Assessing and managing venous irritation associated with vinorelbine tartrate (Navelbine)

PURPOSES/OBJECTIVES: To determine the effect of duration of infusion time on venous irritation in patients receiving vinorelbine tartrate (Navelbine, Burroughs Wellcome Co., Research Triangle Park, NC) in combination with cisplatin or mitomycin. DESIGN: Prospective and descriptive. SETTING: Five outpatient hematology/oncology units in southern Louisiana and Mississippi. SAMPLE: 96 patients receiving vinorelbine in combination with cisplatin or mitomycin through a peripheral vein. METHOD: Nurses completed the Venous Irritation Record (VIR), on which they documented the incidence of irritation reactions on the day of infusion as well as 24 hours and one to two weeks later. MAIN RESEARCH VARIABLES: Incidence and severity of venous irritation as well as the duration of administration. FINDINGS: Significantly lower incidence of venous irritation at 6-10 minute infusion rate was observed (p < 0.05). No difference in incidence was observed when vinorelbine was given with a vesicant (mitomycin) or a nonvesicant (cisplatin) drug. CONCLUSIONS: Although venous irritation is a problem associated with peripherally administered vinorelbine, it does not necessitate central line placement. Incidence of this problem can be reduced with a shorter duration of administration. The VIR was feasible, easy to use, and could be adapted for other drugs and other toxicities. The National Cancer Institute Common Toxicity Criteria are not adequate for grading venous irritation reactions. IMPLICATIONS FOR NURSING PRACTICE: Vinorelbine should be administered in accordance with the manufacturer's recommendations as a 6-10 minute infusion. Determination of this rate came as a result of clinical nursing research. Nurses involved in clinical trials can and should play a role in describing emergent toxicities and investigating methods to prevent or minimize those toxicities.