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Sblendorio E, Dentamaro V, Lo Cascio A, Germini F, Piredda M, Cicolini G. Integrating human expertise & automated methods for a dynamic and multi-parametric evaluation of large language models' feasibility in clinical decision-making. Int J Med Inform 2024; 188:105501. [PMID: 38810498 DOI: 10.1016/j.ijmedinf.2024.105501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Recent enhancements in Large Language Models (LLMs) such as ChatGPT have exponentially increased user adoption. These models are accessible on mobile devices and support multimodal interactions, including conversations, code generation, and patient image uploads, broadening their utility in providing healthcare professionals with real-time support for clinical decision-making. Nevertheless, many authors have highlighted serious risks that may arise from the adoption of LLMs, principally related to safety and alignment with ethical guidelines. OBJECTIVE To address these challenges, we introduce a novel methodological approach designed to assess the specific feasibility of adopting LLMs within a healthcare area, with a focus on clinical nursing, evaluating their performance and thereby directing their choice. Emphasizing LLMs' adherence to scientific advancements, this approach prioritizes safety and care personalization, according to the "Organization for Economic Co-operation and Development" frameworks for responsible AI. Moreover, its dynamic nature is designed to adapt to future evolutions of LLMs. METHOD Through integrating advanced multidisciplinary knowledge, including Nursing Informatics, and aided by a prospective literature review, seven key domains and specific evaluation items were identified as follows:A Peer Review by experts in Nursing and AI was performed, ensuring scientific rigor and breadth of insights for an essential, reproducible, and coherent methodological approach. By means of a 7-point Likert scale, thresholds are defined in order to classify LLMs as "unusable", "usable with high caution", and "recommended" categories. Nine state of the art LLMs were evaluated using this methodology in clinical oncology nursing decision-making, producing preliminary results. Gemini Advanced, Anthropic Claude 3 and ChatGPT 4 achieved the minimum score of the State of the Art Alignment & Safety domain for classification as "recommended", being also endorsed across all domains. LLAMA 3 70B and ChatGPT 3.5 were classified as "usable with high caution." Others were classified as unusable in this domain. CONCLUSION The identification of a recommended LLM for a specific healthcare area, combined with its critical, prudent, and integrative use, can support healthcare professionals in decision-making processes.
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Affiliation(s)
- Elena Sblendorio
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy
| | - Vincenzo Dentamaro
- Department of Computer Science, University of Bari "Aldo Moro", Bari, Italy. https://twitter.com/vincenzoden
| | - Alessio Lo Cascio
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy; La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy
| | - Francesco Germini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy; Direttore di Distretto Sociosanitario, ASL Bari, Bari, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Giancarlo Cicolini
- Department of Innovative Technologies in Medicine & Dentistry, "G.d'Annunzio" University of Chieti - Pescara, Italy
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Bauters T, Clottens N, Albert-Marí MA. Extravasation of monoclonal antibodies commonly used in oncology: Classification, management and the role of the pharmacist. J Oncol Pharm Pract 2024; 30:488-492. [PMID: 37226295 DOI: 10.1177/10781552231178674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Extravasation by conventional cytotoxics has been well documented. While monoclonal antibodies are not considered to have the necrotic potential of some cytotoxic medicines, they require appropriate management in case of extravasation. However, fewer data are available on their classification and appropriate management when extravasation occurs. As monoclonal antibodies are being more commonly used in current daily oncology practice, this is an issue that cannot be ignored. METHODS A scientific literature review on PubMed was conducted. All findings were critically appraised independently by 6 clinical pharmacists in order to provide a classification according to the extravasation hazard. RESULTS A classification of non-conjugated and conjugated monoclonal antibodies according to extravasation hazard has been elaborated for different molecules frequently used in oncology. In addition, general management, in case extravasation of monoclonal antibodies occurs, has been proposed and the role of the pharmacist in the extravasation process has been described. CONCLUSION A classification of hazard extent of extravasation of monoclonal antibodies with concurrent management based on literature data and expert consensus has been elaborated. In addition, the role of the oncology pharmacist is crucial in terms of follow-up and documentation of the extravasated monoclonal antibody and management is described.
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Affiliation(s)
- Tiene Bauters
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Nele Clottens
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - María A Albert-Marí
- Servicio de Farmacia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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3
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Sharma V, Pandey A. A Spectrum of Chemoport-Associated Complications and Their Management in Cancer Patients. Cureus 2024; 16:e58052. [PMID: 38738137 PMCID: PMC11088396 DOI: 10.7759/cureus.58052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Chemotherapy is part and parcel of the multimodality approach to cancer treatment. Chemoports are frequently used to administer chemotherapy, preventing complications associated with the use of peripheral lines. However, chemoports have their own set of complications and can be very debilitating at times. Accurate knowledge and correct technique can help prevent and manage these complications properly. METHODS We retrospectively analyzed all patients who underwent chemoport insertion for chemotherapy infusion over three years between July 2020 and June 2023. The patient's profile, type of cancer, the technique of chemoport insertion, complications related to chemoport, and its management were recorded retrospectively from patient records. RESULTS The total number of patients in our study was 119. The age group of patients ranged from 13 years to 76 years. Of the 119 patients, 55 had breast cancer, 23 had ovarian cancers, 29 had GI cancers including gastroesophageal junction (GEJ)/ stomach/periampullary/colorectal, and 12 had leukemias. The most common intraoperative complication was catheter tip malposition (9.2%). The most common postoperative complications were infection (7.5%), followed by drug extravasation (5.0%), thrombosis (3.3%), wound dehiscence (2.5%), and skin necrosis (0.8%) in decreasing order of frequency. Serious complications such as hemothorax, pneumothorax, air emboli, brachial plexus injury, and pericardial tamponade, commonly reported in the literature, were not seen in any of our cases. CONCLUSION Totally implanted venous access devices (TIVAD)/chemoports are indispensable in the management of cancer patients, especially in patients requiring long duration of infusion and prolonged treatment. Although chemoports are associated with a spectrum of complications, proper technique of implantation and use makes it a safe and reliable tool.
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Affiliation(s)
- Vikas Sharma
- Surgical Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Arun Pandey
- Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, IND
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Jiménez-Pulido I, Albert-Marí MA, Conde-Estévez D, San José-Ruiz B, Gil-Lemus MÁ, Cercós-LLetí AC, Esteban-Mensua MJ, Díaz-Carrasco MS. GEDEFO-SEFH management of antineoplastic extravasations survey results. J Oncol Pharm Pract 2024; 30:67-77. [PMID: 37032471 DOI: 10.1177/10781552231167873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | | | - David Conde-Estévez
- Servicio de Farmacia, Consorci Parc de Salut MAR de Barcelona, Institut Hospital del Mar d'Investigacions Médiques, Barcelona, Catalunya, Spain
| | - Begoña San José-Ruiz
- Servicio de Farmacia, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
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Grant CR, de Kouchkovsky D, Kalebasty AR, Mar N. Drug extravasation with Enfortumab vedotin. J Oncol Pharm Pract 2023; 29:1789-1792. [PMID: 37401244 PMCID: PMC10612376 DOI: 10.1177/10781552231185505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Enfortumab vedotin is an antibody drug conjugate approved for management of pretreated locally advanced or metastatic urothelial carcinoma, which is associated with a rare risk of drug extravasation and soft tissue reactions. CASE REPORT We report two cases of EV extravasation with subsequent development of bullae and cellulitis. MANAGEMENT AND OUTCOME They were both treated for cellulitis and had conservative management without surgical intervention and were able to resume treatment with Enfortumab vedotin without subsequent adverse events. DISCUSSION We propose that EV acts as a vesicant upon extravasation, highlight measures to prevent extravasation events, and encourage appropriate measures when dealing such as attempt of aspiration, removal of catheter, application of compresses, and thorough documentation with photographic evidence.
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Affiliation(s)
| | | | | | - Nataliya Mar
- Department of Hematology/Oncology, University of California Irvine Medical Center, Orange, CA, USA
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Munthuli A, Intanai J, Tossanuch P, Pooprasert P, Ingpochai P, Boonyasatian S, Kittithammo K, Thammarach P, Boonmak T, Khaengthanyakan S, Yaemsuk A, Vanichvarodom P, Phienphanich P, Pongcharoen P, Sakonlaya D, Sitthiwatthanawong P, Wetchawalit S, Chakkavittumrong P, Thongthawee B, Pathomjaruwat T, Tantibundhit C. Extravasation Screening and Severity Prediction from Skin Lesion Image using Deep Neural Networks. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1827-1833. [PMID: 36086628 DOI: 10.1109/embc48229.2022.9871115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Extravasation occurs secondary to the leakage of medication from blood vessels into the surrounding tissue during intravenous administration resulting in significant soft tissue injury and necrosis. If treatment is delayed, invasive management such as surgical debridement, skin grafting, and even amputation may be required. Thus, it is imperative to develop a smartphone application for predicting extravasation severity from skin image. Two Deep Neural Network (DNN) architectures, U-Net and DenseNet-121, were used to segment skin and lesion, and to classify extravasation severity. Sensitivity and specificity for predicting between asymptomatic and abnormal cases were 77.78 and 90.24%. For each severity in abnormal cases, mild extravasation attained the highest F1-score of 0.8049, followed by severe extravasation of 0.6429, and moderate extravasation of 0.6250. The F1-score of moderate-to-severe extravasation classification can improve by applying the our proposed rule-based for multi-class classification. These findings proposed a novel and feasible DNN approach for screening extravasation from skin images. The implementation of DNN-based applications on mobile devices has a strong potential for clinical application in low-resource countries. Clinical relevance- The application can serve as a valuable tool in monitoring when extravasation occurs during intravaneous administration. It can also help in the scheduling process across worksite to reduce the risks associated with working shifts.
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Zhang G, Yuan C, Su X, Zhang J, Gokulnath P, Vulugundam G, Li G, Yang X, An N, Liu C, Sun W, Chen H, Wu M, Sun S, Xing Y. Relevance of Ferroptosis to Cardiotoxicity Caused by Anthracyclines: Mechanisms to Target Treatments. Front Cardiovasc Med 2022; 9:896792. [PMID: 35770215 PMCID: PMC9234116 DOI: 10.3389/fcvm.2022.896792] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/24/2022] [Indexed: 12/06/2022] Open
Abstract
Anthracyclines (ANTs) are a class of anticancer drugs widely used in oncology. However, the clinical application of ANTs is limited by their cardiotoxicity. The mechanisms underlying ANTs-induced cardiotoxicity (AIC) are complicated and involve oxidative stress, inflammation, topoisomerase 2β inhibition, pyroptosis, immunometabolism, autophagy, apoptosis, ferroptosis, etc. Ferroptosis is a new form of regulated cell death (RCD) proposed in 2012, characterized by iron-dependent accumulation of reactive oxygen species (ROS) and lipid peroxidation. An increasing number of studies have found that ferroptosis plays a vital role in the development of AIC. Therefore, we aimed to elaborate on ferroptosis in AIC, especially by doxorubicin (DOX). We first summarize the mechanisms of ferroptosis in terms of oxidation and anti-oxidation systems. Then, we discuss the mechanisms related to ferroptosis caused by DOX, particularly from the perspective of iron metabolism of cardiomyocytes. We also present our research on the prevention and treatment of AIC based on ferroptosis. Finally, we enumerate our views on the development of drugs targeting ferroptosis in this emerging field.
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Affiliation(s)
- Guoxia Zhang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chao Yuan
- Dezhou Second People’s Hospital, Dezhou, China
| | - Xin Su
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianzhen Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Priyanka Gokulnath
- Cardiovascular Division of the Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Gururaja Vulugundam
- Institute of Biochemistry and Cellular Biology, National Research Council of Italy, Naples, Italy
| | - Guoping Li
- Cardiovascular Division of the Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Xinyu Yang
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Na An
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Can Liu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wanli Sun
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hengwen Chen
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Min Wu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shipeng Sun
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Shipeng Sun,
| | - Yanwei Xing
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Yanwei Xing,
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8
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Abe-Doi M, Murayama R, Kawamoto A, Komiyama C, Doorenbos A, Sanada H. Damage to subcutaneous tissue at the catheterization site during chemotherapy: A prospective observational study using ultrasonography. Jpn J Nurs Sci 2021; 18:e12436. [PMID: 34350702 DOI: 10.1111/jjns.12436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/06/2021] [Accepted: 05/02/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Chemotherapy administration can affect subcutaneous tissue at the catheterization site with no macroscopic signs or subjective symptoms. Yet clinical studies about the impact of chemotherapy on tissue at the catheterization site, except for apparent extravasation cases, are limited. This study aimed to investigate subcutaneous tissue changes in nonmacroscopically damaged catheterization sites after chemotherapy administration. METHODS Participants were people with cancer receiving outpatient chemotherapy. Ultrasonographic images were used to assess the condition of subcutaneous tissues, including the vein, at the catheterization site before catheterization, immediately after chemotherapy, and on the next scheduled treatment day. Data on macroscopic inspection, palpation, and subjective symptoms were also collected and analyzed. RESULTS Data from 41 participants were analyzed. All had normal subcutaneous tissues before catheterization. After treatment, 16 (39.0%) manifested abnormalities such as subcutaneous edema, vessel wall thickening, and/or thrombosis; there was no extravasation immediately after treatment. On the next treatment day, 15 (36.6.%) showed persistent or new onset of abnormalities, including subcutaneous edema. Eight of the 15 did not exhibit any subjective symptoms or macroscopic or palpation findings. CONCLUSION After chemotherapy administration via peripheral intravenous catheters, it was found that this damage, which was difficult to detect by the conventional assessment method, persisted. Ultrasonography can provide useful information to avoid reusing damaged sites for chemotherapy administration.
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Affiliation(s)
- Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Atsuo Kawamoto
- Department of Diagnostic Radiology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Chieko Komiyama
- Department of Nursing, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Ardith Doorenbos
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.,Cancer Prevention and Control Program, University of Illinois Cancer Center, Chicago, IL, USA
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Armenteros-Yeguas V, Tomás-López MA, Miranda-Serrano E, Moraza-Dulanto I, Meléndez-Fernández L, Merino-Romero E, Cristóbal-Domínguez E, Gárate-Echenique L. Vascular access care in patients with multimorbidity. ACTA ACUST UNITED AC 2021; 30:S26-S35. [PMID: 33876690 DOI: 10.12968/bjon.2021.30.8.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND More than half of patients with multimorbidity require intravenous therapy during their hospital stay. The aims of this study are to describe difficult intravenous access (DIVA) and vascular access care provided to this patient population and to explore the differences between easy and DIVA groups. METHODS A cohort study was conducted in patients with multimorbidity admitted to 2 hospitals between March and November 2013. The variables used to describe vascular care included choice and placement of devices, catheter swell time, and occurrence of adverse events. The incidence of adverse events was expressed as number cases per 1000 catheter days and χ2, Student's t, or Mann-Whitney U tests were used to compare the care provided between both groups. Odds rates were calculated to determine the risk of complications associated with DIVA. RESULTS We recruited 135 patients, of whom 34.8% were women. Overall, 59.3% had DIVA. A total of 224 catheters were inserted, patients with difficult access requiring a mean of 1.71 catheters and those with easy access 1.58 catheters. Two or more attempts were required to place catheters in 23% of cases in the difficult access group versus 2.50% in the easy access group. Mean catheter dwell time was 3.84 days and 3.99 days, and the adverse event rate was 111/1000 and 83.6/1000 catheter days, respectively. The odds ratio for complications was 1.596. CONCLUSIONS Multimorbid patients with DIVA have a higher rate of complications as well as requiring more catheters and more placement attempts.
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Affiliation(s)
| | | | | | | | | | | | - Estíbaliz Cristóbal-Domínguez
- Bioaraba Health Research Institute, Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Araba, Spain
| | - Lucía Gárate-Echenique
- General Directorate of the Basque Health Service, Osakideza, Vitoria-Gasteiz, Araba, Spain
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10
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Melo JMA, Oliveira PPD, Souza RS, Fonseca DFD, Gontijo TF, Rodrigues AB. Prevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review. Rev Bras Enferm 2020; 73:e20190008. [PMID: 32578734 DOI: 10.1590/0034-7167-2019-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify and synthesize scientific evidence on prevention and management of extravasation of antineoplastic agents in adult patients by nurses. METHODS scoping review, according to Joanna Briggs Institute and PRISMA-ScR. Research was conducted in five electronic databases, Cochrane Library and eight catalogs of theses and dissertations. Data collection occurred from April to July 2018, with no time limit. The extracted data were analyzed and synthesized in a narrative way. RESULTS a total of 3,110 records were retrieved and 18 studies were kept for review. Most publications (66.6%) had a qualitative approach and addressed both aspects, i.e., prevention and management of extravasation of chemotherapy in adult patients. CONCLUSIONS the implementation of protocols based on scientific evidence on prevention and management of extravasation of antineoplastic agents is paramount in order to provide patient safety and support to the nursing staff.
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Affiliation(s)
| | | | - Raíssa Silva Souza
- Universidade Federal de São João del-Rei. Divinópolis, Minas Gerais, Brazil
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11
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Mas V, Simon AL, Presedo A, Mallet C, Ilharreborde B, Jehanno P. Upper limb extravasation of cytotoxic drugs: results of the saline washout technique in children. J Child Orthop 2020; 14:230-235. [PMID: 32582391 PMCID: PMC7302410 DOI: 10.1302/1863-2548.14.200020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Extravasation of cytotoxic vesicant drugs is a surgical emergency (within six hours) since this incident can lead to severe skin and soft-tissue damage. Outcomes after the saline washout procedure have been extensively described in adults, but rarely in children. The aim of this study was to evaluate the outcome of early saline washout procedure for upper limb cytotoxic drug extravasation in children. METHODS All consecutive children with vesicant drug extravasation were retrospectively reviewed. The saline washout procedure was performed. Cosmetic aspect, residual pain and range of movement were analyzed as well as time to surgery and chemotherapy resumption at last follow-up. RESULTS Between 2014 and 2018, 13 cytotoxic vesicant drug extravasations occurred (mean age 8 years (sem 5)), including 11 treated by the saline washout procedure. At mean follow-up of 11 months (sem 7), the patients had no or low pain and ranges of movement were fully conserved. Two patients (one within the six hours' delay) had soft-tissue necrosis leading to extensive reconstructive surgery. CONCLUSION The saline washout procedure is safe and easy and significantly reduces the incidence of extensive skin damage. Early referral to a specialized department is essential. However, the key parameter remains prevention by educating medical staff and nurses about these injuries and by training them for early and urgent management. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Virginie Mas
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France,Department of Orthopaedic Surgery and Hand Emergencies, Hôpital Privé des Peupliers, Paris, France
| | - Anne Laure Simon
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France,Correspondence should be sent to Anne Laure Simon, Department of Pediatric Orthopaedics, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris University, 48 Bd Sérurier, 75019 Paris, France. E-mail:
| | - Ana Presedo
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Cindy Mallet
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Pascal Jehanno
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France,Department of Orthopaedic Surgery, Hôpital Privé Nord Parisien, Sarcelles, France
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Abe‐Doi M, Murayama R, Komiyama C, Sanada H. Incidence, risk factors, and assessment of induration by ultrasonography after chemotherapy administration through a peripheral intravenous catheter. Jpn J Nurs Sci 2020; 17:e12329. [DOI: 10.1111/jjns.12329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mari Abe‐Doi
- Department of Advanced Nursing Technology, Graduate School of MedicineThe University of Tokyo Tokyo Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of MedicineThe University of Tokyo Tokyo Japan
- Global Nursing Research Center, Graduate School of MedicineThe University of Tokyo Tokyo Japan
| | - Chieko Komiyama
- Department of NursingThe University of Tokyo Hospital Tokyo Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of MedicineThe University of Tokyo Tokyo Japan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of MedicineThe University of Tokyo Tokyo Japan
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13
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Jeong IS, Lee EJ, Kim JH, Kim GH, Hwang YJ, Jeon GR. Detection of intravenous infiltration using impedance parameters in patients in a long-term care hospital. PLoS One 2019; 14:e0213585. [PMID: 30897178 PMCID: PMC6428251 DOI: 10.1371/journal.pone.0213585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
Abstract
This study was aimed to evaluate the changes of impedance parameters of patients who were admitted to a long-term care hospital by measuring bioelectrical impedance. The subjects were 18 patients who had infusion therapy through peripheral intravenous (IV) catheters and had at least an infiltration. The impedance parameters were measured with a multi-channel impedance measuring instrument (Vector Impedance Meter) twice; at starting IV infusion after catheter insertion and infiltration detected. As results, the resistance (R) after infiltration significantly decreased compared to the initial resistance. At 50 kHz, the resistances were 498.2±79.3 [Ω] before infiltration and 369.4±85.6 [Ω] after infiltration. The magnitude of the reactance (XC) decreased after infiltration. At 50 kHz, the measured reactance was -31.1±8.3 [Ω] before infiltration and -24.5±5.9 [Ω] after infiltration. The data points plotted in the R-XC graph shifted from the first quadrant before infiltration to third quadrant after infiltration. Our findings suggest that bioelectrical impedance is an effective method for detection of infiltration in a noninvasive and quantitative manner.
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Affiliation(s)
- Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Republic of Korea
| | - Eun-Joo Lee
- Dept, of Nursing, Dong-Eui University, Busan, South Korea
| | - Jae Hyung Kim
- Research Institute of Nursing Science, Pusan National University, Yangsan, Republic of Korea
- * E-mail:
| | - Gun Ho Kim
- Dept. of Medical Science, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Young Jun Hwang
- Dept. of Medical Science, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Gye Rok Jeon
- Dept. of Biomedical Engineering, School of Medicine, Pusan National University, Yangsan, Republic of Korea
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Abstract
Chemotherapy extravasation may result in serious damage to patients, with irreversible local injures and disability. Evidence-based standardization on extravasation management is lacking and many institutions do not practice adequate procedures to prevent the severer damages. Our aim was to explore the prevention and treatment of extravasation injuries, proposing a standard therapeutic protocol together with a review of the literature. From January 1994 to December 2015, 545 cases were reviewed (age range, 5-87 years; 282 men and 263 women). Our therapeutic protocol consisted of local infiltration of saline solution and topical occlusive applications of corticosteroids. The infiltrations were administrated 3 to 6 times a week depending on damage severity. Our protocol allowed us to prevent ulceration in 373 cases. Only 27 patients required surgery (escarectomy, skin graft, regional, and free flap). Numerous treatments have been proposed in literature. The antidotes have been discussed controversially and are not considered standard methods for treatment, especially when polychemotherapy is administrated and the identification of the responsible drug is not possible. We proposed the use of saline solution injection to dilute rapidly the drug, thus reducing its local toxic effects. This method is easy to use and always reproducible even when the drug is not known or when it is administrated in combination with other drugs. It is possible to perform it in ambulatory regimen, and, overall, it represents a standard method.
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Bernabeu-Martínez MA, Ramos Merino M, Santos Gago JM, Álvarez Sabucedo LM, Wanden-Berghe C, Sanz-Valero J. Guidelines for safe handling of hazardous drugs: A systematic review. PLoS One 2018; 13:e0197172. [PMID: 29750798 PMCID: PMC5947890 DOI: 10.1371/journal.pone.0197172] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/27/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To review the scientific literature related to the safe handling of hazardous drugs (HDs). Method Critical analysis of works retrieved from MEDLINE, the Cochrane Library, Scopus, CINHAL, Web of Science and LILACS using the terms "Hazardous Substances", "Antineoplastic Agents" and "Cytostatic Agents", applying "Humans" and "Guidelines" as filters. Date of search: January 2017. Results In total, 1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about HDs; 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances (monoclonal antibodies, gene medicine and other chemical and biological agents). In 14 (23.3%) guides, all the stages in the manipulation process involving a risk due to exposure were considered. Only one guide addressed all stages of the handling process of HDs (including stages with and without the risk of exposure). The most described stages were drug preparation (41 guides, 67.2%), staff training and/or patient education (38 guides, 62.3%), and administration (37 guides, 60.7%). No standardized informatics system was found that ensured quality management, traceability and minimization of the risks associated with these drugs. Conclusions Most of the analysed guidelines limit their recommendations to the manipulation of antineoplastics. The most frequently described activities were preparation, training, and administration. It would be convenient to apply ICTs (Information and Communications Technologies) to manage processes involving HDs in a more complete and simpler fashion.
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Affiliation(s)
- Mari A. Bernabeu-Martínez
- Department of Public Health and History of Science, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - Mateo Ramos Merino
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Juan M. Santos Gago
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Luis M. Álvarez Sabucedo
- Department of Telematics Engineering, Telecommunication Engineering School of the University of Vigo, Vigo, Spain
| | - Carmina Wanden-Berghe
- Health and Biomedical Research Institute of Alicante, University General Hospital of Alicante, Alicante, Spain
| | - Javier Sanz-Valero
- Department of Public Health and History of Science, School of Medicine, Miguel Hernandez University, Elche, Spain
- * E-mail:
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Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1743. [PMID: 29876181 PMCID: PMC5977944 DOI: 10.1097/gox.0000000000001743] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/07/2018] [Indexed: 02/07/2023]
Abstract
Intravenous therapy is a common practice among many specialties. Intravenous therapy extravasation is a potential complication to such therapy. Hospitals without a dedicated wound care team trained in these interventions will often default to plastic surgical consultation, making an understanding of available interventions essential to the initial evaluation and management of these injuries. The goal of this article was to provide plastic surgeons and health care providers with a general overview of the acute management of intravenous infiltration and extravasation injuries. Though the decision for surgical versus nonsurgical management is often a clear one for plastic surgeons, local interventions, and therapies are often indicated and under-utilized in the immediate postinfiltration period. Thorough knowledge of these interventions should be a basic requirement in the armamentarium of plastic surgery consultants.
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Affiliation(s)
- Connor Maly
- Georgetown University School of Medicine, Washington, D.C
| | - Kenneth L Fan
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C
| | - Gary F Rogers
- Division of Plastic Surgery, Children's National Health System, Washington, D.C
| | | | - June Amling
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C.,Division of Nursing, Children's National Health System, Washington, D.C
| | - Kara Johnson
- Division of Nursing, Children's National Health System, Washington, D.C
| | - Laura Welch
- Division of Nursing, Children's National Health System, Washington, D.C
| | - Albert K Oh
- Division of Plastic Surgery, Children's National Health System, Washington, D.C
| | - Jerry W Chao
- Division of Plastic Surgery, Children's National Health System, Washington, D.C.,Division of Plastic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, D.C
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Sisan M, Rayan A, Elmorsy S, Elyan H, Salahat M. Knowledge regarding noncytotoxic medication extravasation among registered nurses working in western Saudi Arabia. JOURNAL OF VASCULAR NURSING 2018; 36:12-22. [PMID: 29452625 DOI: 10.1016/j.jvn.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/20/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
Extravasation and infiltration are among the most common intravenous therapy complications. For noncytotoxic agents, the incidence of extravasation remains unknown. There has been little research into extravasation due to ethical considerations limiting controlled research; most evidences are based on small, uncontrolled trials or case reports. The purpose of this study was to assess the knowledge level regarding noncytotoxic medications extravasation and its associated factors among staff nurses.A descriptive correlational design using self-administered questionnaire was employed. A convenience sample of 387 nurses completed a questionnaire about noncytotoxic medication extravasation. Statistical Package for Social Sciences version 21 was used to analyze data by applying the chi-square test, t test, and the Mann-Whitney test to assess the knowledge difference between open and closed units' nurses.The results indicate that only 19.6% of nurses have a good knowledge about noncytotoxic medications extravasation. There was consistently poor staff knowledge regarding noncytotoxic medications extravasation. Although the closed units' nurses reported relatively higher level of knowledge than open units' nurses, their level of knowledge still inadequate. Health care organizations must consider developing specific policies regarding extravasation. Closed and open units' nurses should be enrolled in special education programs to improve their level of knowledge regarding noncytotoxic medication extravasation.
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Affiliation(s)
- Mo'men Sisan
- Department of Oncology, King Abdullah Medical City, The Holly Capital (KAMC-HC), Mecca, Saudi Arabia.
| | - Ahmad Rayan
- Zarqa University, Faculty of Nursing, Zarqa, Jordan
| | - Soha Elmorsy
- Cairo University, King Abdullah Medical City, The Holly Capital (KAMC-HC), Mecca, Saudi Arabia
| | - Hamza Elyan
- Department of Nursing Education, King Abdullah Medical City, The Holly Capital (KAMC-HC), Mecca, Saudi Arabia
| | - Mosab Salahat
- Magnet Recognition Program, Nursing Services, King Abdullah Medical City, The Holly Capital (KAMC-HC), Mecca, Saudi Arabia
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Armenteros‐Yeguas V, Gárate‐Echenique L, Tomás‐López MA, Cristóbal‐Domínguez E, Moreno‐de Gusmão B, Miranda‐Serrano E, Moraza‐Dulanto MI. Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients. J Clin Nurs 2017; 26:4267-4275. [PMID: 28165645 PMCID: PMC6084302 DOI: 10.1111/jocn.13750] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2017] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors. BACKGROUND In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access. DESIGN A cross-sectional study was conducted. METHODS 'Highly complex' patients (n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated. RESULTS The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85. CONCLUSIONS The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access. RELEVANCE TO CLINICAL PRACTICE The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access.
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Evaluation of the Predictive Validity of Thermography in Identifying Extravasation With Intravenous Chemotherapy Infusions. JOURNAL OF INFUSION NURSING 2017; 40:367-374. [PMID: 29112585 PMCID: PMC5680995 DOI: 10.1097/nan.0000000000000250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Early detection of extravasation is important, but conventional methods of detection lack objectivity and reliability. This study evaluated the predictive validity of thermography for identifying extravasation during intravenous antineoplastic therapy. Of 257 patients who received chemotherapy through peripheral veins, extravasation was identified in 26. Thermography was performed every 15 to 30 minutes during the infusions. Sensitivity, specificity, positive predictive value, and negative predictive value using thermography were 84.6%, 94.8%, 64.7%, and 98.2%, respectively. This study showed that thermography offers an accurate prediction of extravasation.
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20
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Piredda M, Biagioli V, Barrella B, Carpisassi I, Ghinelli R, Giannarelli D, De Marinis MG. Factors affecting difficult peripheral intravenous cannulation in adults: a prospective observational study. J Clin Nurs 2017; 26:1074-1084. [DOI: 10.1111/jocn.13444] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Michela Piredda
- Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | - Valentina Biagioli
- Department of Biomedicine and Prevention; Faculty of Medicine; School of Nursing; Tor Vergata University; Rome Italy
| | - Beatrice Barrella
- Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | - Ilaria Carpisassi
- Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | - Roberta Ghinelli
- Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | - Diana Giannarelli
- Biostatistical Unit; Regina Elena National Cancer Institute; Rome Italy
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Wang Y, Kong M, Ge Y. Extravasation management in the pediatric oncology ward of Children's Hospital of Fudan University: a best practice implementation project. ACTA ACUST UNITED AC 2016; 14:258-265. [PMID: 28009678 DOI: 10.11124/jbisrir-2016-003221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Extravasation in a pediatric patient can cause a serious adverse event, but many nurses have insufficient experience to deal with it during intravenous administration. Our division implemented a best practice project, which included extravasation kit instruction preparation, staff education and an update of institutional policy and procedures. The project focused on auditing the extent to which the protocol was implemented and promoting its implementation. OBJECTIVES The objective of the project was to establish an evidence-based policy and procedure for extravasation management, improve knowledge regarding best practice of extravasation management among staff and formalize the documentation template for extravasation events. METHODS The Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice were used to examine compliance with criteria based on the best available evidence before and after the implementation of strategies to promote the use of the evidence-based practice protocol. RESULTS Four criteria showed a noticeable improvement in compliance: increased use of extravasation kit (0-100%), updated policies and procedure (0-94%), staff education (19-94%) and documented outcomes (13-88%). CONCLUSIONS The project successfully established effective strategies for establishing an extravasation kit instruction sheet, updating policies and procedures, continuous staff education and nursing documentation to ensure best practice and improve patient outcomes.
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Affiliation(s)
- Yingwen Wang
- Hematology Oncology Division, Children's Hospital of Fudan University, Shanghai, China
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23
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Risk management of onco-hematological drugs: how and how fast can we improve? TUMORI JOURNAL 2016; 102:15-29. [PMID: 27581596 DOI: 10.5301/tj.5000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Medication errors in oncology may cause severe damage to patients, professionals, and the environment. The Italian Ministry of Health issued Raccomandazione 14 to provide guidelines for prevention of errors while using antineoplastic drugs. This work aimed at analyzing Raccomandazione 14 through the different viewpoints of the hospital pharmacist, the nurse, the oncologist, and the hospital director. METHODS Twenty-seven Italian healthcare organizations participated in a self-assessment survey evaluating compliance with Raccomandazione 14 within the oncology, hematology, and pharmacy departments. RESULTS The self-assessment results showed a general acknowledgement of the need for centralized management of anticancer agents. The specific responsibility of the pharmacist on the centralized management of anticancer drugs from preparation to disposal emerged as a critical point. The nurse, beyond the skills in drug administration and prevention of extravasation, also plays a fundamental role in educating and supporting the patient. The physicians, who are attentive to scientific, clinical, and regulatory criteria in prescribing and monitoring the therapies, are called upon to improve awareness on the importance of sharing standardized procedures with other professionals, to minimize medication error occurrence. The implementation of a complete computerized management from prescribing to drug administration and follow-up was highlighted. Multidisciplinary groups were constituted across the nation by professionals dedicated to the implementation of electronic health records and drug history and medical reconciliation processes. CONCLUSIONS Our analysis of the Ministerial Raccomandazione 14 urges implementation of the resources for ensuring quality and safety during prescription, preparation, and administration of anticancer drugs.
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Cytotoxic extravasation: an issue disappearing or a problem without solution? TUMORI JOURNAL 2016; 2016:290-3. [PMID: 27032703 DOI: 10.5301/tj.5000486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE The incidence and management of antitumoral compound extravasation that occurred in our medical day hospital unit were registered in a 10-year period. METHODS A total of 114 episodes were consecutively recorded out of an estimated number of 211,948 administrations performed (0.05%). Type of compound, localization, timing, symptoms, treatment, resolution, or sequelae were documented. RESULTS Extravasations after anthracyclines (17/114), platinum compounds (34/114), vinca alkaloids (7/114), and taxanes (34/114) were more frequently associated with edema and erythema ± pain. Five cases of monoclonal antibodies extravasation were observed without sequelae. With the involvement of an interdisciplinary task force and the use of dedicated guidelines, conservative management was successful in all patients. In the great majority of cases, recovery was complete within 48 hours after antidote administration. The support of our pharmacy was crucial. Physiatric evaluation was considered in several cases. No patients required surgery. CONCLUSIONS We confirm that the adopted standardized approach to this event resulted in a satisfactory outcome and could be suggested as appropriate for managing extravasation in a large clinical context.
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Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention and management of chemotherapy extravasation. World J Clin Oncol 2016; 7:87-97. [PMID: 26862492 PMCID: PMC4734939 DOI: 10.5306/wjco.v7.i1.87] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/04/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
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.
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Pagnutti L, Bin A, Donato R, Di Lena G, Fabbro C, Fornasiero L, Gerratana A, Rigon L, Gonella S, Palese A. Difficult intravenous access tool in patients receiving peripheral chemotherapy: A pilot-validation study. Eur J Oncol Nurs 2016; 20:58-63. [DOI: 10.1016/j.ejon.2015.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/14/2015] [Accepted: 06/19/2015] [Indexed: 11/24/2022]
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Lutterodt CG, Miranda BH, McArthur G. Re: Goutos I, Cogswell LK, Giele H. Extravasation injuries: a review. J Hand Surg Eur. 2014, 39: 808-18. J Hand Surg Eur Vol 2015; 40:1016. [PMID: 26494910 DOI: 10.1177/1753193415601327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- C G Lutterodt
- Chelsea and Westminster Hospital NHS Trust, London, UK
| | - B H Miranda
- Chelsea and Westminster Hospital NHS Trust, London, UK
| | - G McArthur
- Chelsea and Westminster Hospital NHS Trust, London, UK
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Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care (Engl) 2015; 24:771-800. [PMID: 26274490 DOI: 10.1111/ecc.12363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/16/2022]
Abstract
Management of cytotoxic drug extravasation remains contentious, with differing views on the most effective management strategy. With the increasing drive to provide effective, evidence-based healthcare, while ensuring the patient experience of the treatment provided plays a significant part in the development of clinical practice guidelines, the purpose of this literature review was to both critically analyse the quality of evidence that underpins contemporary practice and to determine if the patient experience is taken into account. A literature search was undertaken sourcing publications from the 1960s to July 2014 identifying all studies detailing strategies aimed at preventing the need for surgical debridement and all studies evaluating extravasation management from the patient's perspective. No conclusive evidence was found to suggest one clinical strategy as more effective than the other. No studies were identified that evaluated outcome from the patient's perspective. It is therefore suggested that outcomes-based research should underpin contemporary extravasation management guidelines to determine what the final outcome or 'end result' is and how this impacts on the patient and that the current lack of research into the patient experience of extravasation management is an area that needs to be addressed.
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Affiliation(s)
- K Harrold
- Chemotherapy Unit, Mount Vernon Cancer Centre, Northwood, UK
| | - D Gould
- Cardiff School of Healthcare Sciences, Cardiff Univeristy, Cardiff, UK
| | - N Drey
- School of Health Sciences, City University, London, UK
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Ghanem AM, Mansour A, Exton R, Powell J, Mashhadi S, Bulstrode N, Smith G. Childhood extravasation injuries: Improved outcome following the introduction of hospital-wide guidelines. J Plast Reconstr Aesthet Surg 2015; 68:505-18. [DOI: 10.1016/j.bjps.2014.12.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/13/2014] [Indexed: 11/26/2022]
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Wohlrab J, Wohlrab D, Wohlrab L, Wohlrab C, Wohlrab A. Use of Hyaluronidase for Pharmacokinetic Increase in Bioavailability of Intracutaneously Applied Substances. Skin Pharmacol Physiol 2014; 27:276-82. [DOI: 10.1159/000360545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/04/2014] [Indexed: 11/19/2022]
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Sakaida E, Sekine I, Iwasawa S, Kurimoto R, Uehara T, Ooka Y, Akanuma N, Tada Y, Imai C, Oku T, Takiguchi Y. Incidence, risk factors and treatment outcomes of extravasation of cytotoxic agents in an outpatient chemotherapy clinic. Jpn J Clin Oncol 2013; 44:168-71. [PMID: 24302758 DOI: 10.1093/jjco/hyt186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Extravasation, the accidental leakage of an anticancer agent from a vessel into the surrounding tissues, can lead to irreversible local injuries and severe disability. Despite its considerable clinical importance, evidence-based information on extravasation in chemotherapy is lacking. This study characterized the clinical features of extravasation and identified issues to be resolved in current cancer chemotherapy performed in outpatient settings. METHODS We retrospectively reviewed the medical charts of patients who received chemotherapy and sustained extravasation in our Outpatient Chemotherapy Clinic from April 2007 to August 2012. Chemotherapy administration and extravasation management procedures were standardized using the in-house chemotherapy guideline. RESULTS Among 43 557 patients who received chemotherapy, 35 (0.08%) experienced extravasation. The duration between the start of infusion and extravasation was >2 h in 28 (80.0%) patients. The severity of extravasation was Grades 1, 2 and 3 in 28, 2 and 5 patients, respectively-three of whom were associated with port trouble. The contributing factor for extravasation was walking in 11 (31.4%) patients. All extravasations were cured without surgical intervention by management according to our guidelines. CONCLUSIONS The incidence of extravasation is as low as 0.08%, using our in-house chemotherapy guideline. Extravasation from implanted ports tends to be severe.
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Affiliation(s)
- Emiko Sakaida
- *Department of Medical Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba 260-8670, Japan.
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Conde-Estévez D, Mateu-de Antonio J. Treatment of anthracycline extravasations using dexrazoxane. Clin Transl Oncol 2013; 16:11-7. [PMID: 23949792 DOI: 10.1007/s12094-013-1100-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/31/2013] [Indexed: 02/07/2023]
Abstract
Extravasation of cytotoxic agents is a true medical emergency. Dexrazoxane is the only licensed drug for the treatment of anthracycline extravasations. Dexrazoxane proved to be effective and moderately well tolerated. However, alternative approaches for the management of anthracycline extravasations are available such as topical DMSO and cooling. There appears to be general agreement about dexrazoxane usefulness when extravasations involve large volumes of anthracycline and/or central venous access device. Nevertheless, the non-invasive combination of DMSO and cooling is the most commonly described therapy, particularly in small anthracycline extravasations. Further research is still needed to establish unequivocal situations where dexrazoxane must be initiated.
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Affiliation(s)
- D Conde-Estévez
- Department of Pharmacy, Hospital Universitari del Mar. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain,
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Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. Management of chemotherapy extravasation: ESMO--EONS clinical practice guidelines. Eur J Oncol Nurs 2013; 16:528-34. [PMID: 23304728 DOI: 10.1016/j.ejon.2012.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J A Pérez Fidalgo
- Department of Hematology and Medical Oncology, Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain
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Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract 2013; 67:244-9. [PMID: 23409691 DOI: 10.1111/ijcp.12103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/04/2012] [Indexed: 11/30/2022] Open
Abstract
Extravasation is recognised as a major complication of administering intravenous chemotherapy treatment. Of the agents involved in extravasation, anthracyclines are associated with the greatest risk to patients because they are vesicant agents, having the potential to cause blistering and ulceration. If not identified and left untreated, anthracycline extravasation can lead to more serious complications such as tissue necrosis and functional impairment. Dexrazoxane (Savene(®) ) is the only licensed antidote for the treatment of anthracycline extravasation and clinical evidence has shown Savene(®) to be highly effective for preventing the need for surgery following anthracycline extravasation, allowing full recovery in the majority of patients. To date, there have been eight published studies reporting a total of 102 cases of Savene(®) use. Here, we review the published data on the efficacy of Savene(®) and present an analysis of 12 UK case studies. All UK oncology centres where Savene(®) has been used to manage anthracycline extravasation were contacted by SpePharm UK, who requested case studies for this publication. All of the cases received, including two from our own experience of using Savene(®) have been included in the analysis.
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de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, Mayer-Steinacker R, Bokemeyer C, Jordan K. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. ACTA ACUST UNITED AC 2013; 36:127-35. [PMID: 23486002 DOI: 10.1159/000348524] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel. MATERIAL AND METHODS A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined. RESULTS Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended. CONCLUSION We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.
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Affiliation(s)
- Maike de Wit
- Klinik für Innere Medizin - Hämatologie und Onkologie, Vivantes Klinikum Neukölln, Berlin, Germany.
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Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol 2013; 23 Suppl 7:vii167-73. [PMID: 22997449 DOI: 10.1093/annonc/mds294] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J A Pérez Fidalgo
- Department of Hematology and Medical Oncology, Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain
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Challenging the distal-to-proximal cannulation technique for administration of anticancer therapies: a prospective cohort study. Cancer Nurs 2012; 35:E35-40. [PMID: 22067699 DOI: 10.1097/ncc.0b013e3182352916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Distal-to-proximal technique has been recommended for anticancer therapy administration. There is no evidence to suggest that a 24-hour delay of treatment is necessary for patients with a previous venous puncture proximal to the administration site. OBJECTIVES This study aims to identify if the practice of 24-hour delay between a venous puncture and subsequent cannulation for anticancer therapies at a distal site is necessary for preventing extravasation. METHODS A prospective cohort study was conducted with 72 outpatients receiving anticancer therapy via an administration site distal to at least 1 previous venous puncture on the same arm in a tertiary cancer center in Australia. Participants were interviewed and assessed at baseline data before treatment and on day 7 for incidence of extravasation/phlebitis. RESULTS Of 72 participants with 99 occasions of treatment, there was 1 incident of infiltration (possible extravasation) at the venous puncture site proximal to the administration site and 2 incidents of phlebitis at the administration site. CONCLUSION A 24-hour delay is unnecessary if an alternative vein can be accessed for anticancer therapy after a proximal venous puncture. IMPLICATIONS FOR PRACTICE Infiltration can occur at a venous puncture site proximal to an administration site in the same vein. However, the nurse can administer anticancer therapy at a distal site if the nurse can confidently determine that the vein of choice is not in any way connected to the previous puncture site through visual inspection and palpation.
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Boschi R, Rostagno E. Extravasation of antineoplastic agents: prevention and treatments. Pediatr Rep 2012; 4:e28. [PMID: 25396033 PMCID: PMC4227315 DOI: 10.4081/pr.2012.e28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/02/2011] [Indexed: 11/22/2022] Open
Abstract
The extravasation of antineoplastic agents is an unwanted and distressing situation that can easily occur. It may cause severe and irreversible local injuries. Left untreated, vesicant chemotherapy extravasation can potentially cause tissue necrosis, functional impairment and permanent disfigurement. This article provides a review of current literature regarding recommendations on the prevention and treatment of extravasation of antineoplastic agents.
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Griffiths P, Richardson A, Blackwell R. Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review. Eur J Oncol Nurs 2012; 16:238-46. [DOI: 10.1016/j.ejon.2011.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/31/2011] [Accepted: 06/12/2011] [Indexed: 11/29/2022]
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Recovery of symptomatic extravasation of liposomal doxorubicin after dexrazoxane treatment. Anticancer Drugs 2012; 23:139-40. [PMID: 21934601 DOI: 10.1097/cad.0b013e32834be51a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A patient with metastatic ovarian cancer was treated with liposomal doxorubicin and carboplatin. She had an extravasation during liposomal doxorubicin infusion. Initially, she was treated conservatively with cold compresses and topical treatment. However, because of worsening of symptoms, she received dexrazoxane once daily for 3 days after which complete recovery occurred. This is the first casereport on symptomatic extravasation of liposomal doxorubicin treated with dexrazoxane.
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Soares CR, Almeida AMD, Gozzo TDO. A avaliação da rede venosa pela enfermagem em mulheres com câncer ginecológico durante o tratamento quimioterápico. ESCOLA ANNA NERY 2012. [DOI: 10.1590/s1414-81452012000200005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Estudo de abordagem exploratória e descritiva que teve como objetivos: avaliar a rede venosa das mulheres com câncer cérvico uterino, no início e ao final do tratamento quimioterápico; analisar a ocorrência de flebite provocada pelas drogas utilizadas nos protocolos de quimioterapia neoadjuvante e adjuvante e relacionar os tipos de veia com os dispositivos mais utilizados, tempo de permanência e intercorrências. Utilizou-se um instrumento de avaliação da rede venosa para os membros superiores. Foram incluídas 20 mulheres atendidas em um hospital de ensino do interior do Estado de São Paulo. A avaliação da rede venosa demonstrou poucas alterações, e a intercorrência mais frequente foi o hematoma (60%). Os resultados deste estudo apontam para aspectos da prática de enfermagem relacionados à administração de quimioterápicos e ressaltam a necessidade de elaborar e implantar protocolos para o cuidado.
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Fontaine C, Noens L, Pierre P, De Grève J. Savene® (dexrazoxane) use in clinical practice. Support Care Cancer 2012; 20:1109-12. [PMID: 22278308 DOI: 10.1007/s00520-012-1382-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 01/02/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anthracycline extravasation (ACEV) is a rare but potentially devastating event which can result in severe injuries including ulceration and necrosis, slow-healing lesions, serious joint damage and permanent disfigurement. It can delay further scheduled chemotherapy and affect cancer treatment outcome. Savene® (dexrazoxane) is the only approved antidote for ACEV in Europe (Totect® in the USA) and is administered by intravenous infusion. Its efficacy has been demonstrated in clinical trials with biopsy-verified ACEV with a 98% success rate (no need for surgical debridement) allowing for immediate continuation of chemotherapy in 71% of patients. Adverse events, mainly haematological toxicity, were rapidly reversible. The objective of the study was to assess, in clinical practice, the efficacy and safety profile of Savene® for ACEV in different Belgian hospitals. PATIENTS AND METHODS A survey of Savene® use was conducted in Belgium from 2007 to 2010 by using a questionnaire sent to 44 hospitals. MAIN RESULTS Data were obtained for 41 cancer patients, 68% (28/41) had ACEV from central venous catheters. Surgical debridement due to ACEV could be avoided in 26 out of 28 extravasations from a central venous access and in 95% (39/41) of the total population treated with Savene®. Planned chemotherapy was maintained in 73% (30/41) of patients. Eight adverse events were reported in four patients treated with Savene®, six events were assessed to be of common toxicity criteria grades 1-2 (nausea, leucopenia and arm pain) and two events (neutropenia and pancytopenia) were assessed to be grade 3. CONCLUSION These data are comparable with the data from previous clinical trials and confirm the efficacy and safety profile of Savene® in clinical practice for the treatment of anthracycline extravasation, including extravasations from central venous catheters.
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Affiliation(s)
- Christel Fontaine
- Department of Medical Oncology, University Hospital of Brussels, 1090, Jette, Belgium.
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Langer SW, Thougaard AV, Sehested M, Jensen PB. Treatment of experimental extravasation of amrubicin, liposomal doxorubicin, and mitoxantrone with dexrazoxane. Cancer Chemother Pharmacol 2011; 69:573-6. [PMID: 22143379 DOI: 10.1007/s00280-011-1794-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/25/2011] [Indexed: 01/04/2023]
Abstract
PURPOSE Dexrazoxane is an established treatment option in extravasation of the classic anthracyclines such as doxorubicin, epirubicin, and daunorubicin. However, it is not known whether the protection against the devastating tissue injuries extends into extravasation with new types of anthracyclines, the anthracenediones, or the liposomal pegylated anthracycline formulations. We therefore tested the antidotal efficacy of dexrazoxane against extravasation of amrubicin, mitoxantrone, and liposomal pegylated doxorubicin in mice. METHODS A total of 80 female B6D2F1 mice were tested in an established mouse extravasation model. The mice had experimental extravasations of amrubicin, mitoxtanrone, and Caelyx and were immediately hereafter treated with systemic dexrazoxane or saline. RESULTS AND CONCLUSION Systemic treatment with dexrazoxane resulted in significant protection against extravasation injuries from all three drugs. Moreover, the vesicant potential of the three test drugs was weaker than seen in previous experiments with the classic anthracyclines.
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Affiliation(s)
- Seppo W Langer
- Department of Oncology 5073, The Finsen Center, Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark.
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Affiliation(s)
- Helen Roe
- North Cumbria University Hospitals NHS Trust
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Lewis MA, Hendrickson AW, Moynihan TJ. Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin 2011; 61:287-314. [PMID: 21858793 DOI: 10.3322/caac.20124] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Oncologic emergencies can occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient's cancer history and its possible complications forms an important part of any clinician's knowledge base. Prompt identification of and intervention in these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This article reviews hypercalcemia, hyponatremia, hypoglycemia, tumor lysis syndrome, cardiac tamponade, superior vena cava syndrome, neutropenic fever, spinal cord compression, increased intracranial pressure, seizures, hyperviscosity syndrome, leukostasis, and airway obstruction in patients with malignancies. Chemotherapeutic emergencies are also addressed.
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Affiliation(s)
- Mark A Lewis
- Senior Hematology and Oncology Fellow, Division of Hematology, Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN
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Abstract
OBJECTIVE To present a clinical update on the prevention, detection, and evidence-based management of vesicant chemotherapy extravasations. DATA SOURCES Journal articles, published and unpublished case reports, personal experience. CONCLUSION In the 4 years that have elapsed since the publication of the original article, much more is known about vesicant chemotherapy extravasation, and effective evidence-based treatments now are available. The antidotes sodium thiosulfate for mechlorethamine extravasations and hyaluronidase for plant alkaloid extravasations are recommended by the manufacturers of these vesicants and cited in nursing guidelines. The anthracycline extravasation treatment dexrazoxane for injection, the first and only extravasation treatment with proven effectiveness, is now available as Totect (dexrazoxane; TopoTarget USA, Rockaway, NJ, USA) in the US and Savene (SpePharm, Amsterdam, The Netherlands) in Europe. IMPLICATIONS FOR NURSING PRACTICE Nurses who administer vesicant chemotherapy agents need to be aware of the most current evidence (or lack of evidence) for various types of extravasation treatment. Well-informed nurses are patient advocates and instrumental in detecting, managing, and documenting extravasations. Most importantly, nurses play a key role in preventing vesicant chemotherapy extravasations.
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Chanes DC, da Luz Gonçalves Pedreira M, de Gutiérrez MGR. Antineoplastic agents extravasation from peripheral intravenous line in children: a simple strategy for a safer nursing care. Eur J Oncol Nurs 2011; 16:17-25. [PMID: 21440502 DOI: 10.1016/j.ejon.2011.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 10/14/2010] [Accepted: 01/16/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The antineoplastic agents infusion through peripheral lines may lead to several adverse events such as extravasation that is one of the most severe acute reactions of this sort of treatment. The extravasation prevention and management must be part of a safe and evidence-based nursing care. Due to this fact, two algorithms were developed with the purpose of guiding nursing care to children who undergo chemotherapy through peripheral line. The objectives of this study were to determine the content validity of both algorithms with pediatric oncology nurses in Brazil and United States of America, and to verify the agreement between the evaluations of both groups. METHODS AND SAMPLE A descriptive validation study was carried out through the Delphi Technique that has the following steps: development of the data collection instrument, application to the specialists, data analysis, algorithms' review, re-evaluation by the specialists, final data analysis and content validity determination. RESULTS The data analysis was descriptive and based on the specialists agreement consensus equal or higher than 80% in every step of the algorithms. The process showed that the agreement with both instruments ranged from 92.8% to 99.0%. CONCLUSION The algorithms are valid for application in nursing care with the main purpose of preventing and managing the antineoplastic agents' extravasation.
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