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Set of guidelines governing the management of complications associated with vascular access devices (VADs) inserted into a peripheral or central vein.  

Prepare and inject insulin subcutaneously with a syringe.

Definitions: Non-irritant: An agent which may produce a mild inflammatory reaction if inadvertently injected outside of the vein Irritant: An agent which may produce irritation or inflammation along the vein when injected; in the event of infiltration, may produce a transient tissue reaction characterized by edema, pain and redness but no necrosis Vesicant: An agent which, in the event of extravasation, has the potential to cause tissue damage which may lead to blistering, tissue necrosis, and damage to underlying structures Extravasation: The inadvertent administration of vesicant infusate into surrounding tissue instead of the intended vascular pathway Infiltration: The inadvertent administration of non-vesicant infusate into surrounding tissue instead of the intended vascular pathway Venous spasm /irritation: A reaction which may occur during infusion in a peripheral vein, characterized by aching, tightness and possible darkening along the vein, without edema and in the presence of a blood return Flare reaction: A reaction which may occur during infusion in a peripheral vein, characterized by blotching, streaking or local wheals and possible itchiness along the vein, without pain or swelling and in the presence of a blood return   Table 1: Vesicant potential of antineoplastic drugs Non-vesicant Vesicant Non-irritant Irritant Alemtuzumab Arsenic trioxide Asparaginase Azacitidine Bevacizumab Bleomycin Brentuximab Cabazitaxel Cetuximab Cladribine Clofarabine Cyclophosphamide Cytarabine Eribulin Fludarabine Ipilimumab Interferon Leucovorin Mesna Methotrexate Ofatumumab Panitumumab Pemetrexed Pentostatin Pertuzumab Raltitrexed Ramucirumab RiTUXimab Temsirolimus Thiotepa Trastuzumab Bortezomib CARBOplatin CISplatin Dacarbazine DOXOrubicin Liposomal Etoposide Fluorouracil (5FU) Gemcitabine Ifosfamide Irinotecan Melphalan Nelarabine Temozolomide Teniposide Topotecan Trastuzumab emtansine Amsacrine Busulfan Bendamustine Carmustine Dactinomycin DAUNOrubicin DOCEtaxel* DOXOrubicin EPIrubicin IDArubicin MitoMYCIN-C MitoXANTRONE Oxaliplatin* PACLItaxel* PACLItaxel-Nab* Streptozocin Trabectedin VinBLAStine VinCRIStine Vindesine VinORELBine   *Oxaliplatin, DOCEtaxel, PACLItaxel and PACLItaxel-NAB have been described by some sources as irritants, however there have been isolated cases of tissue necrosis after extravasation of these agents and they should therefore be treated like vesicants.  

Set of guidelines governing the administration of a medication or the infusion of a solution using the subcutaneous route.

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