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  Table of Contents  
LETTER TO THE EDITOR
Year : 2016  |  Volume : 53  |  Issue : 2  |  Page : 303
 

Inadvertent intramuscular administration of vincristine in two pediatric patients with uneventful outcomes


Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

Date of Web Publication6-Jan-2017

Correspondence Address:
V Radhakrishnan
Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.197731

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How to cite this article:
Radhakrishnan V, Murali A, Mishra S. Inadvertent intramuscular administration of vincristine in two pediatric patients with uneventful outcomes. Indian J Cancer 2016;53:303

How to cite this URL:
Radhakrishnan V, Murali A, Mishra S. Inadvertent intramuscular administration of vincristine in two pediatric patients with uneventful outcomes. Indian J Cancer [serial online] 2016 [cited 2019 Aug 21];53:303. Available from: http://www.indianjcancer.com/text.asp?2016/53/2/303/197731


Sir,

Extravasation of vincristine during intravenous administration can lead to tissue necrosis and ulceration as it is a vesicant.[1] We report on the management of two cases where vincristine was inadvertently administered as a deep intramuscular injection. The first patient was a 17-year-old girl with pre-B acute lymphoblastic leukemia (ALL) undergone induction chemotherapy. She was planned for intramuscular L-asparaginase injection; however, she received 2 mg of vincristine intramuscularly in the left gluteal region. She developed erythema at the injection site 30 min later. The patient had mild pain and tenderness. The patient was treated with local warm compression and multiple infiltrations of hyaluronidase 0.2 ml (150 units/ml) using an insulin syringe and 30-gauge needle, along the leading edge of the erythematous area. The hyaluronidase injection was administered every 2 h for a total duration of 12 h. The pain and swelling did not interfere with the patient's routine daily activities, and the symptoms completely resolved by day 7. The second patient was a 5-year-old boy with pre-B ALL who received vincristine 0.9 mg as an intramuscular injection in the left gluteal region instead of the planned L-asparaginase injection. The patient developed mild pain and tenderness at the injection site 2 h later. He was also managed like the first patient with warm compression and hyaluronidase injection. The patient's symptoms resolved in 5 days. In both the cases, the error occurred during administration as the patients were incorrectly identified. There have been very few reports in the literature on management of intramuscular vincristine injection. Hot and cold compression, 8.4% sodium bicarbonate, hydrocortisone, and hyaluronidase have been used.[2],[3],[4] It is not known whether administration of the above agents will alter the clinical course. The outcomes of the patients who have inadvertently received intramuscular vincristine have been excellent with patients developing only mild erythema and tenderness, and there have been no reports of severe tissue damage such as necrosis and ulceration.[2],[3],[4] Intramuscular vincristine may be associated with less serious vesicant reactions because of the rapid dilution of the drug by the increased vascularity and area of the muscle tissue compared to subcutaneous tissue. Steps to minimize chemotherapy administration errors include use of electronic templates for prescription, checking of prescription by two individuals, preparation of drugs in designated area, proper labeling of the medications, and administration of the medication in the presence of two nurses after proper patient identification.[1]

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F; ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol 2012;23 Suppl 7:vii167-73.  Back to cited text no. 1
    
2.
Clark BS, Gallegos E, Bleyer WA. Accidental intramuscular vincristine: Lack of untoward effects and recommendations for management. Med Pediatr Oncol 1997;28:314-5.  Back to cited text no. 2
    
3.
Olcay L, Safak T. Inadvertent intramuscular administration of vincristine: Lack of untoward effects without any treatment except administration of hot compresses. Pediatr Hematol Oncol 2003;20:427-8.  Back to cited text no. 3
    
4.
Patiroglu T, Unal E, Ozdemir MA, Karakukucu M, Mutlu FT. Accidental intramuscular overdose administration of vincristine. Drug Chem Toxicol 2012;35:232-4.  Back to cited text no. 4
    




 

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