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Abe-Doi M, Murayama R, Morita K, Nakagami G, Sanada H. Predictive Factors for Infusion Site Induration After Outpatient Chemotherapy in Japan: A Secondary Analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:269-275. [PMID: 38101470 DOI: 10.1016/j.anr.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Even in the absence of extravasation, some patients develop induration at the peripheral intravenous catheterization site prior to the next day's treatment. Infusion site induration commonly affects patients who undergo repeated chemotherapy administrations. Vessel health is crucial for the continuation of chemotherapy. However, there is no effective method to prevent induration. Hence, this study aimed to investigate the factors that could cause induration for preventing its occurrence. METHODS This study was a secondary analysis of a prospective observational study. All participants were undergoing outpatient chemotherapy. Participant characteristics and related catheterization data were collected on the treatment day as baseline, and induration incidence was recorded on the subsequent treatment day. Receiver operating characteristic (ROC) analysis was performed to determine the sensitivity and specificity of cutoff points of the vein and catheter diameter ratios for distinguishing between developed induration and not developed induration. Additionally, cox regression analysis with multiple imputation was used to investigate the factors that predicted induration. RESULTS Seventy-one patients participated in the study. The cutoff point of the vein/catheter diameter ratio calculated using ROC analysis was ≥3.7. The ratio of larger-diameter veins to catheter diameter of ≥3.7 times was negatively associated with induration in both complete case analysis (HR: 0.11; p = 0.034) and multiple imputation analysis (HR: 0.12; p = .049). CONCLUSIONS Selecting the vein with 3.7 times higher diameter than the catheter diameter for the catheterization site may help prevent induration on the next treatment day.
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Affiliation(s)
- Mari Abe-Doi
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryoko Murayama
- Research Center for Implementation Nursing Science Initiative, Research Promotion Headquarters, Fujita Health University, Aichi, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Department of Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan.
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Ghaffary S, Gholami N, Samankan S, Pourkarim F. Delayed presentation of vincristine extravasation. J Oncol Pharm Pract 2023; 29:2023-2026. [PMID: 37475540 DOI: 10.1177/10781552231187591] [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: 07/22/2023]
Abstract
INTRODUCTION Vincristine is a vesicant chemotherapeutic agent which may leak from the vessel at the infusion site to the perivascular tissue and cause extravasation. Extravasation, a severe complication of chemotherapeutic drugs, can result in tissue necrosis that is considered an oncological emergency. CASE REPORT We aimed to report a case of a 29-year-old woman with ALL-B cell (Acute lymphoblastic leukemia) on maintenance chemotherapy regimen including vincristine, methotrexate, prednisolone, and 6-mercaptopurine (POMP). 48 h after administering intravenous vincristine, the patient experienced burning, pain and tenderness at the injection site (left hand - cubital cavity). MANAGEMENT & OUTCOME 7 days after the onset of symptoms, the patient was hospitalized with a large brown lesion at the site. She was prescribed betamethasone cream, DSMO (Dimethyl sulfoxide) solution, and oral levofloxacin on his second day after admission. The lesion was completely improved 10 days after initiation of therapy and there were no serious problems. DISCUSSION Due to the ineffectiveness of antidote therapy for the management of delayed extravasation of vincristine and beneficial effect of our clinical approach, it could consider for the management of similar cases with delayed extravasation following vincristine administration.
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Affiliation(s)
- Saba Ghaffary
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Gholami
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sama Samankan
- Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pourkarim
- Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
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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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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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Ohisa K, Yamana H, Morita K, Matsui H, Fushimi K, Yasunaga H. Association between subcutaneous steroid injection for extravasation of vesicant anticancer drugs and skin ulcers requiring surgery. Eur J Oncol Nurs 2022; 58:102119. [DOI: 10.1016/j.ejon.2022.102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
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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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Management of Chemotherapy Infusion Extravasation in Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ehmke N. Chemotherapy Extravasation: Incidence of and Factors Associated With Events in a Community Cancer Center. Clin J Oncol Nurs 2021; 25:680-686. [PMID: 34800094 DOI: 10.1188/21.cjon.680-686] [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: 11/17/2022]
Abstract
BACKGROUND The administration of chemotherapy is a high-risk and nurse-sensitive practice. One complication is extravasation. OBJECTIVES The purpose of this study was to determine the incidence of and iatrogenic factors associated with extravasation in the ambulatory and inpatient settings of a community cancer center. METHODS Events were reviewed by agent, route of administration, patient characteristics, and RNs administering the agent. A one-year, retrospective review of electronic health records and pharmacy and nursing reports was conducted. FINDINGS The number of vesicants, irritants, and irritants with vesicant properties administered was 12,260 in the ambulatory setting and 612 on the inpatient unit, with 21 and 1 extravasation events, respectively. Incidence rates for both settings were 0.001%. The most common agent to extravasate was docetaxel, and all events occurred via peripheral route. The incidence of events was lower than the reported benchmark for National Cancer Institute-designated cancer centers.
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Abe-Doi M, Murayama R, Kawamoto A, Komiyama C, Doorenbos A, Sanada H. Damage to subcutaneous tissue at the catheterization site during chemotherapy: A prospective observational study using ultrasonography. Jpn J Nurs Sci 2021; 18:e12436. [PMID: 34350702 DOI: 10.1111/jjns.12436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/06/2021] [Accepted: 05/02/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Chemotherapy administration can affect subcutaneous tissue at the catheterization site with no macroscopic signs or subjective symptoms. Yet clinical studies about the impact of chemotherapy on tissue at the catheterization site, except for apparent extravasation cases, are limited. This study aimed to investigate subcutaneous tissue changes in nonmacroscopically damaged catheterization sites after chemotherapy administration. METHODS Participants were people with cancer receiving outpatient chemotherapy. Ultrasonographic images were used to assess the condition of subcutaneous tissues, including the vein, at the catheterization site before catheterization, immediately after chemotherapy, and on the next scheduled treatment day. Data on macroscopic inspection, palpation, and subjective symptoms were also collected and analyzed. RESULTS Data from 41 participants were analyzed. All had normal subcutaneous tissues before catheterization. After treatment, 16 (39.0%) manifested abnormalities such as subcutaneous edema, vessel wall thickening, and/or thrombosis; there was no extravasation immediately after treatment. On the next treatment day, 15 (36.6.%) showed persistent or new onset of abnormalities, including subcutaneous edema. Eight of the 15 did not exhibit any subjective symptoms or macroscopic or palpation findings. CONCLUSION After chemotherapy administration via peripheral intravenous catheters, it was found that this damage, which was difficult to detect by the conventional assessment method, persisted. Ultrasonography can provide useful information to avoid reusing damaged sites for chemotherapy administration.
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Affiliation(s)
- Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Atsuo Kawamoto
- Department of Diagnostic Radiology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Chieko Komiyama
- Department of Nursing, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Ardith Doorenbos
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.,Cancer Prevention and Control Program, University of Illinois Cancer Center, Chicago, IL, USA
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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10
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Nedomansky J, Haslik W, Pluschnig U, Kornauth C, Deutschmann C, Hacker S, Steger GG, Bartsch R, Mader RM. Tissue distribution of epirubicin after severe extravasation in humans. Cancer Chemother Pharmacol 2021; 88:203-209. [PMID: 33907881 PMCID: PMC8236455 DOI: 10.1007/s00280-021-04280-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE As critical parameter after extravasation of cytotoxic vesicants, anthracyclines were determined in removed tissue from patients requiring surgical intervention due to tissue necrosis. We monitored their distribution within the affected lesion to establish a possible dose-toxicity relation. METHODS From six patients scheduled for surgery, removed tissue flaps were systematically analysed by HPLC (epirubicin: 5 subjects; doxorubicin: 1 subject). RESULTS After extravasation, tissue concentrations were highly variable with an individual anthracycline distribution pattern ranging from a few nanograms up to 17 µg per 100 mg tissue, which indicated a substantial difference in tissue sensitivity among patients. The resection borders coincided with the extension of the erythema and guided the surgical intervention after demarcation of the lesion, which occurred usually 2 or 3 weeks after extravasation. At that time, drug was hardly detected at the resection borders. Wound drains were negative for the extravasated drugs while showing a time profile of vascular growth factors and inflammatory cytokines, which was highly similar to routine surgery. In all six patients, surgical debridement with immediate wound closure led to healing within approximately 2 weeks, when therapy was resumed in all patients with reasonable time delay. CONCLUSION Surgical intervention after demarcation of the extravasation lesion allows for almost uninterrupted continuation of treatment independent of the amount of extravasated anthracycline. As even minor amounts of the vesicants may trigger tissue necrosis, preventive measures merit the highest priority.
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Affiliation(s)
- Jakob Nedomansky
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Werner Haslik
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Ursula Pluschnig
- Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christoph Kornauth
- Department of Pathology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Stefan Hacker
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Günther G Steger
- Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rupert Bartsch
- Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Robert M Mader
- Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Karius DL, Colvin CM. Managing Chemotherapy Extravasation Across Transitions of Care: A Clinical Nurse Specialist Initiative. JOURNAL OF INFUSION NURSING 2021; 44:14-20. [PMID: 33394869 DOI: 10.1097/nan.0000000000000411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chemotherapy extravasation can lead to serious patient harm in patients with cancer. For nurses who administer vesicant chemotherapy, extravasation is a primary concern. Regardless of nurse experience level and despite prevention strategies, extravasations occur. Literature related to nurse management of chemotherapy extravasation beyond initial treatment is lacking, and no descriptors are available for a formalized process. Communication gaps and a lack of standardized follow-up within a 1400-bed, quaternary care academic medical institution contributes to challenges in care continuity when patients transition between hospital and ambulatory settings. With chemotherapy extravasation, the site does not immediately exhibit signs of tissue injury, leading to a false sense of security. As a result, tissue damage can be significant by the time the patient returns for his or her regular appointment. Two oncology clinical nurse specialists (CNSs) recognized an opportunity to bridge the gap and overcome the challenges by addressing patient needs postextravasation. Between 2015 and 2016, a formal consult process was designed, approved, and implemented to observe, manage, and make recommendations for timely care and follow-up. Since implementation of the process, the oncology CNSs have received multiple requests for consultations. Nursing staff report increased comfort levels with this process in place. A formalized process for managing chemotherapy extravasations increases patient safety and patient and nurse satisfaction.
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Affiliation(s)
- Diana L Karius
- Cleveland Clinic, Cleveland, Ohio
- Diana L. Karius, MS, APRN, CNS, AOCN® , is a clinical nurse specialist in hematology and oncology at Cleveland Clinic. A member of the Oncology Nursing Society (ONS), she has presented nationally at ONS Annual Congress and Infusion Nurses Society (INS) National Academy Conference. She has published and presented on a variety of topics, such as improving chemotherapy safety, pain management, delirium, and palliative care. Ms Karius is also the recipient of the 2011 ONS Excellence in Cancer Nursing Education Award. Karius entered the profession of nursing in 1979, and her extensive career includes health care organizations such as the College of Nursing at Valparaiso University, the University of Chicago Medical Center, University Hospital Home Care in Cleveland, and the Cleveland Clinic Taussig Cancer Institute. Throughout her career she has worked as a clinical teaching assistant, research clinical specialist, case manager, and oncology clinical nurse specialist. With research and evidence-based practice at the forefront of her patient care philosophy, Karius is a member of several national and local industry associations, has served as a publication content reviewer, and is a well-versed presenter. She has also taught as an adjunct faculty member at 3 Northeast Ohio schools of nursing
- Christina M. Colvin, MSN, APRN, AOCNS®, CRNI® , is a clinical nurse specialist in hematology and oncology at Cleveland Clinic. A member of ONS and INS, she has published on topics concerning nurses' safe handling of chemotherapy drugs and care of patients undergoing cancer treatment. Ms Colvin has presented nationally at the INS National Academy Conference
| | - Christina M Colvin
- Cleveland Clinic, Cleveland, Ohio
- Diana L. Karius, MS, APRN, CNS, AOCN® , is a clinical nurse specialist in hematology and oncology at Cleveland Clinic. A member of the Oncology Nursing Society (ONS), she has presented nationally at ONS Annual Congress and Infusion Nurses Society (INS) National Academy Conference. She has published and presented on a variety of topics, such as improving chemotherapy safety, pain management, delirium, and palliative care. Ms Karius is also the recipient of the 2011 ONS Excellence in Cancer Nursing Education Award. Karius entered the profession of nursing in 1979, and her extensive career includes health care organizations such as the College of Nursing at Valparaiso University, the University of Chicago Medical Center, University Hospital Home Care in Cleveland, and the Cleveland Clinic Taussig Cancer Institute. Throughout her career she has worked as a clinical teaching assistant, research clinical specialist, case manager, and oncology clinical nurse specialist. With research and evidence-based practice at the forefront of her patient care philosophy, Karius is a member of several national and local industry associations, has served as a publication content reviewer, and is a well-versed presenter. She has also taught as an adjunct faculty member at 3 Northeast Ohio schools of nursing
- Christina M. Colvin, MSN, APRN, AOCNS®, CRNI® , is a clinical nurse specialist in hematology and oncology at Cleveland Clinic. A member of ONS and INS, she has published on topics concerning nurses' safe handling of chemotherapy drugs and care of patients undergoing cancer treatment. Ms Colvin has presented nationally at the INS National Academy Conference
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12
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Abe‐Doi M, Murayama R, Komiyama C, Sanada H. Changes in the subcutaneous tissue of catheterization site from the precatheterization state to the onset of anticancer drug-induced induration: A case report. Clin Case Rep 2021; 9:57-60. [PMID: 33505685 PMCID: PMC7813117 DOI: 10.1002/ccr3.3402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/10/2020] [Accepted: 09/20/2020] [Indexed: 11/12/2022] Open
Abstract
This case showed that anticancer drug administration induces unhealthy subcutaneous tissue (thrombus or edema) without subjective symptoms, abnormal sign by palpation, or inspection, which have an extravasation risk.
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Affiliation(s)
- Mari Abe‐Doi
- Department of Advanced Nursing TechnologyGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Ryoko Murayama
- Department of Advanced Nursing TechnologyGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
- Global Nursing Research CenterGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Chieko Komiyama
- Department of NursingThe University of Tokyo HospitalBunkyo‐kuJapan
| | - Hiromi Sanada
- Global Nursing Research CenterGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
- Department of Gerontological Nursing/Wound Care ManagementGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
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13
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Abe-Doi M, Murayama R, Tanabe H, Komiyama C, Sanada H. Evaluation of a thermosensitive liquid crystal film for catheterization site assessment immediately following chemotherapy administration: An observational study. Eur J Oncol Nurs 2020; 48:101802. [PMID: 32942231 DOI: 10.1016/j.ejon.2020.101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Extravasation incidence is exceptionally low; however, ulceration or necrosis occurs in severe cases, possibly requiring surgical treatment. Early extravasation signs and symptoms are not always evident on treatment day, and inflammation, which leads to ulceration or necrosis, may appear several days later. Therefore, to minimize damage, identification of high-risk groups is required. This study aims to investigate the relationship between subcutaneous edema which is an early extravasation sign, and skin surface temperature using a thermosensitive liquid crystal film. METHODS Patients receiving chemotherapy through a peripheral intravenous catheter were recruited. Subcutaneous tissue around the catheterization site was observed for the presence of subcutaneous edema by ultrasonography. During chemotherapy initiation, a thermosensitive liquid crystal film was placed on the catheterization site. Color changes of the film were observed, and each case was classified according to low-temperature distribution patterns. To investigate the factors associated with temperature distribution pattern, logistic regression analysis was performed using clinically selected independent variables. RESULTS Data from 63 patients were analyzed. No obvious extravasation was observed. Film analysis revealed 34 cases of broadening low-temperature area from the vein and 23 cases of non-broadening low-temperature area from the vein. Subcutaneous edema was observed in 18 patients: 17 with broadening low-temperature area from the vein and 1 with non-broadening low-temperature area from the vein. Subcutaneous edema was positively correlated with broadening low-temperature area from the vein. CONCLUSION Catheter site skin temperature distribution pattern during chemotherapy was associated with subcutaneous edema which is the early extravasation sign immediately after chemotherapy.
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Affiliation(s)
- Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hidenori Tanabe
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Kanagawa, Japan
| | - Chieko Komiyama
- Department of Nursing, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
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14
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Little M, Dupré S, Wormald JCR, Gardiner M, Gale C, Jain A. Surgical intervention for paediatric infusion-related extravasation injury: a systematic review. BMJ Open 2020; 10:e034950. [PMID: 32764083 PMCID: PMC7412604 DOI: 10.1136/bmjopen-2019-034950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/21/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This systematic review aims to assess the quality of literature supporting surgical interventions for paediatric extravasation injury and to determine whether there is sufficient evidence to support invasive techniques in children. METHODS We performed a systematic review by searching Ovid MEDLINE and EMBASE as well as AMED, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception to February 2019. Studies other than case reports were eligible for inclusion if the population was younger than 18 years old, if there was a surgical intervention aimed at treating extravasation injury and if they reported on outcomes. Study quality was graded according to the National Institutes of Health study quality assessment tools. RESULTS 26 studies involving 728 children were included-one before-and-after study and 25 case series. Extravasation injuries were mainly confined to skin and subcutaneous tissues but severe complications were also encountered, including amputation (one toe and one below elbow). Of the surgical treatments described, the technique of multiple puncture wounds and instillation of saline and/or hyaluronidase was the most commonly used. However, there were no studies in which its effectiveness was tested against another treatment or a control and details of functional and aesthetic outcomes were generally lacking. CONCLUSION Surgical management is commonly reported in the literature in cases where there is significant soft tissue injury but as there are no comparative studies, it is unclear whether this is optimal. Further observational and experimental research evaluating extravasation injuries, including a centralised extravasation register using a universal grading scheme and core outcome set with adequate follow-up, are required to provide evidence to guide clinician decision-making.
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Affiliation(s)
- Max Little
- Trauma & Orthopaedic Surgery, Whittington Hospital NHS Trust, London, UK
| | - Sophie Dupré
- Plastic and Reconstructive Surgery, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Justin Conrad Rosen Wormald
- Plastic and Reconstructive Surgery, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
- Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - Matthew Gardiner
- Plastic and Reconstructive Surgery, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
- Plastic and Reconstructive Surgery, Wexham Park Hospital, Slough, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Abhilash Jain
- Plastic and Reconstructive Surgery, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
- Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
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15
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Melo JMA, Oliveira PPD, Souza RS, Fonseca DFD, Gontijo TF, Rodrigues AB. Prevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review. Rev Bras Enferm 2020; 73:e20190008. [PMID: 32578734 DOI: 10.1590/0034-7167-2019-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify and synthesize scientific evidence on prevention and management of extravasation of antineoplastic agents in adult patients by nurses. METHODS scoping review, according to Joanna Briggs Institute and PRISMA-ScR. Research was conducted in five electronic databases, Cochrane Library and eight catalogs of theses and dissertations. Data collection occurred from April to July 2018, with no time limit. The extracted data were analyzed and synthesized in a narrative way. RESULTS a total of 3,110 records were retrieved and 18 studies were kept for review. Most publications (66.6%) had a qualitative approach and addressed both aspects, i.e., prevention and management of extravasation of chemotherapy in adult patients. CONCLUSIONS the implementation of protocols based on scientific evidence on prevention and management of extravasation of antineoplastic agents is paramount in order to provide patient safety and support to the nursing staff.
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Affiliation(s)
| | | | - Raíssa Silva Souza
- Universidade Federal de São João del-Rei. Divinópolis, Minas Gerais, Brazil
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16
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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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17
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Abe‐Doi M, Murayama R, Komiyama C, Sanada H. Incidence, risk factors, and assessment of induration by ultrasonography after chemotherapy administration through a peripheral intravenous catheter. Jpn J Nurs Sci 2020; 17:e12329. [DOI: 10.1111/jjns.12329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mari Abe‐Doi
- Department of Advanced Nursing Technology, Graduate School of MedicineThe University of Tokyo Tokyo Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of MedicineThe University of Tokyo Tokyo Japan
- Global Nursing Research Center, Graduate School of MedicineThe University of Tokyo Tokyo Japan
| | - Chieko Komiyama
- Department of NursingThe University of Tokyo Hospital Tokyo Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of MedicineThe University of Tokyo Tokyo Japan
- Department of Gerontological Nursing/Wound Care Management, Graduate School of MedicineThe University of Tokyo Tokyo Japan
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18
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Abstract
BACKGROUND Intravenous (IV) lines are ubiquitous in hospital settings. These lines can malfunction, leaking noxious contents into subcutaneous tissue. Existing literature describes invasive intervention and complex treatment protocols. These persist despite significant changes in the composition and administration of IV agents. The purpose of this study is to examine the consequences of IV infiltrations at a tertiary medical center to update protocols and treatment algorithms. MATERIALS AND METHODS This study is an observational, retrospective chart review performed at a tertiary care medical center. All inpatient plastic surgery consultations for IV infiltration were reviewed from 2011 to 2017. Patients were included if IV infiltration was suspected or documented. Data were collected for each injury regarding patient demographics, substance, and intervention. RESULTS The plastic surgery service evaluated 381 IV infiltration injuries from 2011 to 2017, with 363 meeting the criteria. Injuries per year progressively increased, with 32 consultations in 2011 and 102 consultations in 2017. The vast majority of injuries identified (91%) were treated with only elevation and observation. The minority consisted of wound care (7%) performed by nursing or any form of incision, aspiration, or antidote injection (2%) performed by the physician. Of the 363 injuries, the most common infiltrates were noncytotoxic (35%), radiographic contrast (27%), and known vesicants (18%). Interestingly, a large portion of consultations were requested by other surgical services (32%). CONCLUSIONS Although there is an increase in expert involvement for cases of IV infiltration injuries, the vast majority of these injuries are managed with minimal intervention. This is most likely owing to recent changes that have decreased the potential for harmful infiltration. Contrary to existing literature, invasive intervention is almost never indicated.
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