Feb 10, 2016 chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. Management of extravasation policy document version. Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. The information provided on this site, including links to relevant websites and the information contained therein, is for use by health care providers and health care organizations only. Evidencebased standardization on extravasation management is lacking and many. 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. Definitions extravasation is the inadvertent leakage of intravenous drugs out of the vein into surrounding tissues. 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. 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. Review of extravasation reports from chemotherapy delivery group. Managing chemotherapy extravasations in practice hospital. The incidence of infiltration and extravasation is hard to determine because of limited reporting. Network guidelines for the management of extravasation of a. Preventing intravenous extravasation injuries neil johnson, md barb tofani, rn, msn sylvia rineair, rn, msha, vabc mary haygood, rn, bsn julie stalf, rn, msn, vabc cincinnati childrens vascular access team noone has all the answers cha webinar february 20.
Inject subcutaneously into the extravasation area within 12 hours of extravasation. Evidencebased standardization on extravasation management is lacking and many institutions do not practice adequate procedures to prevent the severer damages. If extravasation occurs with vesicant drugs, the result may be tissue damage and necrosis. 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. Refer to local trust policies for management of noncytotoxic extravasation. Consequences range from local irritation to amputation. The incidence of extravasation injury depends on both the patient and the medication, with nonvesicant extravasations occurring in 0. These concerns include extravasation of chemotherapy, which is. Prepare by diluting 5 mg phentolamine in 10 ml of 0. Hyperbaric oxygen therapy and free radical production.
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. West midlands expert advisory group for chemotherapy. Extravasation of chemotherapeutic agents portland, maine. Health, general cancer chemotherapy complications and side effects. Overview, prevention and management of chemotherapy extravasation. While immediate action using appropriate measures ie, dilution, extraction, antidotes, and supportive treatments can decrease the need for surgical intervention, many injuries may be. While centerbased guidelines and policies attempt to minimize its risk, chemotherapy extravasation still has a prevalence that can range from 0. Aug 10, 2016 an extravasation occurs when a chemotherapy drug accidentally leaks from the intended compartment vein into the surrounding tissue and beyond. 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. Chemotherapy extravasation guideline woscan september 2009 page 1. 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.
Extravasation is the leakage of intravenously iv infused, and potentially damaging, medications into the extravascular tissue around the site of infusion. 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. Rarely, a chemo drug may leak out of the vein or port into the surrounding tissue. Extravasation of liposomal doxorubicin induces irritant. Guideline for the management of extravasation university. Dexrazoxane dexrazoxane is an iron chelator that prevents anthracyclineiron complexes and free radical. Chemotherapy extravasation is one of the major problems that have. Extravasation occurs when medication or any other type of fluid is transmitted into the subdermal or subcutaneous tissue surrounding the administration site. Extravasation refers to the escape of a drug into the extravascular space, either by. Extravasation is the inadvertent leakage from the intended vascular path of an i. Pdf chemotherapy extravasation may result in serious damage to. Jan, 2014 extravasation injuries are a major cause of iatrogenic morbidity to the hospitalized patient.
Advisory groups\ chemotherapy \guidelines 2017\network guidelines for the mgt of extravasation of a systemic anticancer therapy including cytotoxic agents v1. The scarcity of evidence available makes it difficult to develop an optimal management scheme. Key points to understand from the extravasation guidelines. Most chemotherapy agents are not vesicants and rarely cause ulceration of tissue if inadvertently extravasated.
Overview, prevention and management of chemotherapy. The extravasation of anthracycline is recognized as a complication that is. 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. Guidelines for prevention and management of chemotherapy. Cen eons guideline module european oncology nursing. Management of the extravasation of antineoplastic agents. Administration of cytotoxics using a peripheral site should be via a recently sited cannula. The exact mechanism of lack of vesicant injury following extravasation of liposomal doxorubicin is unclear. The purpose was to establish a benchmark for the incidence of chemotherapy extravasation with vesicants, irritants, and irritants.
Can you recognize the risk factors for vesicant extravasation. 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. Pdf chemotherapy administration is a serious procedure. Extravasation injury from chemotherapy and other non. 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. Chemotherapy extravasation may result in serious damage to patients, with irreversible local injures and disability. 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. Extravasation injury from cancer chemotherapy is reported to be 11% in children and 22% in adults. Epirubicin is a chemotherapy agent used in the treatment of many neoplastic conditions including breast, gastric and oesophageal cancer. A chemotherapeutic extravasation is considered an oncologic emergency. Assessing the quality of existing clinical practice. Oncology nursing society ukons north zone chemotherapy group.
The leakage can occur through brittle veins in the elderly, through previous venipuncture access, or through direct leakage from wrongly positioned venous access devices. Extravasation is the unintentional r leakage of intravenous drugs into the surrounding perivascular tissue or subcutaneous spaces. The early detection of the extravasation of intravenous anticancer drugs. It may be that liposomes protect skin and soft tissue from free. Extravasation is a potentially severe complication that can occur during the administration of chemotherapy. Guidelines for the management of extravasation of a systemic. Chemotherapy extravasation guideline beatson west of scotland. Extravasation injury from vesicantirritant drugs is best described with antineoplastic agents, but a number of other nonantineoplastic drugs can cause extravasation injury. Jan, 2014 overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports. Chemotherapy extravasation guideline woscan september 2009 page 7 cannulation site careful selection of a new and appropriate site is essential to minimise the risk of extravasation and limit the damage to tissues should an incident occur. It acts as an iron chelator and thereby reduces irondependant free.
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. View chemotherapy extravasation ppts online, safely and virus free. The prevention of the extravasation of intravenous anticancer drugs. The volume, contact time, and drug properties are all factors that have to be considered when assessing an extravasation event. This article describes prevention and management of extravasation from a peripheral catheter. The extravasation kit contains the equipment and information necessary to manage a suspected or actual. Chemotherapy extravasation please note that this policy refers to the management of extravasation of cytotoxic chemotherapy only. You get your chemotherapy chemo through a vein in your arm or a port in your chest. Extravasation is a serious problem when chemotherapeutic agents are administered through an intravenous or intraarterial delivery system. Extravasation is the process by which any liquid fluid or drug accidentally leaks into the surrounding tissue. Accidental extravasation is relatively rare and has been estimated to occur in 0. Extravasation of chemotherapeutic agents which bind to nucleic acids can lead to a prolonged course of injury. Extravasation is the leakage of a vesicant drug into the subcutaneous tissue, which is capable of causing pain, necrosis, or sloughing of tissues. Extravasation may happen if the tube in your arm slips out of the vein.
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