Management Of Extravasation Research Articles

The Role of Nursing in the Management of Chemotherapy Extravasation: A Systematic Review Regarding Public Health.

The scientific literature was reviewed with the aim of analysing the state of the art on the role of nursing in the management of chemotherapy extravasation, recognising the possible risk factors and identifying effective training programmes for nurses. WOS, Scopus, and PubMed databases were used to perform the searches. Papers that met the inclusion criteria and that had been published in the last 9 years were selected. The Effective Public Health Practice Project (EPHPP) instrument was applied to the selected studies. In addition, this research was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: 512480). Out of the 23 initially selected articles, a total of 9 articles were eventually included, since they met the eligibility criteria that were established after a more exhaustive analysis, which included reading their abstracts and full texts. The results show that the management of chemotherapy extravasation is closely related to factors that largely depend on the nursing staff. Among the most relevant findings are factors including the identification of the nursing role in the management of extravasation due to chemotherapy; risk factors; and effective training programmes for nursing. Nurses play a crucial role throughout the entire process of treatment, prevention, and health education in chemotherapy treatment. Training programmes for nurses are fundamental, as they increase their professional competence and improve the safety of the patient. Adequate knowledge of chemotherapy treatment and the risk factors of extravasation are basic elements for the prevention of this type of injury, as well as for the improvement of the quality of life of patients under this kind of intravenous therapy.

Implementation and Interim Analysis of a Standardized Renal Trauma Imaging and Urinary Extravasation Management Protocol.

The AUA recommends delayed-phase imaging (DPI) in renal injuries to evaluate the collecting system. A renal trauma imaging protocol for early conservative management of urinary extravasation (UE) was implemented to improve guideline adherence. We aimed to determine if increased adherence led to changes in outcomes. Patients with American Association for the Surgery of Trauma III to V renal injury presenting from January 2018 to September 2022 were identified from an institutional trauma registry. Patients were included if a contrasted CT scan of the abdomen was obtained on admission. Frequency of DPI and patient outcomes were compared before and after protocol implementation. Of 223 included patients, 131 (58.7%) were pre protocol and 92 (41.3%) were post protocol. Following protocol implementation, the rate of DPI on admission nearly doubled from 32.8% to 58.7% (P < .001). The rate of follow-up cross-sectional imaging increased from 18.3% to 58.7% (P < .001). Although there were no significant differences in rates of immediate or delayed interventions following protocol implementation, the postprotocol immediate intervention rate did decrease to 0%. Readmissions due to symptomatic UE were unchanged after protocol implementation (0.0% vs 0.0%). Implementation of a multidisciplinary renal trauma early imaging and management protocol improved AUA guideline adherence. With protocol adherence, there was also an elimination of immediate interventions for UE. Despite decreases in early intervention, there was no significant increase in interval interventions or UE-related readmissions. More research is needed to determine the role for routine follow-up imaging in conservative management of high-grade renal trauma.

Management of remdesivir extravasation in patients with COVID: a case report and systematic review

Management of remdesivir extravasation in patients with COVID: a case report and systematic review

Nursing Management of Extravasation Complications Related to Intravenous Catheters: A Narrative Review

Background: The existing literature on nursing management of extravasation complications is fragmented, inconsistent, and outdated. When it comes to nursing management of extravasation complications, there are several gaps that need to be addressed as generally of study participants had poor knowledge of the prevention and management of cytotoxic extravasation, a high number of nurses were not were not trained on cytotoxic extravasation. Methods: We conducted a narrative review by searching the following databases for relevant clinical practice guidelines published from Oct 2013 to Oct 2023: PubMed, Cochrane Library, CINAHL, Scopus and Clinical practice guidelines developed by institutes, hospitals, associations, and cancer groups, based on systematic and evidence-based review. We used the AMSTAR 2 tool for assessing the quality of systematic reviews, and summarized the characteristics and findings of the included studies in a narrative synthesis including year of publication, title, Institution/authors, key highlight (assessment, management, prevention). Results and discussions: These Clinical practice guidelines have some similarities and differences in their scope, methods, recommendations, and quality. They all aim to provide evidence-based and standardized guidance for the prevention and management of extravasation, and to improve the quality and safety of intravenous therapy. Conclusions: In conclusion, while significant progress has been made in understanding and managing extravasation injuries, there is still much work to be done. By continuing to research, educate, and apply evidence-based practices, healthcare professionals can significantly improve the care and outcomes for patients at risk of extravasation injuries

Extravasation of Non-Cytotoxic Drugs in Older People.

Objective To describe the risk factors of extravasation, its impact on the pharmacokinetics of non-cytotoxic drugs, and management of extravasation in older individuals. Extravasation occurs when vesicants leak from blood vessels into surrounding tissue causing severe injury such as tissue necrosis while infiltration is caused by leakage of an irritant that causes injury but does not lead to tissue necrosis. Extravasation occurs in approximately 0.01% to 6% of patients, particularly with cytotoxic agents. However, there is limited documentation about extravasation of non-cytotoxic agents, particularly in older people. Data Sources A literature search of Pubmed and Medline was performed using the following search items: "extravasation," "infiltration," "elderly," and "non-cytotoxic drugs," as well as a combination of these terms. Conclusion It is important to recognize, identify, and manage extravasation early since it can have deleterious consequences for older people. It is more important to prevent extravasation than manage it using standardized evidence-based protocols, and this can be implemented in the nursing facility and acute care setting.

COMPARISON OF THE EFFECTS OF THE IN SITU SIMULATION AND SIMULATED CLINICAL IMMERSION METHODS ON CANCER NURSING STUDENTS’ EXTRAVASATION MANAGEMENT: RANDOMIZED CONTROLLED TRIAL

In situ simulation is thought to offer a good learning environment due to the fact that it is carried out in real clinical practice. This study was performed to compare the effect of in situ simulation and simulated clinical immersion environment on cancer nursing students extravasation management. The study was carried out with a randomized controlled pretest-posttest comparative design. The participants were randomly assigned to either the simulated clinical immersion group (n=19) or the in situ simulation group (n=24). The study data were collected using Extravasation Management Knowledge Test, Objective Structured Clinical Assessment, Students’ Satisfaction and Self-Confidence Scale and the State Anxiety Inventory. The pre-posttest mean scores for the knowledge level and anxiety mean scores of the participants in the simulated clinical immersion group and the in situ group were not statistically significant (p˃.05). The satisfaction and self-confidence scale mean scores and the skill levels of the students in both settings were similar after the implementation (p˃.05). The students' knowledge, skills, anxiety, self-confidence and satisfaction were similar in both simulation-based learning environments. In situ simulation can be recommended for use in nursing education. Considering cost-effectiveness and resources, both simulation methods can be used.

Management of Extravasation Injury in Infants: A Systematic Review of Clinical Trials

Context: One of the common procedures in the neonatal intensive care unit (NICU) is the insertion of a venous catheter, and one of the most important and serious complications is extravasation, which is a leading cause of death in hospitalized infants. Based on the researcher’s experience in the NICU and the necessity of extravasation injury management in infants, this review study focused on extravasation injury management in infants. Methods: The literature was searched in ProQuest, Scopus, and PubMed databases using the terms “extravasation” OR “vascular leakage” OR “Peripheral Infiltration” AND “Neonatal” OR “Newborn” OR “Infants” OR “NICU.” The search procedure was performed in the title, abstract, and full text of articles published in English from 2000 to 2022. Results: In the initial search, 3414 articles were extracted. After removing the duplicates and searching the titles and abstracts of the articles, 132 related articles were found, and their full texts were studied. Finally, 20 articles entered the final analysis stage. Nine case report studies, five case series studies, three clinical trials, and three retrospective review studies were found. The results showed that various treatment methods are available, including elevating limbs, pain relief, hot and cold compresses, flush-out technique with saline, dressings (hydrocolloid, hydrogel, and hydrocellular foam), medications (2% nitroglycerin ointment and subcutaneous administration of hyaluronidase and phentolamine), and new methods such as amniotic membranes, omega-3-rich fish skin (Kerecis), active leptospermum honey (ALH), PRP, and surgical removal. Conclusions: Despite many medical advances, there is still no specific approach to managing extravasation in infants. The ideal approach to extravasation injuries is still to prevent them initially. The best next step is to minimize the damage using antidotes or hyaluronidase. Using saline to remove the solution and physically minimize damage can be useful. Thus, more studies are needed to address extravasation management in infants.

GEDEFO-SEFH management of antineoplastic extravasations survey results.

Extravasation is a potentially severe complication of intravenous administration of antineoplastic drugs. The limited data makes it difficult to develop an optimal management scheme. The objective of this study is to describe the clinical practice in the extravasation management of antineoplastic agents in Spanish centers. An online survey was distributed to oncology pharmacists using the email distribution list of the Spanish Society of Hospital Pharmacists. Respondents were surveyed on the standard operational protocol (SOP) of extravasation, tissue damage risk classification, and specific measures of extravasation management. A total of 68 surveys were completed. A specific extravasation SOP was available in 82.4% centers. The pharmacist participates in the authorship (100%) and actively collaborates in extravasation management (76.5%). A tissue damage risk classification based on the three categories was mostly adopted (48.2%) and 73.2% applied specific criteria based on concentration and/or extravasated volume. Extravasation management was mainly performed with the application of physical measures and/or antidotes (91.2%). High variability in the choices of pharmacological and/or physical measures recommended is outstanding. The results of this study highlight the involvement of Spanish pharmacists in extravasation management, the application of physical measures and/or pharmacological measures as the method of choice in extravasation management, as well as the existing discrepancies in tissue damage risk classification and management recommendations.

Management of noncytotoxic extravasation injuries: A focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline.

Extravasation is the leakage of intravenous solutions into surrounding tissues, which can be influenced by drug properties, infusion techniques, and patient-related risk factors. Although peripheral administration of vesicants may increase the risk of extravasation injuries, the time and resources required for central venous catheter placement may delay administration of time-sensitive therapies. Recent literature gathered from the growing use of peripheral vasopressors and hypertonic sodium suggests low risk of harm for initiating these emergent therapies peripherally, which may prevent delays and improve patient outcomes. Physiochemical causes of tissue injury include vasoconstriction, pH-mediated, osmolar-mediated, and cytotoxic mechanisms of extravasation injuries. Acidic agents, such as promethazine, amiodarone, and vancomycin, may cause edema, sloughing, and necrosis secondary to cellular desiccation. Alternatively, basic agents, such as phenytoin and acyclovir, may be more caustic due to deeper tissue penetration of the dissociated hydroxide ions. Osmotically active agents cause cellular damage as a result of osmotic shifts across cellular membranes in addition to agent-specific toxicities, such as calcium-induced vasoconstriction and calcifications or arginine-induced leakage of potassium causing apoptosis. A new category has been proposed to identify absorption-refractory mechanisms of injury in which agents such as propofol and lipids may persist in the extravasated space and cause necrosis or compartment syndrome. Pharmacological antidotes may be useful in select extravasations but requires prompt recognition and frequently complex administration strategies. Historically, intradermal phentolamine has been the preferred agent for vasopressor extravasations, but frequent supply shortages have led to the emergence of terbutaline, a β2 -agonist, as an acceptable alternative treatment option. For hyperosmolar and pH-related mechanisms of injuries, hyaluronidase is most commonly used to facilitate absorption and dispersion of injected agents. However, extravasation management is largely supportive and requires a protocolized multidisciplinary approach for early detection, treatment, and timely surgical referral when required to minimize adverse events.

Effectiveness of structured teaching programme on knowledge regarding management of extravasation of chemotherapeutic drugs

Background: More than 1 million intravenous chemotherapy infusions are given worldwide each day which leads to extravasation. Health professionals must know the drugs that cause tissue injury and take the necessary measures to prevent extravasation. Objectives: The study aimed to assess the knowledge regarding the management of extravasation of chemotherapeutic drugs before and after the implementation of a structured teaching program among staff nurses. Method: The pre-experimental group pre-test and post-test designs were adopted for the study. The convenience sampling technique was used to obtain 30 staff nurses of Ramaiah Medical College Hospital, India. Both Pre-test and Post-test were performed using the same structured knowledge questionnaire followed by 45 minutes of the structured teaching program. Data were processed through Statistical Package for Social Sciences version 20 and analyzed using descriptive and inferential statistics. Results: More than half of the subjects were female (66.7%) and 36.7% of the subject had more than 10 years of professional experience. Most of the subjects (70%) had inadequate knowledge during the pretest. The mean knowledge score was 15.33 ± 4.003 and 24.67 ± 5.384 in pre-test and post-test respectively. There was a significant difference in pre-test and post-test knowledge scores regarding the management of extravasation of chemotherapeutic drugs. Conclusion: The Study concluded that the structured teaching program was significantly effective in improving the knowledge regarding the management of extravasation of chemotherapeutic drugs among nurses.

The effect of high-fidelity simulation technology on the competency of nursing students in managing chemotherapy extravasation in patients with cancer.

Nursing education suffers from a lack of high-quality clinical experiences for students, especially among medical specialty groups such as cancer patients, in Saudi Arabia. A paucity of empirical evidence is supporting simulation in education and the transfer of psychomotor skills to patient care. In particular, although generally recognized as an essential oncology nursing skill, effective strategies for teaching the management of chemotherapy extravasation to students have not been investigated. To investigate the effects of high-fidelity simulation (HFS) technology on the competency of nursing students in the management of chemotherapy extravasation and the transfer of this skill from traditional learning labs to clinical settings. A quasi-experimental study comprising a two-group pretest-posttest with repeated measures was used. The intervention was a scenario-based, HFS. Third-year students (n=68) from a nursing program were randomly allocated to either intervention or control groups. Competency was measured in both groups using the same standardized assessment checklist. Competency scores were lower in the control group compared to the intervention group at both posttesting times. These results, however, were not statistically significant. There was no statistically significant difference between the groups regarding skill transfer. Nursing faculty can use either HFS or traditional learning methods to effectively teach students how to manage chemotherapy extravasation and transfer this skill to clinical settings.

A new approach to skin extravasation injury management during the neonatal period

BackgroundTo identify a standard protocol for managing extravasation injuries in neonates.MethodsWe recruited all the neonates with extravasation wounds from the neonatal intensive care unit of Shariati hospital, Tehran, Iran, between October 2018 and October 2020. Sixteen patients with grade 3–4 extravasation were evaluated in this retrospective study. All grade 3 and 4 extravasation wounds were injected with hyaluronidase at 5 points of the wound circle; the procedure was repeated every 5 min at different points in a smaller circle to the core. The wound was then covered with a warm compress for 24 h. Twenty-four hours after injection, the cover was changed twice a day with normal saline irrigation. Fibrinolysin ointment was applied on top of the wound. The ulcer was then dressed with phenytoin ointment until healing.ResultsOut of 16 neonates who were followed up, 10 of them were male, with the average birth weight being 1.37 (range 1.05–3.75) kg. The mean (± SD) wound healing duration was 13.12 (± 6) (range: 7–29) days. Factors including the cannulation duration before the appearance of the lesion (R:0.2, P = 0.2), birth weight (R = -.37, P = 015), and extravasated substances (p = 0.2) were not associated with the duration of hospital stay. The only exception to this trend is the wound size factor of 7.31(± 7.45) (R = .83, P < 0.001). Continuous and categorical variables were summarized as mean (SD) and proportions, respectively, and the Kruskal–Wallis test and Spearman correlation coefficients were used.ConclusionsLimited evidence exists on the effects of different protocols on extravasation management in neonates in the NICU. We recommend our method as a standard protocol in NICU for high-stage extravasated lesions because of the shorter duration of healing, non-invasive nature of this procedure, and lack of side effects or surgical involvement.

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

EXTRAVASATION OF OXYTOCIN: AN UNUSUAL LABOR EVENT

The present case report highlights the extravasation of oxytocin which is an extremely rare event even in busiest of labour rooms. A 26-year-old second gravida with history of one abortion, presented at 38 weeks period of gestation with complaints of labor pains and suffered this rare incidence of oxytocin infusion extravasation at minimal therapeutic dose. Oxytocin antagonists like Atosiban may be considered in future cases of drug extravasation with oxytocin unresponsive to conservative measures. Further research is needed for management of extravasation of such rarity to prevent devastating complications of amputation &amp; gangrene that may result in loss of permanent limb function even in minimal doses.

Chemotherapy-Induced Extravasation Injury: Classification and Management

Chemotherapy is a category of medicines that are utilized to kill and eradicate immediately the abnormally growing cells in the body. It is commonly utilized to treat cancer because cancer cells grow and divide at a faster rate than other cells. Extravasation is the mechanism by which any liquid (fluid or drug) accidentally enters the surrounding tissue. Extravasation in cancer treatment indicates the unintentional chemotherapy infiltration into the subdermal tissues or subcutaneous enclosing the intravenous or intra-arterial location of administration. Extravasated agents are categorized as vesicants, exfoliants, irritants, inflammators, and neutrals. Based on their potential for causing harm, management of chemotherapy-related extravasation includes both non-pharmacological treatment and pharmacological treatment.

Antineoplastic extravasation management: Consensus of the Spanish Oncology Pharmacy Group (GEDEFO).

Antineoplastic extravasation management: Consensus of the Spanish Oncology Pharmacy Group (GEDEFO).

Effect of Evidence Based Guideline on Neonatal Nurse's Adherence Regarding Prevention and Management of Intravenous Infiltration and Extravasation

Effect of Evidence Based Guideline on Neonatal Nurse's Adherence Regarding Prevention and Management of Intravenous Infiltration and Extravasation

Management of Ketamine Extravasation in a Pediatric Patient During Procedural Sedation.

Ketamine is a commonly used intravenous and intramuscular medication for procedural sedation within pediatric emergency medicine. There is limited availability of data on the rate of absorption and use of subcutaneous ketamine administration. We describe the case of a 12-year-old male who was sedated after extravasation and subsequent absorption of ketamine 1 mg/kg from a peripheral intravenous line (PIV). Despite being an unintended route, absorption of subcutaneous ketamine resulted in satisfactory procedural sedation with no complications. Given limited data on subcutaneous ketamine pharmacokinetics, the aim of this case report is to present the observed absorption of subcutaneous ketamine due to extravasation of PIV during a pediatric procedural sedation.

Nursing management of drug extravasation during intravenous pumping of potassium chloride in a patient with multiple myeloma

Nursing management of drug extravasation during intravenous pumping of potassium chloride in a patient with multiple myeloma

Acute Management of Intraperitoneal Extravasation of Total Parenteral Nutrition (TPN) in a Very Preterm Infant: Case Report and Literature Review

Acute Management of Intraperitoneal Extravasation of Total Parenteral Nutrition (TPN) in a Very Preterm Infant: Case Report and Literature Review