collagenase clostridium histolyticum

collagenase clostridium histolyticum

Xiaflex

Indications

Action

Pharmacokinetics

Time/action profile (cord disruption)

Contraindications/Precautions

Adverse Reactions/Side Effects

Cardiovascular

• vasovagal syncope

Musculoskeletal

• ligament injury
• complex regional pain syndrome (CRPS)
• sensory abnormality of hand
• tendon rupture

Local

• contusion (most frequent)
• hemorrhage (most frequent)
• injection site reaction (most frequent)
• pain (most frequent)
• pruritus (most frequent)
• swelling (most frequent)

Miscellaneous

• allergic reactions including anaphylaxis (life-threatening)
• axillary pain
• lymphadenopathy

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess severity of Dupuytren’s contracture prior to and following injection.

Potential Nursing Diagnoses

Implementation

• Allow powder and diluent vials to stand at room temperature for 15–60 min prior to mixing. Use only diluent supplied for reconstitution. Use a syringe with 0.01 mL graduations with a 27 gauge, 1/2 inch needle to withdraw diluent. Withdraw 0.39 mL for cords affecting a MP joint and 0.31 mL for cords affecting a PIP joint. Inject diluent slowly into sides of vial; do not invert of shake vial. Slowly swirl solution to ensure all powder is in solution. Reconstituted solution should be clear without particulate matter. Solution is stable for 1 hr at room temperature or up to 4 hrs if refrigerated. If refrigerated, allow to stand at room temperature for 15 min before administering.
• Intralesional: Do not administer local anesthesia prior to injection; may interfere with placement of medication. Use a new hubless syringe with 0.01 graduations with a permanently fixed, 27-gauge, 1/2 inch needle to withdraw volume to be injected. For MP joint, withdraw 0.25 mL. For PIP joint, withdraw 0.20 mL. Follow manufacturer’s instructions for injection procedure.
• Wrap hand with a bulky dressing following injection.

Patient/Family Teaching

• Instruct patient to return to health care professional’s office the next day for an examination of the injected hand and for possible finger extension procedure to disrupt the cord.
• Instruct patient not to flex fingers of injected hand to reduce extravasation of medication out of the cord.
• Advise patient not to disrupt injected cord by manipulation.
• Instruct patient to elevate hand as much as possible until bedtime.
• Advise patient that injection is likely to result in swelling, bruising, bleeding, and/or pain of the injected site and surrounding tissue.
• Advise patient to promptly notify health care professional if signs of infection (fever, chills, increasing redness or swelling), sensory changes in the treated finger, trouble bending the finger after swelling goes down occur.

Evaluation/Desired Outcomes

• Reduction in Dupuytren’s contracture.