Management Of Chemotherapy Extravasation Research Articles

Effect of an Educational Program for Nurses on Prevention and Management of Chemotherapy Extravasation

Effect of an Educational Program for Nurses on Prevention and Management of Chemotherapy Extravasation

CATASTROPHIC COMPLICATIONS OF CHEMOTHERAPY EXTRAVASATION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Chemotherapy is the mainstay of cancer treatment. Hematological side effects are well described; however, not many dermatological complications have been reported. We present a case of fatal necrotizing fasciitis (NF) secondary to chemotherapy extravasation. CASE PRESENTATION: 55-year-old African American man with anaplastic ALK-negative large T cell lymphoma presented with fatigue, fevers, and palpitations for several weeks. Physical examination was remarkable for tachycardia and tachypnea; he required 4 liters of supplemental oxygen to saturate >90%. Laboratory workup was remarkable for WBC 18.200 m/mm3 and ESR 67 mm/h. CT scan revealed significant mediastinal lymphadenopathy. The symptoms were attributed to the malignancy and CHOP chemotherapy was started. Shortly thereafter, a painful blister at the infusion site was noted. It was deemed to be a local cutaneous vesicant effect from doxorubicin; chemotherapy was stopped and topical dimethyl sulfoxide (DMSO) was applied. No infectious process was identified but the patient continued to be febrile and tachycardic. He developed hypotension hence broad-spectrum antibiotics were started. His respiratory status deteriorated and he was intubated. A new subcutaneous tissue induration near the blister rose concern for necrotizing fasciitis (NF) and he was emergently taken to the OR. The fascia was compromised and the biceps muscle was found to be necrotic. He underwent multiple surgical debridements; however, he developed septic shock and died. DISCUSSION: Necrotizing soft tissue infections are a rare but potentially fatal complication of chemotherapy. As vesicants, doxorubicin, and vincristine extravasation is known to result in tissue necrosis. Doxorubicin, an anthracycline, is associated with the highest risk for cutaneous damage. Other risk factors are immunosuppression, obesity, and previous frequent blood draws. DMSO helps with the reabsorption of chemotherapeutics. NF is characterized by rapid fascial destruction with relative skin-sparing; accompanied by pain and systemic toxicity. Prompt identification is of paramount importance; however, the diagnosis is challenging as early symptoms tend to be vague. Early surgical debridement and fasciotomy improve survival; broad-spectrum antibiotic coverage and hyperbaric oxygen therapy should be started rapidly as well. Overwhelming sepsis leads to death in more than 70% of the cases. CONCLUSIONS: Chemotherapy extravasation can cause severe skin lesions and death. Initial symptoms may be mild, however, a high degree of suspicion is needed as delays in treatment are associated with poor outcomes. REFERENCE #1: Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention and management of chemotherapy extravasation. World J Clin Oncol. 2016;7(1):87-97. doi:10.5306/wjco.v7.i1.87 DISCLOSURES: No relevant relationships by Daniel Bustamante-Soliz, source=Web Response No relevant relationships by Dennis Kumi, source=Web Response No relevant relationships by Valeria Trelles Garcia, source=Web Response No relevant relationships by Catherine Weir, source=Web Response

Effectiveness of Saline Washout Technique in the Management of Chemotherapy Extravasations Among Cancer Patients

Cancer cells display uncontrolled growth invasion and sometimes metastatic spread to other location in the body via lymph nodes or blood. Cancer affects people are mostly in elder ages peoples with risk for most type increasing with age cancer caused about 13% of all human death 2008(7.6million). While improved the cancer patients first important for administer the chemotherapy. But they may cause many of side effects in main side effects is “EXTRAVASATION in” extravasations is infiltration or leakage of intravenous chemotherapeutic agents. It mostly affected in extremities, into the local tissue surrounding the administration site may result of local tissue damage or extravasations. Drugs that is associated with severe necroes is when extravasations are known as vesicants. Whereas those associated with less severe burning or inflammation are known as irritation. The aim of the present study was conducted to assess the effect of saline washout technique in the management of chemotherapy extravasation among cancer patients. A pre-experimental design was chosen to assess the effectiveness of saline washout technique on chemotherapy extravasations. The present was conducted at SMCH with 100 male and female who come under inclusion criteria and they were selected by non-probability convenience sampling technique. The demographical variables was collected by using Semi-structured questionnaire and extravasations was assessed by INS (Infusion nurses society) infiltration and extravasation scale. The result revealed the pretest results show that 30% had mild stage, 31% had moderate stage, 24% had severe stage and 15% had very severe stage on chemotherapy extravasation among cancer patients. The post-test data revealed that 35% had normal stage, 24%hadmildstage,21%hadmoderatestage, 14% had severe stage and 6% had very severe stage on chemotherapy extravasation among cancer patients. The result revealed that saline washout technique was more effective in the management of chemotherapy extravasation among cancer patients.

Effect of Intervention Guidelines on Nurses' Performance Regarding Prevention and Management of Intravenous Extravasation Chemotherapy for Children

Background: Extravasation of chemotherapy is accidental leakage of chemotherapy drugs into the subcutaneous tissue tissues surrounding the administration site. Aim of the study was to evaluate the effect of intervention guidelines for prevention and management of intravenous extravasation chemotherapy on nurses' performance. Quasi- experimental research design was used. It was carried out at Pediatric Hematology and Oncology Unit of Tanta University Hospital. A convenient sample of 20 nurses working in Pediatric Hematology and Oncology Unit and responsible for providing direct care for 50 children receiving chemotherapy. Materials and Method: Four tools were used to collect data: An assessment tool of nurses' knowledge about chemotherapy, chemotherapy administration observational checklist, extravasation scale and developed intervention guidelines. The results revealed that the total scores of knowledge for more than half of nurses were poor before the guidelines application while immediately and after one month from the guidelines application the total scores of nurses' knowledge improved and all of nurses and the majority of them obtained good scores respectively. The total score of practice for three quarter of nurses' performances were poor before the guidelines application while immediately and after one month from the guidelines application the nurses' performances improved and three quarter of nurses and more than half of them obtained good scores respectively. Conclusion: it can be concluded that there was a significant improvement in nursing staff knowledge and performance in relation to prevention and management of chemotherapy extravasation. Recommendation: In-service training program should be conducted periodically for teaching to the nurses the basic clinical skills.

Overview, prevention and management of chemotherapy extravasation.

Chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. We review in this article the clinical aspects of chemotherapy extravasation and latest advances in definitions, classification, prevention, management and guidelines. We review the grading of extravasation and tissue damage according to various chemotherapeutic drugs and present an update on treatment and new antidotes including dexrazoxane for anthracyclines extravasation. We highlight the importance of education and training of the oncology team for prevention and prompt pharmacological and non-pharmacological management and stress the availability of new antidotes like dexrazoxane wherever anthracyclines are being infused.

Development of chemotherapy-induced extravasation management algorithm to facilitate and improve care of cancer patients.

224 Background: Chemotherapy administration has up to a 6% incidence of extravasation, which can cause ulcer formation, tissue necrosis and loss of limb function, requiring surgical intervention (debridement and skin grafting). Because of its rare occurrences and the lack of uniform consensus on management strategies, much time is spent on decision making process by the patient care team and treatments are often delayed. To facilitate and improve the care of cancer patients in cases of chemotherapy extravasation, a task force was created to develop chemotherapy extravasation management algorithm. Methods: Chemotherapy extravasation management task force comprised of oncology pharmacy and oncology nursing leaderships. Literature search (limited to English language) was performed in PubMed (through April 2014) and of 34 “hits”, 13 articles on management of chemotherapy extravasation were reviewed. An algorithm was developed which contained 7 distinct intervention pathways dependent upon the drug involved in extravasation. The treatment algorithm was adopted after review by the cancer institute’s QI committee and oncology pharmacy and therapeutics subcommittee. Results: Chemotherapy extravasation algorithm provides the following guidance to nurses and providers: (1) Initial steps for nurses to follow in case of chemotherapy extravasation; (2) Chemotherapeutic agent-specific recommendations for cold or hot compress with antidote if indicated; (3) Nursing instruction for documentation of the adverse event and recommendation to photograph the site of extravasation; (4) Preparation and administration instruction of the antidotes (hyaluronidase, dexrazoxane, sodium thiosulfate, and DMSO). Finalized chemotherapy extravasation algorithm was made available in all oncology treatment areas and included in each extravasation kit. Conclusions: The development of algorithm for chemotherapy extravasation management provides clear and comprehensive instructions to oncology nurses and oncology providers on management and shortens the time to initiate management, thereby minimizing the risk of potentially debilitating sequelae from delayed management.

Management of chemotherapy extravasation: ESMO–EONS Clinical Practice Guidelines

Extravasation is the process by which any liquid (fluid or drug) accidentally leaks into the surrounding tissue. In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intra-arterial administration site. Extravasated drugs are classified according to their potential for causing damage as ‘vesicant’, ‘irritant’ and ‘nonvesicant’ (Table 1). Some vesicant drugs are further classified into two groups: DNA binding and non-DNA binding. Allwood et al. (2002) divided the drugs into vesicants, exfoliants, irritants, inflammitants and neutrals.

Role of dimethylsulfoxide for management of chemotherapy extravasation

Extravasation of anthracyclines is a rare complication that can lead to severe tissue necrosis and ulceration. With conservative measures (e.g., limb elevation, cooling), ulceration may develop in 28% of patients. Topical dimethylsulfoxide is commonly suggested as an antidote. However, there are inconsistent and sometimes conflicting animal data on its efficacy and safety. Ovid Medline (1966 to April 2004) was searched using the medical subject headings of ‘Dimethyl Sulfoxide’ and ‘Extravasation of Diagnostic and Therapeutic Materials’, and limited to English language and human articles. There have been no controlled trials on dimethylsulfoxide comparing its efficacy with cooling alone. Of a total of 147 patients, ulceration was uncommon after anthracycline extravasation when patients were managed with dimethylsulfoxide with or without cooling. Dimethylsulfoxide was well tolerated, with the most common toxicities being early mild reversible burning sensation, blistering, followed later by itch, erythema and superficial scaling. Dimethylsulfoxide is probably effective in preventing ulceration in patients who may not respond to cooling alone. When applied appropriately, dimethylsulfoxide seems well tolerated, with self-limiting local irritation to be the most common adverse effect. Hence, it is reasonable to consider topical dimethylsulfoxide 99% solution when managing extravasation of anthracyclines and mitomycin.