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Topic: Vesicant

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	CDC \|\| Toxic Syndrome Description: Vesicant/Blister Agent Poisoning
		Vesicants, also referred to as “blister agents,” were the most commonly used chemical warfare agents during World War I. The most likely routes of exposure are inhalation, dermal contact, and ocular contact.
		Vesicants are highly reactive chemicals that combine with proteins, DNA, and other cellular components to result in cellular changes immediately after exposure.
		Depending on the vesicant, clinical effects may occur immediately (as with phosgene oxime or lewisite) or may be delayed for 2 to 24 hours (as with mustards).
	www.bt.cdc.gov /agent/vesicants/tsd.asp (493 words)

	Blister or vesicant agents
		Blister or vesicant agents are likely to be used both to produce casualties and to force opposing troops to wear full protective equipment thus degrading fighting efficiency, rather than to kill, although exposure to such agents can be fatal.
		HD and HN are the most feared vesicants historically, because of their chemical stability, their persistency in the field, the insidious character of their effects by attacking skin as well as eyes and respiratory tract, and because no effective therapy is yet available for countering their effects.
		L is a vesicant (blister agent), also, it acts as a systemic poison, causing pulmonary edema, diarrhea, restlessness, weakness, subnormal temperature, and low blood pressure.
	www.globalsecurity.org /wmd/intro/cw-blister.htm (1572 words)

	Emergency Medicine
		Vesicants are so named because exposure to these agents causes vesicles or blisters to form on the skin.
		The rapid penetration of vesicant agents is enhanced by moisture, heat, and thin skin, such as on the external genitalia, perineum, axillae, and neck.
		Once bound, vesicants are thought to exert their biological damage via DNA alkylation and crosslinking in rapidly dividing cells, although the exact mechanism is not known.
	www.emedmag.com /html/pre/ter/CT0902.asp (2939 words)

	Virtual Naval Hospital: FM 8-9: NATO Handbook on the Medical Aspects of NBC Defensive Operations AMedP-6(B): Part III - ... (Site not responding. Last check: 2007-10-09)
		The vesicant agents include sulphur mustard (HD), nitrogen mustard (HN), the arsenical vesicants such as lewisite (L) (this may well be used in a mixture with HD), and the halogenated oximes whose properties and effects are very different from those of the other vesicants.
		HD and HN3 are the most feared vesicants historically, because of their chemical stability, their persistency in the field, the insidious character of their effects by attacking skin as well as eyes and respiratory tract, and because no effective therapy is yet available for countering their effects.
		Vesication of the buttocks usually results from sitting on contaminated ground or in contaminated trousers for prolonged periods.
	www.vnh.org /MedAspNBCDef/3ch3.htm (8637 words)

	Vesicant definition - Medical Dictionary definitions of popular medical terms
		Vesicants can be used as agents of chemical warfare, as was the case in World War I, or as agents of terrorism.
		Depending on the particular vesicant, clinical effects may occur immediately (as with phosgene oxime or lewisite) or may be delayed for 2 to 24 hours (as with mustards).
		The amount and route of exposure to the vesicant, the type of vesicant, and the premorbid condition of the person exposed will contribute to the time of onset and the severity of illness as well as the treatment.
	www.medterms.com /script/main/art.asp?articlekey=11549 (355 words)

	United States Patent Application: 0040139731
		In this way, the rubber vesicant has radial function of electromagnetic wave of the far infrared ray, which can rearrange the gas molecule and air molecule within the three pipes in order so as to accelerate the fuel to a complete combustion and achieve the purpose of gas saving, decreasing exhaust gas.
		The rubber vesicant 10 is in cylinder shape and in an open structure of non-sealing.
		So by way of spreading the tiny powders in vesicant forming, they can be equally spread into the surface of the tiny apertures, which present a round space so as to activate the electromagnetic wave of the far infrared ray.
	appft1.uspto.gov /netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=/netahtml/PTO/srchnum.html&r=1&f=G&l=50&s1="20040139731".PGNR.&OS=DN/20040139731&RS=DN/20040139731 (1759 words)

	The MSDS HyperGlossary: Vesicant
		Vesicants are highly active corrosive materials even at extremely low concentration.
		One of the most familiar examples of a vesicant is called mustard gas, which has been used as a chemical warfare agent, in World War I and the Iran-Iraq war.
		Vesicants have other uses besides chemical warfare; in these cases the vesicating properties are an undesirable/unwanted side effect or symptom.
	www.ilpi.com /msds/ref/vesicant.html (282 words)

	Virtual Naval Hospital: Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries: FM8-285 (Site not responding. Last check: 2007-10-09)
		Liquid arsenical vesicants on the skin, as well as inhaled vapor, are absorbed and may cause systemic poisoning.
		Examples are injuries causing total disability and blindness, vesication of extensive areas of the trunk, or vesication of an entire limb.
		While there are differences between the typical mustard and arsenical vesicant lesions, it is not recommended that the medical officer in the field try to dispose of such cases separately.
	www.vnh.org /FM8285/Chapter/chapter4.html (7300 words)

	Virtual Hospital: P & T News (Site not responding. Last check: 2007-10-09)
		Hyperosmolar solutions, vasopressor agents, and cytotoxic agents are the cause of the most frequently encountered wounds.6-8 Cytotoxic agents are classified as vesicants, irritants, and non-vesicants according to their potential to cause local toxicity.9, 10 Not all cytotoxic agents have vesicant potential.
		The process of tissue destruction caused by the leakage of a vesicant into tissue is by nature indolent and progressive.4 The first sign of extravasation is usually pain and burning at the site of infiltration.
		The infrequent occurrence of vesicant extravasation in clinical practice and restrictions imposed by ethical considerations of studying these adverse reactions in humans contribute substantially to the inadequacy of the currently available information.
	www.vh.org /adult/provider/pharmacyservices/PTNews/1996/12.96.PTN.html (2873 words)

	Oncology Nursing Society.
		Numerous factors have been identified with the incidence of vesicant extravasation; among them are the skill of the nurse performing the venipuncture and the method used for administering the drug.
		The pathophysiology of tissue damage is the result of the vesicant drug binding to host DNA or microtubules in a process that is self-perpetuated when the vesicant is released as the affected cells are lysed (Langstein, Duman, Seelig, Butler, & Evans, 2002).
		For example, a standard of practice for the delivery of vesicants is that this classification of medications should be administered as a bolus and pushed through a free-flowing IV line.
	www.ons.org /publications/journals/ONF/Volume32/Issue1/320127.asp (2741 words)

	Nursing Spectrum- Career Fitness Online
		Vesicant extravasation can lead to short-term complications, such as blistering, ulceration, infection, impaired venous access, delay in receiving prescribed infusion therapy, tissue necrosis, and eschar formation.
		While antineoplastic medications usually top the list of vesicant agents, extravasation is also associated with many nonantineoplastic parenteral medications and solutions, including dopamine, epinephrine, and norepinephrine; high concentrations of potassium chloride and sodium bicarbonate; amphotericin B; phenytoin; dextrose in concentrations of 10% or greater; parenteral nutrition; radiographic media; and calcium and calcium-containing compounds.
		Educate nurses administering vesicant solutions and medications and validate their competency in vesicant infusate administration, venipuncture technique, care and maintenance strategies of VADs, and recognition and management of device- and infusion-related complications.
	www.nursingspectrum.com /StudentsCorner/StudentFeatures/Extravasation_stk.htm (1101 words)

	Research Results For Vesicant (Site not responding. Last check: 2007-10-09)
		Formerly, the pure form of nitrogen mustard was produced for use as a vesicant in chemical warfare.
		A vesicant is a counter-irritant which raises blisters - such as cantharides.
		Long exposure also burns the skin, so that the gas is a complex of lung injurant, toxic, and vesicant effects.
	www.probertencyclopaedia.com /cgi-bin/res.pl?keyword=Vesicant&offset=0 (373 words)

	[No title] (Site not responding. Last check: 2007-10-09)
		Vesicant chemotherapeutics produce soft tissue damage which can be severe upon infiltration or extravasation into tissue surrounding an injection or infusion site.
		The term"formulation comprising a vesicant chemotherapeutic"refers to a composition comprising a vesicant chemotherapeutic.
		The vesicant drug/photoinactivation inducing compound/photoenhancer combinations of the present invention are often mixed with diluents or excipients which are compatible and physiologically tolerable.
	www.wipo.int /cgi-pct/guest/getbykey5?KEY=98/01136.980423&ELEMENT_SET=DECL (11748 words)

	8. Drug Administration: BC Cancer Agency
		First and foremost, the nature of the chemotherapy drug(s) being administered must be determined because whether the drug(s) is a vesicant, irritant, or neither will have considerable bearing on the following issues.
		vesicants are irritating and may increase vein fragility.
		Vesicants via peripheral line, to ensure venous integrity throughout procedure.
	www.bccancer.bc.ca /HPI/DrugDatabase/Appendices/Appendix8.htm (718 words)

	Nursing: Preventing and managing peripheral extravasation (Site not responding. Last check: 2007-10-09)
		Vesicant drugs or solutions (such as certain antineoplastic drugs, antibiotics, electrolytes, anticmetics such as promethazine, and vasopressors) cause severe tissue injury or destruction when they extravasate.
		Although short and midline peripheral catheters aren't recommended for continuous infusion of vesicants, they may be appropriate for single injections.
		Lack of blood return doesn't always indicate an infiltrating catheter: Blood return may be impeded if the vein is small or the catheter lumen is pressed against the vein wall.
	www.findarticles.com /p/articles/mi_qa3689/is_200405/ai_n9377062 (1078 words)

	Policy III-20: BC Cancer Agency (Site not responding. Last check: 2007-10-09)
		The majority of vesicants are injected into the medication injection port of IV tubing slowly enough that the IV drip does not stop or reverse.
		The following vesicants: mechlorethamine, streptozocin, and vinorelbine are mixed in a minibag and infused by intermittent infusion due to irritation caused by IV push.
		Topical dimethylsulfoxide for the prevention of soft tissue injury after extravasation of vesicant cytotoxic drugs: a prospective clinical study.
	www.bccancer.bc.ca /HPI/DrugDatabase/Appendices/Appendix2/ExtravasationofChemotherapyPreventionandManagementofPolicyIII20.htm (1973 words)

	BoDD (Botanical Dermatology Database) - RANUNCULACEAE
		The juice of the plant is irritant (Dalziel 1937) and the leaves are used as a vesicant in Africa (Irvine 1961).
		The plant is vesicant and has been used as a medicinal vesicatory since Ancient times; cattle will not eat the fresh plants; when dried in hay they produce no harm (White 1887).
		Hill, R. and van Heyingen, R. (1951) Ranunculin: the precursor of the vesicant substance of the buttercup.
	bodd.cf.ac.uk /BotDermFolder/BotDermR/RANU.html (3843 words)

	Journal of Medical Chemical Defense (Site not responding. Last check: 2007-10-09)
		The vesicant dichloroethyl sulfide (sulfur mustard; HD) is a strong alkylating agent that induces injury similar to that incurred by exposure to ionizing radiation (Papirmeister et al., 1991).
		Moreover, an extracellular intervention through vesicant oxidation might also reduce the level of induction of these intracellular cell death pathways and assist the actions of intracellular vesicant antagonists.
		As illustrated by the long-term effects of mustard exposure on military and civilian victims of the Iraq-Iran war (Bijani et al., 2002), developing effective antagonists of this chemical warfare agent is of paramount importance.
	www.jmedchemdef.org /Issue_0201/Dubose_0704.html (3795 words)

	BoDD (Botanical Dermatology Database) - PLUMBAGINACEAE
		The compound was found to be present in a paste of Babink or Babini root (botanically unidentified) used in Turkey to produce false evidence of violence by way of purplish discoloration of the skin indistinguishable from bruising.
		Following cases of alleged assault, the Turkish police instigated an investigation of the composition of the root and plumbagin was isolated and identified.
		The plant reddens and vesicates healthy skin (Piffard 1881) and is used as a counter-irritant (Burkill 1935).
	bodd.cf.ac.uk /BotDermFolder/BotDermP/PLUM.html (873 words)

	PICC (Site not responding. Last check: 2007-10-09)
		Vesicant infusion through the midline catheter tip location is usually not recommended.
		When a vesicant is given by IV push, the nurse can frequently assess for blood return, the site condition, and patient complaints of pain or burning.
		However, with a continuous infusion, the nurse would not always be present for a constant assessment of the site, thus creating the potential for a large volume of fluid to escape.
	www.hadawayassociates.com /article_vesicant.htm (684 words)

	NGC - NGC Summary
		Vincristine is a vesicant; with extravasation, local tissue necrosis occurs.
		IV push: Use the push-pull technique to administer a vesicant to children: Push a very small amount, pull back on the syringe to obtain a blood return, and then push a small amount again; continue until the total amount has been administered.
		It is imperative that the nurse administer vesicant therapy into a central line of any type very carefully.
	www.guidelines.gov /summary/summary.aspx?doc_id=3209&nbr=2435&string=myeloid%2BAND%2Bleukemia (10967 words)

	King, J (Site not responding. Last check: 2007-10-09)
		Lewisite (L) is a potent organic arsenical that causes rapid onset of pain and severe vesication on contact with epithelial tissues.
		The objective of this study was to characterize IPPSF responses after topical exposure to six concentrations of L ranging from 0.07 to 5.0 mg/ml (n=4/treatment plus controls).
		The sensitivity of the IPPSF to L exposure and the similarity of lesions to those described for humans suggests that this model provides a relevant in vitro model with which to study mechanisms of chemical vesication and arsenic toxicity, as well as protective and therapeutic intervention for vesicant exposure.
	www.invitroderm.com /abstracts/king2.html (214 words)

	CancerSourceRN.com Live Chat Event Transcript (Site not responding. Last check: 2007-10-09)
		The definition of a vesicant is a drug that can cause tissue damage when infiltrated into subcutaneous tissue.
		For instance, ONS recommends a central venous access catheter for vesicant infusions lasting longer than 30-60 minutes, and blood return should be verified periodically.
		SPEAKER_Marty_Polovich: Nitrogen mustard is a vesicant not an irritant.
	www.cancersourcern.com /community/archive.cfm?contentid=24678 (3433 words)

	Extravasation Follows Chemotherapy Administration, Potential Complication or Nursing Negligence
		The patient was initially given Cytotoxan (not a vesicant) through a peripheral IV line in her right hand.
		Soon after administration of the vesicants, there were further complaints of pain, and new complaints of “burning.” An extravasation was then reported to the physician.
		In this case, when the nurse injected the vesicants into an IV site that had already been reported as “causing discomfort,” that duty was clearly not adhered to.
	www.nursefriendly.com /nursing/clinical.cases/040130.htm (2070 words)

	APPENDIX 7
		Vesicant agents are those which are destructive to the subcutaneous tissues and can cause extensive tissue necrosis upon extravasation.
		Highly vesicant agents however, are extremely destructive and extensive tissue necrosis, often with permanent disability and a need for skin grafting, may result from even small interstitial leaks.
		It is essential that vesicant agents be given either through central lines or through large peripheral veins with rapidly running IV's.
	www.vhpharmsci.com /PDTM/APDX7i.htm (1046 words)

	Mitretek Systems :: Chemistry of Lewisite (Site not responding. Last check: 2007-10-09)
		L-1 is the vesicant agent; it reacts with the active sites of certain enzymes.
		The vesicant properties of the mixture are reported to remain unchanged after storage for 10 weeks in sea water.
		This is roughly consistent with the observation of continued vesicant properties after 10 weeks at 0ÉC in sea water.
	www.mitretek.org /home.nsf/homelandsecurity/Lewisite (1049 words)

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