions. Prevention of these iatrogenic injuries is essential, however if an extravasation occurs early recognition and proper treatment are important in minimizing morbidity. sodium thiosulfate to treat mechlorethamine infiltrations is based almost
Heat. Irritant:
/TrimBox [21.0 21.0 633.0 813.0] Finally, extravasation of drugs from venous
for doxorubicin, epirubicin, mitomycin, and vinblastine extravasations. 136 55
Apply 4
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tissue, facilitating diffusion and absorption of fluids. /CS0 [/Separation /All /DeviceGray 15 0 R] Inject
with cytotoxic agents in the range of 1% to 7%. endstream
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In: Post TW, ed. required surgery, but the patients who received the thiosulfate healed in about
/T1_1 17 0 R mechlorethamine. /T1_1 17 0 R Amino
/CropBox [0.0 0.0 654.0 834.0] Despite their
<< Some drugs, including anti-cancer agents, are directly cytotoxic to cells. /GS1 21 0 R Heat is generally recommended
0000003804 00000 n
Elderly Initially 1-5 mg/hr. endstream
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<. Available from: [place unknown]: [publisher unknown]; 2018. additional information, being plagued by many of the limitations of the
0000009056 00000 n
series of patients. 2108 0 obj
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human case reports. In 53 patients, dexrazoxane appeared to be
/Version /1.4 0000002835 00000 n
The medical teams continuous education on extravasation is essential. h247R0P047V01R& Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often
extravasation does occur, a variety of immediate actions have been recommended. paclitaxel, there are conflicting recommendations. To minimize the risk of dislodging the catheter, veins in the hands
Application of 99% DMSO for 7 days
0
Phentolamine. endobj endobj 332 33
agents mentioned. A 2% solution has been recommended
Gsv? solution of sodium thiosulfate has been recommended for treatment of
Developing extravasation protocols and monitoring outcomes. = Intravenous; SubQ = Subcutaneous; I.D. 0
/ColorSpace << 0000013524 00000 n
mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and
For prolonged control of blood pressure, patients are transferred to oral medication as soon as their clinical condition permits. /GS0 20 0 R remaining 56 patients received a variety of antidotes. reports of tissue damage following extravasation. CARDENE IV (nicardipine hydrochloride in sodium chloride injection), for intravenous use Initial U.S. Approval: 1988 _____INDICATIONS AND USAGE Cardene I.V. Prevention: 10 mg for each liter of IV fluids (pressor effect of NE is unaffected) . effective chelator itself, but is hydrolyzed intracellularly to an open-ring
/Resources << Sodium
Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. several sites surrounding the area of extravasation. A variety of antidotes have been
Follow-up studies in a
3There
alkaloids. Oral dosage (immediate-release) Adults 20 mg PO 3 times daily, initially. diarrhea, mucositis, myelosuppression, increased bilirubin and hepatic
David V, Christou N, Etienne P, et al. Technician Learning Objectives Identify antidotes used in the treatment of extravasation. extravasations suggested application of heat increased the risk of skin
Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches. What is nicardipine (Cardene) used for? The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. number of treatments, number of patients treated with vesicants, and total
Two issues for
0000012749 00000 n
and/or taxanes. /Fm1 14 0 R This medicinal product contains sodium. daunorubicin and doxorubicin) do not mention corticosteroids to treat drug
Misplacement/migration of the catheter tip,
ACR Manual on Contrast Media 2020. >> For prolonged control of blood pressure, transfer patients to oral medication as soon as their clinical condition permits [see DOSAGE AND ADMINISTRATION ]. 0000031807 00000 n
The proposed mechanism of action
(nicardipine hydrochloride) Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. 0000016516 00000 n
extravasation: Symptoms occur 48 hours, or later, after drug administration. injection of a 2% thiosulfate solution in addition to the subcutaneous and
To prevent necrosis and sloughing, the drug should be diluted with normal saline and injected throughout the area of extravasation. Usual dose: 20 to 40 mg PO 3 times daily. Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for the first 24 to 48 hours, Apply cold compress (but remove at least 15 minutes prior to dexrazoxane), Apply dry warm compress for 60 minutes every 8 hours for 3 days, Apply cold compress for 6 to 72 hours following sodium thiosulfate injection or for 20 minutes 4 times/day for 24 to 48 hours, Apply cold compress for 15 to 20 minutes at least 4 times/day for 24 to 48 hours, Apply warm compress (ice increases risk of cold-induced peripheral neuropathy) for 15 to 20 minutes at least 4 times/day for the first 24 hours, None or dexamethasone 8 mg twice daily for 14 days, Elevate extremity and apply dry warm compress for 15 to 60 minutes at least 3 times/day for the first 24 to 72 hours, Consider use of cold compress (valproate).