More research is needed to improve knowledge of patient risk, prompt recognition of the extravasation, and time course for tissue injury, and to develop prevention and treatment strategies for extravasation injuries. Rarely, a chemo drug may leak out of the vein or port into the surrounding tissue. The purpose was to establish a benchmark for the incidence of chemotherapy extravasation with vesicants, irritants, and irritants. The volume, contact time, and drug properties are all factors that have to be considered when assessing an extravasation event. Health, general cancer chemotherapy complications and side effects. Extravasation occurs when medication or any other type of fluid is transmitted into the subdermal or subcutaneous tissue surrounding the administration site. Guidelines for prevention and management of chemotherapy. Extravasation of chemotherapeutic agents portland, maine. Chemotherapy extravasation please note that this policy refers to the management of extravasation of cytotoxic chemotherapy only.
Refer to local trust policies for management of noncytotoxic extravasation. Prepare by diluting 5 mg phentolamine in 10 ml of 0. Accidental extravasation is relatively rare and has been estimated to occur in 0. Feb 10, 2016 chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients.
Evidencebased standardization on extravasation management is lacking and many. Extravasation is a potentially hazardous event that may occur during chemotherapy. This article describes prevention and management of extravasation from a peripheral catheter. Extravasation is the leakage of intravenously iv infused, and potentially damaging, medications into the extravascular tissue around the site of infusion. Chemotherapy extravasation may result in serious damage to patients, with irreversible local injures and disability.
In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intraarterial administration site. Sep 21, 2009 treatment modalities utilized for the management of vesicant extravasation include immediate discontinuation of chemotherapy and cooling or dilution of the site of extravasation. The prevention of the extravasation of intravenous anticancer drugs. This guideline, published in cooperation with the european oncology nursing society eons, focuses on risk factors for extravasation, prevention, diagnosis, management of extravasation, and surgical management of severe tissue damage. While immediate action using appropriate measures ie, dilution, extraction, antidotes, and supportive treatments can decrease the need for surgical intervention, many injuries may be.
If extravasation occurs with vesicant drugs, the result may be tissue damage and necrosis. Most chemotherapy agents are not vesicants and rarely cause ulceration of tissue if inadvertently extravasated. Extravasation is a potentially severe complication that can occur during the administration of chemotherapy. Extravasation may happen if the tube in your arm slips out of the vein. Dexrazoxane dexrazoxane is an iron chelator that prevents anthracyclineiron complexes and free radical. The early detection of the extravasation of intravenous anticancer drugs. Review of extravasation reports from chemotherapy delivery group. The most destructive extravasation injuries are those caused by antitumor drugs which bind to deoxyribonucleic acid dna, such as doxorubicin, adriamycin which has been a primary part of chemotherapeutic regimes since the late 1960s. While centerbased guidelines and policies attempt to minimize its risk, chemotherapy extravasation still has a prevalence that can range from 0. The incidence of infiltration and extravasation is hard to determine because of limited reporting. The incidence of extravasation injury depends on both the patient and the medication, with nonvesicant extravasations occurring in 0.
Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. It is important to note that even some nontoxic compounds can do harm if they are injected intraarterially or extravasate into a muscle compartment, increasing the risk. When assessing a chemotherapy extravasation, it is important to understand the classification of the chemotherapeutic agent in terms of its potential to cause cellular damage if extravasated. Extravasation is the unintentional r leakage of intravenous drugs into the surrounding perivascular tissue or subcutaneous spaces. Guidelines for the management of extravasation of a systemic. A number of agents used in cancer chemotherapy are extremely irritating if they extravasate or infiltrate into the tissues rather than remaining within the vasculature. Hyperbaric oxygen therapy and free radical production.
A chemotherapeutic extravasation is considered an oncologic emergency. Management of extravasation of antineoplastic agents via medica. It acts as an iron chelator and thereby reduces irondependant free. The scarcity of evidence available makes it difficult to develop an optimal management scheme. The incidence of peripheral extravasation injuries caused by chemotherapy agents is estimated to be between 0.
Managing chemotherapy extravasations in practice hospital. The leakage can occur through brittle veins in the elderly, through previous venipuncture access, or through direct leakage from wrongly positioned venous access devices. Network guidelines for the management of extravasation of a. Evidencebased standardization on extravasation management is lacking and many institutions do not practice adequate procedures to prevent the severer damages. Advances in treatment include the availability of hyaluronidase for treating plant alkaloid extravasations and the introduction and approval of dexrazoxane for anthracycline extravasation treatment. Pdf chemotherapy administration is a serious procedure. Chemotherapy extravasation is one of the major problems that have. West midlands expert advisory group for chemotherapy. Administration of cytotoxics using a peripheral site should be via a recently sited cannula. Aug 10, 2016 an extravasation occurs when a chemotherapy drug accidentally leaks from the intended compartment vein into the surrounding tissue and beyond.
Extravasation is the process by which any liquid fluid or drug accidentally leaks into the surrounding tissue. Overview, prevention and management of chemotherapy. Assessing the quality of existing clinical practice. The aim of this study is to assess the quality of existing clinical practice guidelines cpgs for chemotherapy drug extravasation by appraisal of guidelines for research and evaluation ii agree ii. Jan, 2014 overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports. Chemotherapy extravasation management extravasation is a term that describes a drug inadvertently or accidentally leaking into surrounding tissue or the subcutaneous space during iv infusions. Consequences range from local irritation to amputation.
Chemotherapy extravasation guideline woscan september 2009 page 1. To reduce the morbidity associated with extravasation, it is vital that clinicians are well informed of the treatments available and work quickly to avoid further. Cen eons guideline module european oncology nursing. Management of extravasation policy document version. It may be that liposomes protect skin and soft tissue from free. Guideline for the management of extravasation university. Chemotherapy extravasation guideline beatson west of scotland. Extravasation of chemotherapeutic agents which bind to nucleic acids can lead to a prolonged course of injury. Extravasation is a serious problem when chemotherapeutic agents are administered through an intravenous or intraarterial delivery system. These concerns include extravasation of chemotherapy, which is. The extravasation kit contains the equipment and information necessary to manage a suspected or actual. Management of the extravasation of antineoplastic agents. It is important to note that even some nontoxic compounds can do harm if they are injected intraarterially or extravasate into a muscle compartment, increasing the risk for acute compartment syndrome.
When assessing a chemotherapy extravasation, it is important to understand the classification of the chemotherapeutic agent in terms of its potential to cause cellular damage if. Inject subcutaneously into the extravasation area within 12 hours of extravasation. Extravasation is the leakage of a vesicant drug into the subcutaneous tissue, which is capable of causing pain, necrosis, or sloughing of tissues. The extravasation of anthracycline is recognized as a complication that is.
Extravasation is the inadvertent leakage from the intended vascular path of an i. Can you recognize the risk factors for vesicant extravasation. Key points to understand from the extravasation guidelines. Oncology nursing society ukons north zone chemotherapy group. Extravasation occurs when a peripheral catheter erodes through the vessel wall at a second point, when increased venous pressure causes leakage around the original venipuncture site, or when a needle pulls out of the vein. Overview, prevention and management of chemotherapy extravasation. Extravasation injury from chemotherapy and other non. Jan, 2014 extravasation injuries are a major cause of iatrogenic morbidity to the hospitalized patient. Extravasation refers to the escape of a drug into the extravascular space, either by. The exact mechanism of lack of vesicant injury following extravasation of liposomal doxorubicin is unclear. Extravasation of liposomal doxorubicin induces irritant. Epirubicin is a chemotherapy agent used in the treatment of many neoplastic conditions including breast, gastric and oesophageal cancer. Extravasation injury from cancer chemotherapy is reported to be 11% in children and 22% in adults.
547 1198 1258 158 1004 450 122 1534 1410 1277 347 1384 1520 1098 859 41 280 1270 1146 730 42 406 876 958 1282 1105 96 196 572 617 1384 445 182 379 1324 1071 178 388 709 171 921 619 1360 427 745 118 362 571 516