1
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Perrey HM, Taylor E, Cropp BF, Bumpus MJ, Lessard S, Pretorius JA, Angus JH, Duperreault MF, Snow A, Wang D, Curtis M, Couture LA, Adolphson DR, Smith K, Moody JH, Bianchi MJ, Parker MG, Sanyal A, Remick SC. Seeking American Society of Clinical Oncology-Quality Oncology Practice Initiative (ASCO-QOPI) certification in a northern New England rural health system and cancer care network. Learn Health Syst 2024; 8:e10415. [PMID: 39036533 PMCID: PMC11257055 DOI: 10.1002/lrh2.10415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 07/23/2024] Open
Abstract
In 2006 following several years of preliminary study, the American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI). This cancer-focused quality initiative evolved considerably over the next decade-and-a-half and is expanding globally. QOPI is undoubtedly the leading standard-bearer for quality cancer care and contemporary medical oncology practice. The program garners attention and respect among federal programs, private insurers, and medical oncology practices across the nation. The MaineHealth Cancer Care Network (MHCCN) has undergone expansive growth since 2017. The network provides cancer care to more than 70% of the cases in Maine in a largely rural health system in Northern New England. In fall 2020, the MHCCN QOPI project leadership, following collaborative discussions with the ASCO-QOPI team, elected to proceed with a health system-cancer network-wide QOPI certification. Key themes emerged over the course of our two-year journey including: (1) Developing a highly interprofessional team committed to the project; (2) Capitalizing on a single electronic medical record for data transmission to CancerLinQ; (3) Prior experience, especially policy development, in other cancer-focused accreditation programs across the network; and (4) Building consensus through quarterly stakeholder meetings and awarding Continuing Medical Education (CME) and American Board of Medical Specialists (ABMS) Maintenance of Certification (MOC) credits to oncologists. All participants demonstrated a genuine spirit to work together to achieve certification. We report our successful journey seeking ASCO-QOPI certification across our network, which to our knowledge is the first-of-its-kind endeavor.
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Affiliation(s)
- Hilary M. Perrey
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Evelyn Taylor
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Brett F. Cropp
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Meaghan J. Bumpus
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Shannon Lessard
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Jeanette A. Pretorius
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Jonathan H. Angus
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Megan F. Duperreault
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Amanda Snow
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Dorothy Wang
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Meredith Curtis
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Lauren A. Couture
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - David R. Adolphson
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Kimberly Smith
- Harold Alfond Center for Cancer Care at Maine General Medical CenterAugustaMaineUSA
| | - Joy H. Moody
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Michael J. Bianchi
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Mark G. Parker
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
| | - Amit Sanyal
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
- ASCO MembersAlexandriaVirginiaUSA
| | - Scot C. Remick
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
- ASCO MembersAlexandriaVirginiaUSA
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Pham TD, Tsunoyama T. Exploring Extravasation in Cancer Patients. Cancers (Basel) 2024; 16:2308. [PMID: 39001371 PMCID: PMC11240416 DOI: 10.3390/cancers16132308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Extravasation, the unintended leakage of intravenously administered substances, poses significant challenges in cancer treatment, particularly during chemotherapy and radiotherapy. This comprehensive review explores the pathophysiology, incidence, risk factors, clinical presentation, diagnosis, prevention strategies, management approaches, complications, and long-term effects of extravasation in cancer patients. It also outlines future directions and research opportunities, including identifying gaps in the current knowledge and proposing areas for further investigation in extravasation prevention and management. Emerging technologies and therapies with the potential to improve extravasation prevention and management in both chemotherapy and radiotherapy are highlighted. Such innovations include advanced vein visualization technologies, smart catheters, targeted drug delivery systems, novel topical treatments, and artificial intelligence-based image analysis. By addressing these aspects, this review not only provides healthcare professionals with insights to enhance patient safety and optimize clinical practice but also underscores the importance of ongoing research and innovation in improving outcomes for cancer patients experiencing extravasation events.
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Affiliation(s)
- Tuan D. Pham
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
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3
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Nietvelt F, Van Herreweghe I, Godschalx V, Soetens F. Extravascular injection of neuromuscular blocking drugs: A systematic review of current evidence and management. Eur J Anaesthesiol 2024; 41:367-373. [PMID: 38410855 PMCID: PMC10990036 DOI: 10.1097/eja.0000000000001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Extravascular injection of neuromuscular blocking drugs (NMBDs) can cause a neuromuscular block because of systemic absorption. Currently, there are no guidelines available on managing extravasation of NMBDs. This article reviews the available literature on extravasation of NMBDs. Medline and Embase databases were searched for studies concerning the paravenous or subcutaneous injection of NMBDs. Nine articles were included consisting of seven case reports, one case series and one clinical trial. Rocuronium was used as primary NMBD in nine cases, vecuronium in two cases and pancuronium in one case. Although there exists significant heterogeneity between the reported information in the included studies, the majority of the case reports describe a slower onset, with a median delay of 20 min and prolonged duration of the neuromuscular block. Nine patients had a residual neuromuscular block at the end of the surgery. Postoperative monitoring in the recovery room was prolonged (median time 4 h). Most studies suggest that the delay in NMBD onset and recovery is caused by the formation of a subcutaneous depot, from which the NMBD is slowly absorbed into the systemic circulation. According to the current literature, extravasation of NMBDs results in an unpredictable neuromuscular block. Strategies to prevent potentially harmful side effects, such as frequent train-of-four (TOF) monitoring, the use of NMBD reversal agents and prolonged length of stay in the postanaesthesia care unit (PACU), should be considered. This article suggests a clinical pathway that can be used after extravascular injection of NMBDs.
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Affiliation(s)
- Frederik Nietvelt
- From the Department of Anaesthesiology, UZ Leuven, Leuven, Belgium (FN, VG), Department of Anaesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium (IVH) and Department of Anaesthesiology, AZ Turnhout, Turnhout, Belgium (FS)
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4
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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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5
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Montague T, Weaver SB, Wingate LT. Extravasation of Non-Cytotoxic Drugs in Older People. Sr Care Pharm 2023; 38:457-464. [PMID: 37885098 DOI: 10.4140/tcp.n.2023.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Objective To describe the risk factors of extravasation, its impact on the pharmacokinetics of non-cytotoxic drugs, and management of extravasation in older individuals. Extravasation occurs when vesicants leak from blood vessels into surrounding tissue causing severe injury such as tissue necrosis while infiltration is caused by leakage of an irritant that causes injury but does not lead to tissue necrosis. Extravasation occurs in approximately 0.01% to 6% of patients, particularly with cytotoxic agents. However, there is limited documentation about extravasation of non-cytotoxic agents, particularly in older people. Data Sources A literature search of Pubmed and Medline was performed using the following search items: "extravasation," "infiltration," "elderly," and "non-cytotoxic drugs," as well as a combination of these terms. Conclusion It is important to recognize, identify, and manage extravasation early since it can have deleterious consequences for older people. It is more important to prevent extravasation than manage it using standardized evidence-based protocols, and this can be implemented in the nursing facility and acute care setting.
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6
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Hirata I, Mazzotta A, Makvandi P, Cesini I, Brioschi C, Ferraris A, Mattoli V. Sensing Technologies for Extravasation Detection: A Review. ACS Sens 2023; 8:1017-1032. [PMID: 36912628 PMCID: PMC10043935 DOI: 10.1021/acssensors.2c02602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
Peripheral intravenous catheters are administered for various purposes, such as blood sampling or the infusion of contrast agents and drugs. Extravasation happens when the catheter is unintentionally directed outside of the vein due to movement of the intravascular catheter, enhanced vascular permeability, or occlusion of the upstream vein. In this article, extravasation and its mechanism are discussed. Subsequently, the sensorized devices (e.g., single sensor and multimodal detection) to identify the extravasation phenomena are highlighted. In this review article, we have shed light on both physiological and engineering points of view of extravasation and its detection approaches. This review provides an overview on the most recent and relevant technologies that can help in the early detection of extravasation.
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Affiliation(s)
- Ikue Hirata
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Arianna Mazzotta
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
- The
Biorobotics Institute, Scuola Superiore
Sant’Anna, Pontedera 56025, Italy
| | - Pooyan Makvandi
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Ilaria Cesini
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Chiara Brioschi
- IIT-Bracco
Joint Lab, Istituto Italiano di Tecnologia, 16163 Genova, Italy
- Bracco
S.p.A., 20134 Milano, Italy
| | - Andrea Ferraris
- IIT-Bracco
Joint Lab, Istituto Italiano di Tecnologia, 16163 Genova, Italy
- Bracco
S.p.A., 20134 Milano, Italy
| | - Virgilio Mattoli
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
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7
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Kaur S, Kaur P, Kumar Y, Sarin J, Garg D. Development and Validation of the Intravenous Infiltration and Extravasation Risk Assessment Tool (IIERAT) for Pediatric Patients. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2595-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Morita Y, Kobayashi K, Toku Y, Kimura Y, Luo Q, Song G, Ju Y. Nanocarriers for drug-delivery systems using a ureido-derivatized polymer gatekeeper for temperature-controlled spatiotemporal on-off drug release. BIOMATERIALS ADVANCES 2022; 139:213026. [PMID: 35882119 DOI: 10.1016/j.bioadv.2022.213026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
Accidental chemotherapy extravasation exacerbates the side effects of anticancer drugs. Therefore, drug-delivery nanocarriers should be designed to avoid persistent drug release at off-target sites and promote burst drug release at on-target. Considering these requirements, poly(allylamine)-co-poly(allylurea) (PAU), a ureido-derivatized temperature responsive polymer with upper critical solution temperature (UCSTs), is an ideal material. This report describes the fabrication, characterization, and in vitro cellular toxicity of PAU polymer-grafted magnetic mesoporous silica nanoparticles as drug-delivery nanocarriers. A UCST of 43 °C and an ultranarrow transition temperature range of 39-43 °C was realized, ensuring that the nanocarriers suppressed undesirable leakage to below 10 % of the drug loading for 8 h in the absence of a thermal stimulus. A drug release burst of up to 75 % of the drug loading was achieved within 30 min after the stimulus, reducing the viability of the in vitro cancer cells to 12 %. Therefore, the ureido-derivatized polymer is one of the most suitable gatekeepers for drug-delivery nanocarriers.
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Affiliation(s)
- Yasuyuki Morita
- Faculty of Advanced Science and Technology, Kumamoto University, 2-39-1 Kurokami, Chuo-ku, Kumamoto 860-8555, Japan
| | - Koudai Kobayashi
- Department of Micro-Nano Mechanical Sciences & Engineering, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - Yuhki Toku
- Department of Micro-Nano Mechanical Sciences & Engineering, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - Yasuhiro Kimura
- Department of Micro-Nano Mechanical Sciences & Engineering, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
| | - Qing Luo
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Guanbin Song
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Yang Ju
- Department of Micro-Nano Mechanical Sciences & Engineering, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan.
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9
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Keritam O, Juhasz V, Schöfer C, Thallinger C, Aretin MB, Schabbauer G, Breuss J, Unseld M, Uhrin P. Determination of Extravasation Effects of Nal-Iri and Trabectedin and Evaluation of Treatment Options for Trabectedin Extravasation in a Preclinical Animal Model. Front Pharmacol 2022; 13:875695. [PMID: 35721106 PMCID: PMC9204062 DOI: 10.3389/fphar.2022.875695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Extravasation during chemotherapy administration can lead to dangerous adverse effects ranging from pain to tissue necrosis. Evidence-based data about prevention and treatment of extravasation injuries of some clinically used compounds still remains elusive. This work aimed to investigate, in a preclinical mouse model, the effects of extravasation of two chemotherapeutic agents, nanoliposomal irinotecan (nal-Iri) and trabectedin. In addition, we aimed to study treatment options for injuries induced by extravasation of these substances. Methods: Mice were subcutaneously injected with nal-Iri or trabectedin applied in clinically used concentration. Doxorubicin was used as a positive control. In subsequently performed experiments, hyaluronidase, DMSO and tacrolimus were tested as potential treatments against extravasation-induced injuries by trabectedin. Systemic effects were analyzed by observation and documentation of the health status of mice and local reactions were measured and graded. In addition, hematoxylin-eosin stained histological sections of the treated skin areas were analyzed. Results: Of the two tested substances, only trabectedin showed vesicant effects. Subcutaneous injection of trabectedin caused erythema formation in mice by day two that was progressing to skin ulcerations by day five. Furthermore, we found that topical treatment of mice with tacrolimus or DMSO reduced the vesicant effects of trabectedin. The results observed in vivo were supported microscopically by the analysis of histological sections. Conclusions: We recommend classifying trabectedin as a vesicant agent and nal-Iri as a non-vesicant agent. Furthermore, our results obtained in a preclinical model suggest that tacrolimus and DMSO might be suitable treatment options of trabectedin extravasations, a finding that might be further utilized in clinical studies.
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Affiliation(s)
- Omar Keritam
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Viktoria Juhasz
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Christian Schöfer
- Department for Cell and Developmental Biology, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Christiane Thallinger
- Clinical Division of Infectious Disease, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Gernot Schabbauer
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Johannes Breuss
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Matthias Unseld
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Pavel Uhrin
- Institute of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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10
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Shintani Y, Murayama R, Abe-Doi M, Sanada H. Incidence, causes, and timing of peripheral intravenous catheter failure related to insertion timing in the treatment cycle in patients with hematological malignancies: A prospective descriptive study. Jpn J Nurs Sci 2022; 19:e12484. [PMID: 35474606 DOI: 10.1111/jjns.12484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/26/2021] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Abstract
AIM We aimed to reveal detailed descriptive data on peripheral intravenous catheter (PIVC) failure related to insertion timing during the treatment cycle, in patients with lymphoma, leukemia, and myeloma. METHODS We conducted a prospective descriptive study to investigate the incidence of PIVC failure, defined as PIVC removal prior to completing infusion therapy. This was judged by ward nurses for adult patients requiring PIVC insertion for chemotherapy. A research nurse confirmed the timing and determined the causes of PIVC failure using ultrasonographic imaging. Descriptive data were collected in the hematology and oncology ward of a tertiary hospital in Japan. RESULTS We recruited 85 patients (with 303 PIVCs), and analyzed 67 patients (with 280 PIVCs). Of these, 118 PIVCs (42%) were inserted during the chemotherapeutic dosing period of the treatment cycle, and 106 (38%), during the rest period. The incidence of cumulative PIVC failure was 43.2% of all analyzed PIVCs (89.97 per 1,000 PIVC days). Of the PIVCs in patients with lymphoma, those inserted during the dosing period were less likely to show PIVC failure (32% vs. 57%, p < .001). Conversely, those inserted after the treatment cycle were more likely to show PIVC failure (22% vs. 7%, p = .002). CONCLUSION This study demonstrated that the incidence of PIVC failure in patients with hematological malignancies was unacceptably high. Conceivably, the incidence of PIVC failure varies by the onset time of side effects in the treatment cycle. This should be considered when using PIVCs and selecting optimal vascular access devices for patients with hematological malignancies.
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Affiliation(s)
- Yui Shintani
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Abdel Al S. Chemotherapy extravasation injuries beyond the immediate stage: A series of 15 cases treated according to a preset surgical algorithm based on time of presentation. HAND SURGERY & REHABILITATION 2022; 41:391-399. [DOI: 10.1016/j.hansur.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
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12
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Hong S, Kim SH, Lee HK, Lee YM, Kim MY, Lee H, Lee HY. Extravasation of TPN following central venous catheter migration. Respir Med Case Rep 2022; 37:101623. [PMID: 35313559 PMCID: PMC8933707 DOI: 10.1016/j.rmcr.2022.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Central venous catheterization is a preferred method for intensive care patients who require total parenteral nutrition (TPN). TPN can cause tissue damage due to osmotic effects and the presence of ions. We report a case of TPN extravasation into the pleural cavity due to a shift in position of a subclavian central vein catheter. In this report, we discuss the importance of serial follow up of chest X-ray examination in patients with central vein catheterization.
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13
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Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. Efectos de la fotobiomodulación (láser de 660 nm) sobre la extravasación de antraciclinas: estudio experimental. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5786.3692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumen Objetivo: investigar el efecto del uso de diferentes agentes (hialuronidasa tópica, fotobiomodulación y la combinación de fotobiomodulación y hialuronidasa tópica) en la prevención de la formación de lesiones causadas por la extravasación de doxorrubicina y en la reducción de las lesiones formadas por la extravasación de ese fármaco. Método: estudio experimental con 60 ratas Wistar, distribuidos aleatoriamente en cuatro grupos de 15 animales. Grupo 1 (Control); Grupo 2 (Hialuronidasa); Grupo 3 (Fotobiomodulación) y Grupo 4 (Hialuronidasa + Fotobiomodulación). La herida se indujo aplicando 1 mg de doxorrubicina por vía subcutánea en el lomo de los animales. La concentración de hialuronidasa tópica fue de 65 unidades de turbidez/g, la energía utilizada fue de 1 joule de láser rojo de 100 mW por centímetro cuadrado. En la evaluación macroscópica cada dos días durante 28 días se observaron las siguientes variables: piel intacta, presencia de flictena, hiperemia, exudado, sangrado, edema, costra, descamación y tejido de granulación. Resultados: los animales de los grupos con fotobiomodulación obtuvieron mejores resultados en la evaluación de las variables: sangrado, hiperemia, exudado, piel intacta y edema. Conclusión: se demostró que la combinación de fotobiomodulación y hialuronidasa tópica fue eficaz para reducir los efectos locales y ayudó en el proceso de cicatrización de heridas y que la FBM por sí sola previno la aparición de lesiones.
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Affiliation(s)
| | | | | | | | - Hélio Langoni
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
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Freitas KABDS, Minicucci EM, Silva VFBD, Menozzi BD, Langoni H, Popim RC. Efeitos da fotobiomodulação (laser 660 nm) no extravasamento de antraciclina: estudo experimental. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5786.3694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumo Objetivo: investigar o efeito do uso de diferentes agentes (hialuronidase tópica, fotobiomodulação e da associação da fotobiomodulação com a hialuronidase tópica) na prevenção de formação de lesões causadas por extravasamento de doxorrubicina bem como na diminuição de lesões formadas pelo extravasamento desta droga. Método: estudo experimental com 60 ratos Wistar, randomizados em quatro grupos de 15 animais. Grupo 1 (Controle); Grupo 2 (Hialuronidase); Grupo 3 (Fotobiomodulação) e Grupo 4 (Hialuronidase + Fotobiomodulação). Induziu-se ferida aplicando 1 mg de doxorrubicina no subcutâneo do dorso dos animais. A concentração da hialuronidase tópica foi de 65 unidades de turbidez/g, a energia empregada foi de 1 joule de laser vermelho 100 mW por centímetro quadrado. Com avaliação macroscópica a cada dois dias por 28 dias, observou-se as variáveis: integridade da pele, presença de flictema, hiperemia, exsudato, sangramento, edema, crosta, descamação e tecido de granulação. Resultados: os animais dos grupos com fotobiomodulação obtiveram melhores resultados na avaliação das variáveis: sangramento, hiperemia, exsudato, pele íntegra e edema. Conclusão: evidenciou-se que a associação da fotobiomodulação com a hialuronidase tópica foi eficaz na diminuição dos efeitos locais e auxiliou no processo de cicatrização da ferida e que a FBM isolada foi capaz de prevenir o aparecimento de lesões.
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Affiliation(s)
| | | | | | | | - Hélio Langoni
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
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15
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Bicer A, Ercin BS, Gürler T, Yiğittürk G, Uyanikgil Y, Cetin EO. Possibility of Taking an Offensive Stance in Extravasation Injury: Effects of Fat Injection in Vesicant (Doxorubicin) Induced Skin Necrosis Model in Rats. J INVEST SURG 2021; 35:801-808. [PMID: 34402353 DOI: 10.1080/08941939.2021.1966142] [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: 10/20/2022]
Abstract
INTRODUCTION Extravasation injuries are one of the most feared complications of intravenous drug administration. The most common drugs associated with extravasation injury include chemotherapy agents and contrast media. Natural course of vesicant extravasation is discomfort, pain, swelling, inflammation, and ultimately skin ulceration. While diligence is the principle approach in prevention, immediate bed-side measures are as important in controlling the extent of tissue damage. Various options, either medical or interventional are next steps in treatment of the condition including antidotes, volume dilution, flushing, suction, hyperbaric oxygen therapy, and surgery. MATERIALS AND METHODS 12 male Wistar albino rats were divided into two groups; one group received fat injections following subdermal doxorubicin infiltration in their right thighs, while other group received saline injection following subdermal doxorubicin infiltration in their right thighs for dilution. Left thighs of both groups were left untreated following subdermal doxorubicin infiltration. Total area of necrosis, as well as resultant epidermal thicknesses were assessed. Histological analyses were conducted using modified Verhofstad scoring system for comparison. RESULTS Mean necrotic area was significantly smaller in the fat injection group compared to other groups. Median Verhofstad score was lesser in the fat injection group as well. Median epidermal thickness, on the other hand, was greater in the fat injection group. CONCLUSION Injection of fat grafts following vesicant extravasation might be beneficial in preventing the progression of tissue damage, if employed early.
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Affiliation(s)
- Ahmet Bicer
- Department of Plastic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burak Sercan Ercin
- Department of Plastic, Reconstructive and Aesthetic surgery, Bahcesehir University, Istanbul, Turkey.,Department of Plastic, Reconstructive and Aesthetic surgery, Medicalpark Pendik Hospital, Istanbul, Turkey
| | - Tahir Gürler
- Department of Plastic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gürkan Yiğittürk
- Department of Histology and Embryology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Yigit Uyanikgil
- Department of Histology and Embryology, Faculty of Medicine, Ege University, Izmir, Turkey.,Department of Stem Cell, Ege University, Health Science Institue, Izmir, Turkey.,Cord Blood, Cell and Tissue Research and Application Centre, Ege University, Izmir, Turkey
| | - Emel Oyku Cetin
- Department of Pharmaceutical Technology, Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, Ege University, Izmir, Turkey
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Kelly LJ, Snowden A. 'Pinholes in my arms': the vicious cycle of vascular access. ACTA ACUST UNITED AC 2021; 30:S4-S13. [PMID: 34288751 DOI: 10.12968/bjon.2021.30.14.s4] [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 Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD). AIMS To explore how patients make sense of living with a CVAD. METHODS This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author. FINDINGS Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence. CONCLUSION Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually 'embodied' by them.
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Affiliation(s)
| | - Austyn Snowden
- Chair in Mental Health, School of Health and Social Care, Edinburgh Napier University
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17
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Manrique-Rodríguez S, Heras-Hidalgo I, Pernia-López MS, Herranz-Alonso A, Del Río Pisabarro MC, Suárez-Mier MB, Cubero-Pérez MA, Viera-Rodríguez V, Cortés-Rey N, Lafuente-Cabrero E, Martínez-Ortega MC, Bermejo-López E, Díez-Sáenz C, López-Sánchez P, Gaspar-Carreño ML, Achau-Muñoz R, Márquez-Peiró JF, Valera-Rubio M, Domingo-Chiva E, Aquerreta-González I, Ariño IP, Martín-Delgado MC, Herrera-Gutiérrez M, Gordo-Vidal F, Rascado-Sedes P, García-Prieto E, Fernández-Sánchez LJ, Fox-Carpentieri S, Lamela-Piteira C, Guerra-Sánchez L, Jiménez-Aguado M, Sanjurjo-Sáez M. Standardization and Chemical Characterization of Intravenous Therapy in Adult Patients: A Step Further in Medication Safety. Drugs R D 2021; 21:39-64. [PMID: 33346878 PMCID: PMC7937591 DOI: 10.1007/s40268-020-00329-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems. AIM The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access. METHODS The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases. RESULTS In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH < 4 or > 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications. CONCLUSIONS Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices.
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Affiliation(s)
- Silvia Manrique-Rodríguez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain.
| | - Irene Heras-Hidalgo
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Sagrario Pernia-López
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
| | - M Camino Del Río Pisabarro
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - M Belén Suárez-Mier
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Antonia Cubero-Pérez
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Verónica Viera-Rodríguez
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Noemí Cortés-Rey
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - Elizabeth Lafuente-Cabrero
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Nursing Department, Hospital del Mar, Barcelona, Spain
| | - M Carmen Martínez-Ortega
- Sociedad Española de Infusión y Acceso Vascular (SEINAV), Madrid, Spain
- Preventive Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Esther Bermejo-López
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Díez-Sáenz
- Nursing Department (Intensive Care), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Piedad López-Sánchez
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital General de Tomelloso, Ciudad Real, Spain
| | - M Luisa Gaspar-Carreño
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Intermutual de Levante, Valencia, Spain
| | - Rubén Achau-Muñoz
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Intermutual de Levante, Valencia, Spain
| | - Juan F Márquez-Peiró
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Perpetuo Socorro, Alicante, Spain
| | - Marta Valera-Rubio
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Esther Domingo-Chiva
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Irene Aquerreta-González
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ignacio Pellín Ariño
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital de Torrejón de Ardoz, Madrid, Spain
| | - M Cruz Martín-Delgado
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital de Torrejón de Ardoz, Madrid, Spain
| | - Manuel Herrera-Gutiérrez
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Federico Gordo-Vidal
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital Universitario del Henares, Madrid, Spain
| | - Pedro Rascado-Sedes
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Complejo Hospitalario Universitario de Santiago de Compostela, La Coruña, Spain
| | - Emilio García-Prieto
- Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC), Madrid, Spain
- Intensive Care Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Sara Fox-Carpentieri
- Nursing Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Carlos Lamela-Piteira
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
- Pharmacy Department, Hospital Álvarez-Buylla, Mieres, Spain
| | - Luis Guerra-Sánchez
- Nursing Department (Coronary Unit), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Miguel Jiménez-Aguado
- Nursing Department (Coronary Unit), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Sociedad Española de Farmacia Hospitalaria (SEFH), Madrid, Spain
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Pawelzik L, Backhaus C. Evaluation of Impulse-Oscillometric Extravasation Prevention. Med Eng Phys 2021; 88:54-58. [PMID: 33485514 DOI: 10.1016/j.medengphy.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Abstract
Infusion liquid extravasation occurs in up to 6% of all intensive care patients and up to 78% for neonates. Currently, emerging extravasation cannot be detected. An impulse-oscillometric method to detect the onset of extravasation is tested and evaluated in vitro. A pinch valve compresses the infusion line, an impulse is formed, and the pressure response is recorded at the peripheral vein catheter. The response of this catheter-sensor-system is analysed by measuring the transient-step response (n = 10) for an opened and closed pinch valve. Trials utilising porcine shanks (n = 15) are performed with venous and extravasational catheter placement. The fundamental frequency, maximum amplitude, damping and decay constant of the pressure response are tested for differences between venous and extravasational placement. The response of the catheter-sensor-system shows no significant differences between an opened or closed pinch valve. The maximum amplitude, frequency, damping and decay constant of the pressure response differ highly significant for venous and extravasational catheter placement (p < .001). The parameters also differ depending on the presence of infusion liquid flow (p < .001). The method enables the detection of the onset of extravasation. Further tests are performed to investigate the relationships between impulse response and hydraulic impedance.
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Affiliation(s)
- L Pawelzik
- Münster University of Applied Sciences, Centre for Ergonomics and Medical Engineering.
| | - C Backhaus
- Münster University of Applied Sciences, Centre for Ergonomics and Medical Engineering
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19
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Segna AN, Baron RH, Cohen B. Infusion Site Reactions: Classification in the Setting of Fosaprepitant Administration With Chemotherapy. Clin J Oncol Nurs 2020; 24:E79-E84. [PMID: 33216065 DOI: 10.1188/20.cjon.e79-e84] [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: 11/17/2022]
Abstract
BACKGROUND Studies report a wide range of incidence and severity of infusion site adverse events (ISAEs) following fosaprepitant administration. OBJECTIVES The purposes of this study were (a) to determine the incidence of suspected extravasation in patients with cancer receiving fosaprepitant infusions with chemotherapy and (b) to determine whether the documented signs, symptoms, and management strategies aligned with the diagnostic criteria for extravasation versus non-extravasation ISAEs. METHODS Electronic health records were used to identify patients who received fosaprepitant infusion with chemotherapy and had documentation for suspected extravasation. Chart reviews were conducted for a sample of patients to determine whether documentation was consistent with extravasation. FINDINGS About 3% (n = 460 of 15,667) of patients who received fosaprepitant had documentation for suspected extravasation. Among a random sample of patients (N = 110) with suspected extravasation, 6% (n = 6) had documentation consistent with extravasation.
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20
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López-Sundh AE, Quintana-Sancho A, Durán-Vian C, Reguero-DelCura L, Corrales-Martínez AF, Gómez-Fernández C, González-López MA. Clinical and ultrasound response to intralesional sodium thiosulfate for the treatment of calcinosis cutis in the setting of systemic sclerosis. A case-based review. Clin Rheumatol 2020; 40:2985-2989. [PMID: 33244722 DOI: 10.1007/s10067-020-05523-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Calcinosis cutis (CC) is defined as the deposition of calcium salts on the skin and subcutaneous tissue. It is associated with different conditions, including some autoimmune diseases, and it can generate significant inflammation, pain, and functional impairment. Different therapies have been tried with limited results. Intralesional sodium thiosulfate seems a promising therapeutic option. We report a patient with diffuse systemic sclerosis who presented with two symmetrical plaques on both axillae, which caused pain and skin retraction. The clinical diagnosis was consistent with CC, which was confirmed by skin biopsy and ultrasound. The patient was treated with a 250 mg/ml solution of sodium thiosulfate injected into the plaques. Complete resolution was achieved after three monthly sessions. The only reported adverse effect was a transient burning sensation during the injections. Given its effectiveness and safety, we believe that intralesional sodium thiosulfate could become a valid first-line option for the treatment of CC.
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Affiliation(s)
| | - A Quintana-Sancho
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Durán-Vian
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - L Reguero-DelCura
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A F Corrales-Martínez
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Gómez-Fernández
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M A González-López
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Faenza M, Ferraro GA, Fonzone Caccese FP, Verolino P, Papale S, Di Costanzo P, Pieretti G, Izzo S, Fonzone Caccese A. Combined approach with negative pressure wound therapy and dermal substitute for extravasation injury: Why can't they be friends? JPRAS Open 2020; 25:62-67. [PMID: 32743039 PMCID: PMC7387737 DOI: 10.1016/j.jpra.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- M Faenza
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - G A Ferraro
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - F P Fonzone Caccese
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - P Verolino
- Azienda Ospedaliera Universitaria Policlinico, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - S Papale
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - P Di Costanzo
- Università degli Studi della Campania Luigi Vanvitelli, Ph.D. Training Program in Medical, Clinical and Experimental Sciences.- Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - G Pieretti
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - S Izzo
- Università degli Studi della Campania Luigi Vanvitelli, Multidisciplinary Department of Medical Surgical and Dental Specialties, Plastic Surgery Unit, Piazza Luigi Miraglia, 2, 80138 Naples, Italy
| | - A Fonzone Caccese
- Ospedale dei Pellegrini, Hand and Peripheral Nerves Surgery Unit, Via Portamedina alla Pignasecca, 41, 80134 Naples, Italy
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22
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Inherent and modifiable risk factors for peripheral venous catheter failure during cancer treatment: a prospective cohort study. Support Care Cancer 2020; 29:1487-1496. [PMID: 32710173 DOI: 10.1007/s00520-020-05643-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/17/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To identify modifiable and non-modifiable risk factors for peripheral intravenous catheter (PIV) failure among patients requiring intravenous treatment for oncology and haematology conditions. METHODS A single-centre prospective cohort study was conducted between October 2017 and February 2019. Adult in-patients requiring a PIV for therapy were prospectively recruited from two cancer units at a tertiary hospital in Queensland, Australia. The primary outcome was a composite of complications leading to PIV failure (local and bloodstream infection; occlusion; infiltration/extravasation; leakage; dislodgement; and/or phlebitis). Secondary outcomes were (i) PIV dwell time; (ii) insertion and (iii) failure of a CVAD; (iv) adverse events; (v) length of hospital stay. Outcomes were investigated using Bayesian multivariable linear regression modelling and survival analysis. RESULTS Of 200 participants, 396 PIVs were included. PIV failure incidence was 34.9%; the most common failure type was occlusion/infiltration (n = 74, 18.7%), then dislodgement (n = 33, 8.3%), and phlebitis (n = 30, 7.6%). While several patient and treatment risk factors were significant in univariable modelling, in the final multivariable model, only the use of non-sterile tape (external to the primary dressing) was significantly associated with decreased PIV dislodgement (hazard ratio 0.06, 95% confidence interval 0.01, 0.48; p = 0.008). CONCLUSION PIV failure rates among patients receiving cancer treatment are high, the sequelae of which may include delayed treatment and infection. Larger studies on risk factors and interventions to prevent PIV failure in this population are needed; however, the use of secondary securements (such as non-sterile tape) to provide further securement to the primary PIV dressing is particularly important. TRIAL REGISTRATION Study methods were registered prospectively with the Australian New Zealand Clinical Trials Registry on the 27th March 2017 (ACTRN12617000438358); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372191&isReview=true.
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Abstract
Drug reactions resulting from chemotherapy agents are common and frequently affect the skin. Although often benign, a select few of these cutaneous reactions may necessitate immediate changes to the antineoplastic regimens. Given the diversity of chemotherapeutic skin reactions and their complex implications on patient management, an organized conceptual schema is imperative for proper patient care. We evaluate a number of commonly seen chemotherapy-induced skin toxicities organized by pathogenic mechanism and drug class, providing a framework for the identification and categorization of adverse events to prevent unrecognition. Groupings of these reactions include direct cytotoxicity and/or drug accumulation, immunologic hypersensitivity, and aberrant molecular signaling.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA.
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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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Taibi A, Bardet M S, Durand Fontanier S, Deluche E, Fredon F, Christou N, Usseglio J, Mathonnet M. Managing chemotherapy extravasation in totally implantable central venous access: Use of subcutaneous wash-out technique. J Vasc Access 2020; 21:723-731. [PMID: 32056485 DOI: 10.1177/1129729820905174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Totally implanted venous access is widely used in chemotherapy administration. With over 1 million intravenous chemotherapy infusions given worldwide each day, complications are frequent. Accidental cases of extravasation in the presence of a catheter are rare yet very serious and may require discontinuation of chemotherapy. The aim of this study was to evaluate the feasibility and efficacy of the subcutaneous wash-out technique for chemotherapy extravasation treatment. METHODS We retrospectively reviewed the medical charts of patients who had received chemotherapy and sustained extravasation in our hospital between October 2013 and October 2016. Subcutaneous wash-out treatments were carried out exclusively, without the application of antidotes or the use of specific antidotes. RESULTS We documented seven cases of chemotherapy extravasation. Two cases were treated with antidotes and suffered necrosis in the following weeks. The five patients treated using subcutaneous wash-out had no necrosis and had a steady decrease in the inflammatory reaction of the cutaneous and subcutaneous soft tissues. For these five patients, chemotherapy was restarted within 1 month following extravasation. CONCLUSION This study would argue for the feasibility and effectiveness of subcutaneous wash-out in the treatment of chemotherapy extravasations.
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Affiliation(s)
- Abdelkader Taibi
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | | | - Sylvaine Durand Fontanier
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Elise Deluche
- Oncology Department, Dupuytren University Hospital, Limoges, France
| | - Fabien Fredon
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Niki Christou
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Julie Usseglio
- Reconstructive and Aesthetic Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Muriel Mathonnet
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
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David V, Christou N, Etienne P, Almeida M, Roux A, Taibi A, Mathonnet M. Extravasation of Noncytotoxic Drugs. Ann Pharmacother 2020; 54:804-814. [PMID: 32054312 DOI: 10.1177/1060028020903406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective: Commonly used drugs may be dangerous in case of extravasation. The lack of information from health care teams can lead to delays in both diagnosis and treatments. This review aims at alerting health care professionals about drugs and risk factors for extravasation and outlines recommendations for the diagnosis and treatment of extravasation. Data Source: A literature search of MEDLINE/PubMed, Scopus, the Cochrane Library, and Google Scholar was performed from 2000 to December 2019 using the following terms: extravasation, central venous line, peripheral venous line, irritant, and vesicant. Study Selection and Data Extraction: Overall, 140 articles dealing with drug extravasation were considered potentially relevant. Each article was critically appraised independently by 2 authors, leading to the inclusion of 80 relevant studies, guidelines, and reviews. Articles discussing incidents of extravasation in the neonatal and pediatric population of patients were excluded. Data Synthesis: Training of health care teams and writing care protocols are important for an optimal management of extravasations. A prompt consultation should be achieved by a specialist surgeon. The surgical procedure, if necessary, will consist of wound debridement followed by an abundant lavage. Relevance to Patient Care and Clinical Practice: This review discusses the management of drug extravasations according to their mechanism(s) of toxicity on tissues. It highlights the importance of a close monitoring of patients and the training of health care teams likely to face this type of adverse event. Conclusions: Extravasations still contribute to significant morbidity and mortality. A good knowledge of risk factors and the implementation of easily and quickly accessible standardized care protocols are 2 key elements in both prevention and treatment of extravasations.
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Affiliation(s)
| | - Niki Christou
- Endocrine, General and Digestive Surgery Department, CHU of Limoges, Limoges, France
| | | | | | - Alexia Roux
- Endocrine, General and Digestive Surgery Department, CHU of Limoges, Limoges, France
| | - Abdelkader Taibi
- Endocrine, General and Digestive Surgery Department, CHU of Limoges, Limoges, France
| | - Muriel Mathonnet
- Endocrine, General and Digestive Surgery Department, CHU of Limoges, Limoges, France
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Ballieu P, Besharatian Y, Ansari S. Safety and Feasibility of Phenylephrine Administration Through a Peripheral Intravenous Catheter in a Neurocritical Care Unit. J Intensive Care Med 2019; 36:101-106. [PMID: 31757173 DOI: 10.1177/0885066619887111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Blood pressure optimization and maintenance of cerebral and spinal perfusion pressure are mainstays in the treatment of a neurocritically ill patient. Traditionally, central venous access has been required for vasopressor administration, with risk of inherent complications. The authors have previously reported pilot data on the safety of peripheral administration of phenylephrine in a neurocritical care unit. In this follow-up, we report the safety, feasibility, and potential efficacy of peripheral administration of low-concentration phenylephrine in a more robust cohort. METHODS A retrospective chart review was conducted on all consecutive patients who received peripheral phenylephrine in a tertiary care hospital neurocritical care unit. RESULTS A cohort of 125 patients were identified and included in the final analysis. The average age was 59.3 years, with an average intensive care unit (ICU) length of stay of 7.61 days. The most common indication for phenylephrine use was spinal perfusion (both with/without neurogenic shock) in 38.4% of cases, followed by postsurgical/anesthesia resuscitation in 16.8% of cases; 25.6% of patients in our cohort required escalation to central venous access (central venous catheter + peripherally inserted central catheter). A total of 2880 patient-hours were recorded with peripheral phenylephrine infusion, of which 73.9% were at goal blood pressure (either systolic or mean arterial pressure). Only one major complication of thrombophlebitis and 8 minor complications were recorded. CONCLUSIONS Protocol-driven peripheral administration of lower concentration phenylephrine in an ICU setting is safe and feasible. This strategy is potentially effective at achieving hemodynamic targets in the majority of patients avoiding the need for central venous access.
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Affiliation(s)
- Paul Ballieu
- Huntsman Cancer Center, 7060University of Utah, Salt Lake City, UT, USA
| | - Yasaman Besharatian
- Department of Neurology, School of Medicine, 7060University of Utah, Salt Lake City, UT, USA
| | - Safdar Ansari
- Department of Neurology, School of Medicine, 7060University of Utah, Salt Lake City, UT, USA
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Murayama R, Oya M, Abe-Doi M, Oe M, Komiyama C, Sanada H. Characteristics of subcutaneous tissues at the site of insertion of peripheral infusion in patients undergoing paclitaxel and carboplatin chemotherapy. Drug Discov Ther 2019; 13:288-293. [DOI: 10.5582/ddt.2019.01064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Maiko Oya
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Oe
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sanmartín O, Beato C, Suh-Oh HJ, Aragón I, España A, Majem M, Segura S, Gúrpide A, Botella R, Grávalos C. Manejo clínico de los eventos adversos cutáneos en pacientes tratados con quimioterapia: consenso nacional de la Academia Española de Dermatología y Venereología y de la Sociedad Española de Oncología Médica. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:448-459. [DOI: 10.1016/j.ad.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 12/15/2022] Open
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Clinical Management of Cutaneous Adverse Events in Patients on Chemotherapy: A National Consensus Statement by the Spanish Academy of Dermatology and Venereology and the Spanish Society of Medical Oncology. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Corbett M, Marshall D, Harden M, Oddie S, Phillips R, McGuire W. Treatment of extravasation injuries in infants and young children: a scoping review and survey. Health Technol Assess 2019; 22:1-112. [PMID: 30175709 DOI: 10.3310/hta22460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Extravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches. OBJECTIVES To identify which treatments may be best for treating extravasation injuries in infants and young children. DESIGN Scoping review and survey of practice. POPULATION Children aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries. INTERVENTIONS Any treatment for extravasation injury. MAIN OUTCOME MEASURES Wound healing time, infection, pain, scarring, functional impairment, requirement for surgery. DATA SOURCES Twelve database searches were carried out in February 2017 without date restrictions, including MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus and EMBASE (Excerpta Medica dataBASE). METHODS Scoping review - studies were screened in duplicate. Data were extracted by one researcher and checked by another. Studies were grouped by design, and then by intervention, with details summarised narratively and in tables. The survey questionnaire was distributed to NHS staff at neonatal units, paediatric intensive care units and principal oncology/haematology units. Summary results were presented narratively and in tables and figures. RESULTS The evidence identified in the scoping review mostly comprised small, retrospective, uncontrolled group studies or case reports. The studies covered a wide range of interventions including conservative management approaches, saline flush-out techniques (with or without prior hyaluronidase), hyaluronidase (without flush-out), artificial skin treatments, debridement and plastic surgery. Few studies graded injury severity and the results sections and outcomes reported in most studies were limited. There was heterogeneity across study populations in age, types of infusate, injury severity, location of injury and the time gaps between injury identification and subsequent treatment. Some of the better evidence related to studies of flush-out techniques. The NHS survey yielded 63 responses from hospital units across the UK. Results indicated that, although most units had a written protocol or guideline for treating extravasation injuries, only one-third of documents included a staging system for grading injury severity. In neonatal units, parenteral nutrition caused most extravasation injuries. In principal oncology/haematology units, most injuries were due to vesicant chemotherapies. The most frequently used interventions were elevation of the affected area and analgesics. Warm or cold compresses were rarely used. Saline flush-out treatments, either with or without hyaluronidase, were regularly used in about half of all neonatal units. Most responders thought a randomised controlled trial might be a viable future research design, though opinions varied greatly by setting. LIMITATIONS Paucity of good-quality studies. CONCLUSIONS There is uncertainty about which treatments are most promising, particularly with respect to treating earlier-stage injuries. Saline flush-out techniques and conservative management approaches are commonly used and may be suitable for evaluation in trials. FUTURE WORK Conventional randomised trials may be difficult to perform, although a randomised registry trial may be an appropriate alternative. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sam Oddie
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
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Abe-Doi M, Murayama R, Yabunaka K, Tanabe H, Komiyama C, Sanada H. Ultrasonographic assessment of an induration caused by extravasation of a nonvesicant anticancer drug: A case report. Medicine (Baltimore) 2019; 98:e15043. [PMID: 30946347 PMCID: PMC6456028 DOI: 10.1097/md.0000000000015043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
RATIONALE Induration may occur after an anticancer drug extravasation in patients who recurrently receive chemotherapy because of reduced choice of an appropriate vein for inserting a peripheral intravenous catheter, resulting in catheter placement difficulty. Although induration affects treatment, its size, shape, or hardness remains unclear in the conventional observation method using palpation and inspection. Here, we report our observation results in using ultrasonography to assess the induration that occurred after an anticancer drug extravasation as a new assessment method. PATIENT CONCERNS A 58-year-old woman with cervical cancer who complained of pain during the administration of a nonvesicant anticancer drug via a peripheral intravenous catheter. The medical staff's examination showed a swollen site; therefore, the catheter was replaced. DIAGNOSIS Induration occurred on the site after an extravasation. Over 6 months later, pigmentation and induration, which can easily be confirmed through palpation, persisted. INTERVENTIONS The subcutaneous tissue in the induration site was observed using ultrasonography (B-mode and elastography). OUTCOMES The subcutaneous tissue might have degenerated the tissues surrounding the vein, making it thinner. Moreover, the hardness of the subcutaneous tissue was approximately 7 times than that of the surrounding tissues. LESSONS Induration that affects the vein form and its surrounding tissues should be prevented, and ultrasonography is an effective method to objectively observe the site where extravasation occurred.
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Affiliation(s)
| | - Ryoko Murayama
- Department of Advanced Nursing Technology
- Global Nursing Research Center
| | - Koichi Yabunaka
- Global Nursing Research Center
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Hidenori Tanabe
- Department of Advanced Nursing Technology
- Terumo R&D CENTER, Kanagawa
| | | | - Hiromi Sanada
- Global Nursing Research Center
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Milcheski DA, Mota WM, Lobato RC, Monteiro Júnior AA, Gemperli R. Surgical treatment of extravasation injuries: experience of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo. ACTA ACUST UNITED AC 2018; 45:e1912. [PMID: 30141825 DOI: 10.1590/0100-6991e-20181912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/29/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to report the experience of the Division of Plastic Surgery of the Hospital das Clínicas of the Medical School of the University of São Paulo in the treatment of cutaneous lesions due to accidental extravasation of drugs. METHODS we included patients with lesions due to extravasation of drugs over a period of 18 months. We retrospectively evaluated the following parameters: age, diagnoses during hospitalization and comorbidities, serum levels of albumin and hemoglobin, place of hospitalization, drug involved, anatomic segment affected, therapeutic management and death during hospitalization. RESULTS we followed-up 14 patients. The main drug involved was noradrenaline (21%). All patients underwent debridement of tissue necrosis. Three patients were submitted to flaps after preparation of the wound bed with negative pressure therapy, with good results. Seven patients had no definitive treatment of their lesions due to lack of clinical conditions. CONCLUSION in patients with favorable clinical conditions, the definitive treatment with flaps was adequate for cases of wounds due to extravasation of drugs in the subcutaneous tissue when there was exposure of noble structures.
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Affiliation(s)
- Dimas André Milcheski
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia Plástica, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Wellington Menezes Mota
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia Plástica, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Rodolfo Costa Lobato
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia Plástica, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Araldo Ayres Monteiro Júnior
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia Plástica, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Rolf Gemperli
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia Plástica, Hospital das Clínicas, São Paulo, SP, Brasil
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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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Baus A, Keilani C, Bich CS, Entine F, Brachet M, Duhamel P, Amabile JC, Malfuson J, Bey E. Complex upper arm reconstruction using an antero-lateral thigh free flap after an extravasation of Yttrium-90-ibritumomab Tiuxetan: A case report and literature review. ANN CHIR PLAST ESTH 2018; 63:175-181. [DOI: 10.1016/j.anplas.2017.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
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Eisenberg S, Pacheco L. Applying Hazardous Drug Standards to Antineoplastics Used for Ophthalmology Surgery. AORN J 2018; 107:199-213. [DOI: 10.1002/aorn.12022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Purpose: This report describes a case of metronidazole injection infiltration which contrasts the sole other case report in the literature at this time, as the patient described herein experienced mild signs and symptoms with prompt resolution and no significant sequelae. Summary: The patient experienced metronidazole injection infiltration during administration open to gravity via an 18-gauge peripheral catheter in the left brachial vein. The site was examined at bedside within approximately 30 minutes of the incident and was noted to be slightly edematous, erythemic, and painful in terms of a 5.5 × 6.6-cm area. No blanching, blister formation, induration, skin discoloration, or diminished capillary refill were observed. The event was conservatively managed in the form of catheter discontinuation and marking of the affected area with a patient skin marker, as hyaluronidase was not administered due to a product osmolarity of ~314 mOsM/L and pH of 5.8. A bedside evaluation the next morning revealed full resolution of the previously described symptoms. The patient was discharged from the facility 11 days later without further complications from the infiltration event. Conclusion: We describe a case of metronidazole injection infiltration which did not require pharmacologic or nonpharmacologic interventions and resulted in complete resolution. This case supplements the current literature by contrasting the sole other case report which resulted in profound necrosis near the intravenous access site. This case suggests metronidazole infiltrations may not require clinician alarm or treatment if events occur under circumstances similar to that which is presented.
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Affiliation(s)
- Andrew M North
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Central Ohio Poison Center, Columbus, OH, USA
| | - Justin M Yee
- CHI Franciscan Health St. Clare Hospital, Lakewood, WA, USA
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Shibata Y, Yokooji T, Itamura R, Sagara Y, Taogoshi T, Ogawa K, Tanaka M, Hide M, Kihira K, Matsuo H. Injury due to extravasation of thiopental and propofol: Risks/effects of local cooling/warming in rats. Biochem Biophys Rep 2017; 8:207-211. [PMID: 28955958 PMCID: PMC5613958 DOI: 10.1016/j.bbrep.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/23/2016] [Accepted: 09/05/2016] [Indexed: 11/25/2022] Open
Abstract
Inadvertent leakage of medications with vesicant properties can cause severe necrosis in tissue, which can have devastating long-term consequences. The aim of this study was to evaluate the extent of extravasation injury induced by thiopental and propofol, and the effects of cooling or warming of local tissue on extravasation injury at macroscopic and histopathologic levels. Rats were administered intradermally thiopental (2.5 mg/100 µL) or propofol (1.0 mg/100 µL). Rats were assigned randomly to three groups: control (no treatment), cooling and warming. Local cooling (18-20 °C) or warming (40-42 °C) was applied for 3 h immediately after agent injection. Lesion sizes (erythema, induration, ulceration, necrosis) were monitored after agent injection. Histopathology was evaluated in skin biopsies taken 24 h after agent injection. Thiopental injection induced severe skin injury with necrosis. Peak lesions developed within 24 h and healed gradually 18-27 days after extravasation. Propofol induced inflammation but no ulceration, and lesions healed within 1-2 days. Local cooling reduced thiopental- and propofol-induced extravasation injuries but warming strongly exacerbated the skin lesions (e.g., degeneration, necrosis) induced by extravasation of thiopental and propofol. Thiopental can be classified as a "vesicant" that causes tissue necrosis and propofol can be classified as an "irritant". Local cooling protects (at least in part) against skin disorders induced by thiopental and propofol, whereas warming is harmful.
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Affiliation(s)
- Yuuka Shibata
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoharu Yokooji
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryo Itamura
- Faculty of Pharmaceutical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yumeka Sagara
- Faculty of Pharmaceutical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takanori Taogoshi
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katsunari Ogawa
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Maiko Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenji Kihira
- Faculty of Pharmaceutical Sciences, Hiroshima International University, Hiroshima, Japan
| | - Hiroaki Matsuo
- Department of Pharmaceutical Services, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Abstract
Taxanes (docetaxel and paclitaxel) are among the most commonly prescribed anticancer drugs approved for the treatment of metastatic or locally advanced breast, non-small cell lung, prostate, gastric, head and neck, and ovarian cancers, as well as in the adjuvant setting for operable node-positive breast cancers. Although the true incidence of dermatological adverse events (AEs) in patients receiving taxanes is not known, and has never been prospectively analysed, they clearly represent one of the major AEs associated with these agents. With an increase in the occurrence of cutaneous AEs during treatment with novel targeted and immunological therapies when used in combination with taxanes, a thorough understanding of reactions attributable to this class is imperative. Moreover, identification and management of dermatological AEs is critical for maintaining the quality of life in cancer patients and for minimizing dose modifications of their antineoplastic regimen. This analysis represents a systematic review of the dermatological conditions reported with the use of these drugs, complemented by experience at comprehensive cancer centres. The conditions reported herein include skin, hair, and nail toxicities. Lastly, we describe the dermatological data available for the new, recently FDA-and EMA- approved, solvent-free nab-paclitaxel.
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Oya M, Takahashi T, Tanabe H, Oe M, Murayama R, Yabunaka K, Matsui Y, Sanada H. Low-temperature infiltration identified using infrared thermography in patients with subcutaneous edema revealed ultrasonographically: A case report. Drug Discov Ther 2017; 10:117-22. [PMID: 27210893 DOI: 10.5582/ddt.2016.01033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infiltration is a frequent complication of infusion therapy. We previously demonstrated the usefulness of infrared thermography as an objective method of detecting infiltration in healthy people. However, whether thermography can detect infiltration in clinical settings remains unknown. Therefore, we report two cases where thermography was useful in detecting infiltration at puncture sites. In both cases, tissue changes were verified ultrasonographically. The patients were a 56-year-old male with cholangitis and a 76-year-old female with hepatoma. In both cases, infiltration symptoms such as swelling and erythema occurred one day after the insertion of a peripheral intravenous catheter. Thermographic images from both patients revealed low-temperature areas spreading from the puncture sites; however, these changes were not observed in other patients. The temperature difference between the low-temperature areas and their surrounding skin surface exceeded 1.0°C. Concurrently, ultrasound images revealed that tissues surrounding the vein had a cobblestone appearance, indicating edema. In both patients, subcutaneous tissue changes suggested infiltration and both had low-temperature areas spreading from the puncture sites. Thus, subcutaneous edema may indicate infusion leakage, resulting in a decrease in the temperature of the associated skin surface. These cases suggest that infrared thermography is an effective method of objectively and noninvasively detecting infiltration.
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Affiliation(s)
- Maiko Oya
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
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41
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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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Pasquesoone L, Aljudaibi N, Ellart J, Guerreschi P, Duquennoy-Martinot V. [Emergency management of extravasation in children]. ANN CHIR PLAST ESTH 2016; 61:598-604. [PMID: 27614718 DOI: 10.1016/j.anplas.2016.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
The subcutaneous diffusion of intravenous drips, or extravasation, is a frequent iatrogenic complication in children, mainly in the neonatal period. This potentially severe pathology can lead to local ischemia that sometimes mimics compartment syndrome. It can also evolve towards vast soft-tissue necrosis. Nursing staff often underestimate the risk of functional, aesthetic, and psychological consequences. The speed and quality of the initial medical and surgical management can greatly decrease morbidity associated with extravasation. Prevention is fundamental, such as raising awareness in and training medical and paramedical staffs and creating efficient protocols. Surgical management involving aspiration and washing the site as early as possible improves the prognosis. Aspiration and washing can be done on a larger area if one criteria of severity is met, particularly in cases of extravasation using a vesicant or hyperosmolar agent. If necrotic lesions appear, it is wise to wait until they become delimited. Debridement and coverage can be performed using classical methods.
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Affiliation(s)
- L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France.
| | - N Aljudaibi
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France
| | - J Ellart
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France
| | - V Duquennoy-Martinot
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU, rue Emile-Laine, 59037 Lille cedex, France
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Matey L, Camp-Sorrell D. Venous Access Devices: Clinical Rounds. Asia Pac J Oncol Nurs 2016; 3:357-364. [PMID: 28083553 PMCID: PMC5214869 DOI: 10.4103/2347-5625.196480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/17/2016] [Indexed: 12/29/2022] Open
Abstract
Nursing management of venous access devices (VADs) requires knowledge of current evidence, as well as knowledge of when evidence is limited. Do you know which practices we do based on evidence and those that we do based on institutional history or preference? This article will present complex VAD infection and occlusion complications and some of the controversies associated with them. Important strategies for identifying these complications, troubleshooting, and evaluating the evidence related to lack of blood return, malposition, infection, access and maintenance protocols, and scope of practice issues are presented.
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Affiliation(s)
- Laurl Matey
- Oncology Nursing Society, Pittsburgh, PA, USA
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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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Chiu K, Tindholdt TT, Tønseth KA. Extravasation injuries. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:233-5. [PMID: 26860383 DOI: 10.4045/tidsskr.15.0230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
It is common for an intravascular catheter to be inserted to administer various types of therapy. Extravasation occurs frequently, and in the most severe cases plastic surgeons are often summoned to assess the extent of the injury and the possibility for reconstruction. The Department of Plastic and Reconstructive Surgery at Oslo University Hospital assesses approximately 15 severe cases of this type each year.
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Affiliation(s)
- Kenneth Chiu
- Avdeling for plastikk- og rekonstruktiv kirurgi Oslo universitetssykehus
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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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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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Delyon J, Gerard M, Nicodeme M, Fromantin I, Loirat D. [Management of the cutaneous side effects of chemotherapies and targeted therapies]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2015:17-24. [PMID: 26146316 DOI: 10.1016/j.soin.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The treatments used in oncology cause frequent cutaneous side effects. The different types of cutaneous toxicities depend on the class of anti-tumour therapies and can involve the skin, mucosa, nails and hair. Effectively managing these cutaneous toxicities requires adapted preventive and curative measures in order to reduce their impact, notably on patients' quality of life.
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Affiliation(s)
- Julie Delyon
- Service de dermatologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Maud Gerard
- Département d'oncologie médicale, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Marguerite Nicodeme
- Unité Plaies et cicatrisation, département d'anesthésie et réanimation, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Isabelle Fromantin
- Unité Plaies et cicatrisation, département d'anesthésie et réanimation, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Delphine Loirat
- Département d'oncologie médicale, Institut Curie, 26, rue d'Ulm, 75005 Paris, France; Translational Immunotherapy Team- Inserm U932/Département de transfert, Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
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50
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Dal Molin A, Clerico M, Baccini M, Guerretta L, Sartorello B, Rasero L. Normal saline versus heparin solution to lock totally implanted venous access devices: Results from a multicenter randomized trial. Eur J Oncol Nurs 2015; 19:638-43. [PMID: 25933709 DOI: 10.1016/j.ejon.2015.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Our aim was to determine the non-inferiority of normal saline flushing compared to heparin flushing in maintaining the patency of totally implanted venous access devices (TIVADs). METHOD Four hundred and thirty patients were recruited from 14 Italian centres. Patients were randomized to heparin group or to normal saline group. The primary outcome of the study was TIVAD occlusion. RESULTS After randomisation, 203 patients were assigned to normal saline group and 212 to heparin group. Median follow up time was 204 days in normal saline group and 294 in the heparin group. We observed 24 withdrawal occlusions (5.78%): 10 in the heparin group and 14 in the normal saline group. One total occlusion was observed in the normal saline group. Taking as reference the arm treated with heparin, the absolute risk difference was 2.67 with the 90% CI including the non - inferiority margin of 4%. No significant difference between hazards of occlusion was found. CONCLUSIONS This study failed to demonstrate that normal saline flushing is not inferior to heparin flushing, even if a significant difference between the two treatments was not found. The use of heparin is controversial and other prospective trials are necessary in this field. TRIAL REGISTRATION EudraCT number: 2009-013620-22.
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Affiliation(s)
- Alberto Dal Molin
- Nursing School, Biella Hospital, University of Eastern Piedmont, Biella, Italy.
| | | | - Michela Baccini
- Department of Statistics, Informatics and Applications, University of Florence, Florence, Italy; Biostatistics Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
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