Immediate management of extravasation reduces the tissue injury, and morbidity is inevitable if this step is delayed. In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the. Oral dexamethasone for 1014 days after oxaliplatin extravasation may reduce inflammation. Intravenous pumps do not always alert staff to an extravasation injury in progress. The prevention of the extravasation of intravenous anticancer drugs. A safe administration of intravenous chemotherapy protocol and an extravasation management protocol was developed by clinicians. On extravasation, infusion of drug should be stopped at once and. The incidence of intravenous, vesicant chemotherapy extravasation is estimated to be 1% to 6%. The scarcity of evidence available makes it difficult to develop an optimal management scheme.
Although chemotherapy dosechecking software was available and used in some facilities, chemotherapy orders were typically checked manually and entered into a. Depending on the medication that has extravasated, there are potential management options and treatments that aim to minimize damage, although the effectiveness of many of these. Guidelines for the management of extravasation of a systemic. Intravenous extravasation management technique into practice was positively received by patients, medical staff and chemotherapy nurses.
Risk management strategies include careful assessment and use of ports, comprehensive patient teaching about the risk of extravasation and measures to decrease the likelihood of needle dislodgment, and development of extravasation management policies that address port extravasations. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Extravasation management reference sheet medication thermal therapy antidote dose treatment amino acids 4. Docu menting chemotherapy extravasation is another important step to guide the treatment plan. Oncology ehr consent management, chemotherapy management. The incidence of extravasation injury depends on both the patient and the medication, with nonvesicant extravasations occurring in 0. Au wang cl, cohan rh, ellis jh, adusumilli s, dunnick nr so radiology. Oncology nursing society releases updated guidelines on. Assess the extravasation area for pain, blister formation, and skin sloughing periodically as needed or in accordance with institutional policy. Management of the extravasation of antineoplastic agents. Most extravasation kits contain disposable syringes and cannulas, coldhot packs, gauze pads, adhesive plaster, sterile and protective gloves, and medications to treat extravasation e. This may occur in a number of types of endoscopic surgery, such as minimally invasive orthopedic surgery, i.
Management of infiltration injuries newborns extravasation injuries from chemotherapy. Adapted from chemotherapy extravasation guidelines lhsc, revision june 2015. Nursing vigilance along with prompt recognition and management is the key. Single flow chart developed combining management of vesicant, vesicant with irritant properties and irritant extravasation.
Extravasation of irrigation fluid is the unintended migration of irrigation fluid e. I will be presenting an inservice to staff nurses on our next two staff meetings on july and. Revised november 2014, approved by provincial systemic program committee. Should an extravasation occur, it is important to remember that the degree of damage is dependent on the type of drug, the drug concentration, the localization of the. In the event of extravasation of any cytotoxic drug, vesicant, or irritant. Extravasation management immediate management flow chart. In order to minimize the risk of extravasation, the staff involved in the infusion and management of cytotoxic drugs must be trained to implement several preventive protocols. Extravasationthe infiltration of a vesicant drug from an iv line into surrounding tissuecan occur with either a peripheral or central venous catheter.
Oxaliplatin extravasation has been associated with local pain and inflammation which may be severe and lead to complications including necrosis. West midlands expert advisory group for chemotherapy. We present the definitions, grading, classification and guidelines related to chemotherapeutic drugs and groups. Extravasation is particularly serious during chemotherapy, since chemotherapy medications are highly toxic. Ct demonstration of intravenous contrast medium extravasation and subsequent resorption in the mediastinum. Chemotherapy extravasation remains an accidental complication of. Evidencebased standardization on extravasation management is lacking and many.
Initial management of vesicant extravasation ease in providing early intervention may be facilitated by making an extravasation kit available within the institution. In collaboration with the physician or advanced practice nurse, refer the patient for specialized care when indicated or needed e. Overview, prevention and management of chemotherapy extravasation. Guidelines for prevention and management of chemotherapy extravasation please note that this policy refers to the management of extravasation of cytotoxic chemotherapy only. Sep 21, 2009 initial management of vesicant extravasation ease in providing early intervention may be facilitated by making an extravasation kit available within the institution. Stop injection or infusion and attempt to aspirate any residual chemotherapy and blood in intravenous tubing, needle, and skin site. Advisory groups\chemotherapy\guidelines 2017\network guidelines for the mgt of extravasation of a systemic anticancer therapy including cytotoxic agents v1. Management of extravasation if extravasation does occur, prevention of serious injury and tissue damage becomes the main focus of those involved in the patient management.
Recent case reports suggest that oxaliplatin may be better classified as an irritant when extravasated. Extravasational toxicity of anticancer chemotherapy and its. American society of clinical oncologyoncology nursing society chemotherapy administration safety standards. Thus, our main purpose was to evaluate the primary literature for available interventions for the management of extravasations and to provide recommendations. Management of extravasation immediate bedside management. Management of extravasation if extravasation does occur, prevention of serious injury and tissue damage becomes the main focus of. Management of extravasation policy document version. Guide to extravasation management in adult patients. Guidelines for the management of extravasation of a. Inject subcutaneously into the extravasation area within 12 hours of event. The early detection of the extravasation of intravenous anticancer drugs. Limiting the pump cycle to one hour may minimise the extent of tissue damage from extravasation by triggering a reminder to inspect the insertion site and limb for signs of extravasation. Advisory groups\ chemotherapy \guidelines 2017\network guidelines for the mgt of extravasation of a systemic anticancer therapy including cytotoxic agents v1.
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. The management of extravasation involves several stages. The management of cytotoxic chemotherapy extravasation. Extravasation is the process by which any liquid fluid or drug accidentally leaks into the surrounding tissue. Ensure all extravasations are reported in the local incident reporting system. Tulia gonzalez, rn, ocn, is a nurse at florida cancer specialists in. Phentolamine regitine2,5 prepare by diluting 5 to 10 mg phentolamine in 10 ml of 0. As a dreaded complication of chemotherapy, extravasation has gained increasing attention in recent years. Role of dimethylsulfoxide for management of chemotherapy.
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. Overview, prevention and management of chemotherapy. Timeline the project began in mid june 2015 and the projected finish date will be august 17, 2015. The patient complains of burning, stinging pain or any other acute change at the injection site. 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. May 25, 2009 mechlorethamine extravasation is rarely encountered in contemporary oncology practice given that the clinical utility of this chemotherapy has been usurped by other safer, more effective agents. Guidelines for prevention and management of chemotherapy. Stop the infusion immediately and aspirate the drug. Definitions extravasation is the inadvertent leakage of intravenous drugs out of the vein into surrounding tissues. Attempting to aspirate as much of the drug as possible, as soon as extravasation is suspected, may help to reduce the size of the area affected weinstein 2007.
Chemotherapy extravasation guideline woscan september 2009 page 9 detection of extravasation extravasation should be suspected if one or more of the following is observed during or immediately after the injection. These protocols cover prevention, the recognition of extravasation, the possible treatments with antidotes, an immediate management quicklinks table, immediate management flow charts, an assessment chart and patient. Feb 10, 2016 chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. Extravasation is a term that describes a drug inadvertently or accidentally leaking into surrounding tissue or the. Unsurpassed in its comprehensive and broad scope of content, endovault oncology offers all of the aspects of a practice management, consultation and report writing software, along with modules for initial consultations, cancer staging, chemotherapy, chemotherapy order sets, radiation therapy, palliative care and recall management.
The purpose was to establish a benchmark for the incidence of chemotherapy extravasation with vesicants, irritants, and irritants. The purpose of this information is to provide guidance to health professionals in the management of antineoplastic extravasation. Guidelines on treatment of extravasation with cytotoxic drugs. Get unlimited access through an enterprise license. Extravasation management procedures are defined and align with current literature and guidelines. Extravasation of anthracyclines is a rare complication that can lead to severe tissue necrosis and ulceration. Journal articles, published and unpublished case reports, personal experience. Most extravasation kits contain disposable syringes and cannulas, coldhot packs, gauze pads, adhesive plaster, sterile and protective gloves, and medications to treat.
Extravasation injuries are a major cause of iatrogenic morbidity to the hospitalized patient. To present a clinical update on the prevention, detection, and evidencebased management of vesicant chemotherapy extravasations. The volume, contact time, and drug properties are all factors that have to be considered when assessing an extravasation event. Extravasation is a potentially severe complication that can occur during the administration of chemotherapy. Riskmanagement strategies include careful assessment and use of ports, comprehensive patient teaching about the risk of extravasation and measures to decrease the likelihood of needle dislodgment, and development of extravasationmanagement. Consideration and updating the extravasation policy ensuring compliance with the extravasation policy monitoring extravasation incidence and audits, and advising action in response to. Chemotherapy administration carries safety concerns, which include accidental extravasation, to patients. See section guidelines for management of extravasation of vesicant. Get concise advice on drug therapy, plus unlimited access to ce. Oncology practice initiative qopi certification program qcp. Refer to local trust policies for management of noncytotoxic extravasation.
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