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Sblendorio E, Dentamaro V, Lo Cascio A, Germini F, Piredda M, Cicolini G. Integrating human expertise & automated methods for a dynamic and multi-parametric evaluation of large language models' feasibility in clinical decision-making. Int J Med Inform 2024; 188:105501. [PMID: 38810498 DOI: 10.1016/j.ijmedinf.2024.105501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Recent enhancements in Large Language Models (LLMs) such as ChatGPT have exponentially increased user adoption. These models are accessible on mobile devices and support multimodal interactions, including conversations, code generation, and patient image uploads, broadening their utility in providing healthcare professionals with real-time support for clinical decision-making. Nevertheless, many authors have highlighted serious risks that may arise from the adoption of LLMs, principally related to safety and alignment with ethical guidelines. OBJECTIVE To address these challenges, we introduce a novel methodological approach designed to assess the specific feasibility of adopting LLMs within a healthcare area, with a focus on clinical nursing, evaluating their performance and thereby directing their choice. Emphasizing LLMs' adherence to scientific advancements, this approach prioritizes safety and care personalization, according to the "Organization for Economic Co-operation and Development" frameworks for responsible AI. Moreover, its dynamic nature is designed to adapt to future evolutions of LLMs. METHOD Through integrating advanced multidisciplinary knowledge, including Nursing Informatics, and aided by a prospective literature review, seven key domains and specific evaluation items were identified as follows:A Peer Review by experts in Nursing and AI was performed, ensuring scientific rigor and breadth of insights for an essential, reproducible, and coherent methodological approach. By means of a 7-point Likert scale, thresholds are defined in order to classify LLMs as "unusable", "usable with high caution", and "recommended" categories. Nine state of the art LLMs were evaluated using this methodology in clinical oncology nursing decision-making, producing preliminary results. Gemini Advanced, Anthropic Claude 3 and ChatGPT 4 achieved the minimum score of the State of the Art Alignment & Safety domain for classification as "recommended", being also endorsed across all domains. LLAMA 3 70B and ChatGPT 3.5 were classified as "usable with high caution." Others were classified as unusable in this domain. CONCLUSION The identification of a recommended LLM for a specific healthcare area, combined with its critical, prudent, and integrative use, can support healthcare professionals in decision-making processes.
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Affiliation(s)
- Elena Sblendorio
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy
| | - Vincenzo Dentamaro
- Department of Computer Science, University of Bari "Aldo Moro", Bari, Italy. https://twitter.com/vincenzoden
| | - Alessio Lo Cascio
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy; La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy
| | - Francesco Germini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Italy; Direttore di Distretto Sociosanitario, ASL Bari, Bari, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Giancarlo Cicolini
- Department of Innovative Technologies in Medicine & Dentistry, "G.d'Annunzio" University of Chieti - Pescara, Italy
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Shamel S, Zarkesh MR. Acyclovir extravasation in a newborn: a case report. J Med Case Rep 2024; 18:271. [PMID: 38845030 PMCID: PMC11157697 DOI: 10.1186/s13256-024-04585-1] [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: 11/16/2022] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE Extravasation of infused drugs is not a rare problem in medical practice. Acyclovir is a vesicant and an antiviral medication commonly used for young children. In the present study, we presented a neonate with soft tissue damage due to acyclovir extravasation. CASE REPORT A female newborn (Iranian, Asian) with gestational age 37+2 weeks and breech presentation was born by Cesarean delivery from a mother with a recent history of Herpes simplex virus (HSV) infection (Yas Women's Hospital, Tehran, Iran). Intravenous administration of acyclovir was initiated through a peripheral catheter inserted on the dorsal side of the left hand. A few minutes after the second dose, the patient showed a diffused firm swelling, local discoloration, and induration in the dorsum of the hand. The peripheral catheter was removed immediately. Hyaluronidase was injected subcutaneously in five different regions around the catheterization site. Intermittent limb elevation and cold compression (for 10 minutes) were applied. Serial follow-ups and examinations were performed hourly to check limb inflammation, ischemia, and compartment syndrome. The limb swelling and discoloration significantly improved 4 hours after the second dose of hyaluronidase. CONCLUSION Early diagnosis of acyclovir extravasation and immediate management could prevent severe complications in neonates. Further studies are needed to suggest a standard approach and treatment protocol for acyclovir extravasation.
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Affiliation(s)
- Shirin Shamel
- Department of Neonatology, Yas Hospital Complex, Tehran University of Medical Sciences, Sarv Ave., North Nejatolahi Street, Tehran, 1598718311, Iran
| | - Mohammad Reza Zarkesh
- Department of Neonatology, Yas Hospital Complex, Tehran University of Medical Sciences, Sarv Ave., North Nejatolahi Street, Tehran, 1598718311, Iran.
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Hernando J, Riera-Arnau J, Roca M, Garcia A, Capdevila J. Cervical dissecting extravasation of oxaliplatin: A case report. Mol Clin Oncol 2022; 16:60. [PMID: 35127085 DOI: 10.3892/mco.2022.2493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Oxaliplatin is a chemotherapy drug considered to be an irritant and vesicant. Peripheral extravasation could happen following oxaliplatin chemotherapy administration, but mediastinal or cervical events are rare. The present study focused on the case of a 64-year-old female patient with KRAS-mutated colorectal adenocarcinoma. The patient was prescribed folinic acid, fluorouracil and oxaliplatin chemotherapy via a subcutaneous pump or port-a-cath device, which was inserted into the right subclavian vein. The patient reported a sudden throbbing pain in the chest wall and anterior cervical region. After performing a computed tomography scan, anterior cervical collection and jugular-subclavian venous confluence at the distal end was observed at the venous access site of the subcutaneous port-a-cath device, which extended cranially, dissected cervical planes and forming a hydro-aerial collection in the submaxillary region. Subsequently, the port-a-cath device was removed and a warm dry compress was applied. After 2 weeks, the patient had fully recovered without any sequelae at the cervical level. To the best of the authors' knowledge, this is the first case of cervical extravasation of oxaliplatin reported in the literature to date and will help to manage similar situations.
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Affiliation(s)
- Jorge Hernando
- Gastrointestinal and Endocrine Tumors Unit, Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | - Judit Riera-Arnau
- Clinical Pharmacology Service, Department of Pharmacovigilance and Pharmacoepidemiology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | - Maria Roca
- Gastrointestinal and Endocrine Tumors Unit, Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | - Alejandro Garcia
- Gastrointestinal and Endocrine Tumors Unit, Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | - Jaume Capdevila
- Gastrointestinal and Endocrine Tumors Unit, Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Autonomous University of Barcelona, 08035 Barcelona, Spain
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Evidence-Based Medicine G, Neonatologist S, Chinese Medical Doctor A. [Guidelines for neonatal skin management in the neonatal intensive care unit (2021)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:659-670. [PMID: 34266521 PMCID: PMC8292657 DOI: 10.7499/j.issn.1008-8830.2106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
Neonates are easily suffering from local or systematic infections due to their vulnerable skin barrier function, which leads to the increasing risk of death. Therefore, it is important to protect neonatal skin integrity and prevent neonatal skin injury in the neonatal intensive care unit (NICU). Based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and current evidence, the guidelines for neonatal skin management in the NICU were developed to provide recommendations on routine skin care and prevention and treatment of iatrogenic skin injury of neonates for health care providers.
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Yes You Can-Cautiously-Infuse Norepinephrine Intraoperatively Through a Peripheral Intravenous Catheter. Anesth Analg 2020; 131:1057-1059. [PMID: 32925323 DOI: 10.1213/ane.0000000000004616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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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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Oya M, Murayama R, Oe M, Yabunaka K, Tanabe H, Takahashi T, Matsui Y, Otomo E, Komiyama C, Sanada H. Continuous thermographic observation may predict extravasation in chemotherapy-treated patients. Eur J Oncol Nurs 2017; 28:56-61. [PMID: 28478856 DOI: 10.1016/j.ejon.2017.02.009] [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: 06/27/2016] [Revised: 02/18/2017] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Extravasation, or leakage of vesicant drugs into subcutaneous tissues, causes serious complications such as induration and necrosis in chemotherapy-treated patients. As macroscopic observation may overlook symptoms during infusion, we focused on skin temperature changes at puncture sites and studied thermographic patterns related to induration or necrosis caused by extravasation. METHODS Outpatients undergoing chemotherapy using peripheral intravenous catheters were enrolled in this prospective observational study. We filmed and classified infrared thermography movies of puncture sites during infusion; ultrasonography was also utilized at puncture sites to observe the subcutaneous condition. Multiple logistic regression analysis was performed to examine the association of thermographic patterns with induration or necrosis observed on the next chemotherapy day. Differences in patient characteristics, puncture sites, and infusions were analyzed by Mann-Whitney's U test and Fisher's exact test according to thermographic patterns. RESULTS Eight patients developed induration among 74 observations in 62 patients. Among six thermographic patterns, a fan-shaped lower temperature area gradually spreading from the puncture site (fan at puncture site) was significantly associated with induration. Ultrasonography revealed that catheters of patients with fan at puncture site remained in the vein at the end of infusion, indicating that the infusion probably leaked from the puncture site. Patients with fan at puncture site had no significant differences in characteristics and infusion conditions compared with those with the other five thermographic patterns. CONCLUSION We determined that fan at puncture site was related to induration caused by extravasation. Continuous thermographic observation may enable us to predict adverse events of chemotherapy.
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Affiliation(s)
- Maiko Oya
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Makoto Oe
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koichi Yabunaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hidenori Tanabe
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Terumo Corporation, 2-44-1 Hatagaya, Shibuya-ku, Tokyo 151-0072, Japan
| | - Toshiaki Takahashi
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yuko Matsui
- School of Nursing, Kanazawa Medical University, 1-1 Uchinadamachi, Kahoku-gun, Ishikawa 920-0293, Japan
| | - Eiko Otomo
- Department of Nursing, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Chieko Komiyama
- Department of Nursing, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Molas-Ferrer G, Farré-Ayuso E, doPazo-Oubiña F, deAndrés-Lázaro A, Guell-Picazo J, Borrás-Maixenchs N, Corominas-Bosch L, Valverde-Bosch M, Creus-Baró N. Level of adherence to an extravasation protocol over 10 years in a tertiary care hospital. Clin J Oncol Nurs 2015; 19:E25-30. [PMID: 25840394 DOI: 10.1188/15.cjon.e25-e30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extravasation of chemotherapy is an undesirable complication related to the administration of antineoplastic therapy. Establishing the real incidence is difficult. Because of the importance of a quick intervention after an extravasation, every hospital should have an extravasation protocol. OBJECTIVES The purpose of this study was to determine the degree of observance of an extravasation protocol by nursing staff and to determine extravasation incidence. METHODS This descriptive, longitudinal, retrospective study was set in a tertiary-level hospital. The researchers reviewed 117 extravasation notification forms received by the pharmacy department during a 10-year period. Nursing actuation, particularly observance of the extravasation protocol, was analyzed. FINDINGS Protocol adherence was 89%. Twelve deviations from the protocol in the application of recommended measures were detected. An antidote was used in 41 patients, and temperature measures were applied in 14 cases. Ninety-nine patients had at least one episode of reported follow-up. No cases of necrosis or skin ulcers were described, except by one patient, who developed a delayed skin ulcer to vinorelbine. Drugs most frequently reported were etoposide, carboplatin, and paclitaxel. Nursing staff should be continuously trained in extravasation protocol because a rapid actuation can prevent skin lesions.
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Management of the extravasation of anti-neoplastic agents. Support Care Cancer 2015; 23:1459-71. [DOI: 10.1007/s00520-015-2635-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/26/2015] [Indexed: 02/06/2023]
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Barbee MS, Owonikoko TK, Harvey RD. Taxanes: vesicants, irritants, or just irritating? Ther Adv Med Oncol 2014; 6:16-20. [PMID: 24381657 DOI: 10.1177/1758834013510546] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Several classes of antineoplastic agents are universally referred to as vesicants with ample supporting literature. However, the literature surrounding the taxanes is controversial. While the American Society of Clinical Oncology and Oncology Nursing Society Chemotherapy Administration Safety Standards and the Chemotherapy and Biotherapy Guidelines and Recommendations for Practice identify the risks of extravasation and the parameters surrounding the infusion of known vesicants, recommend administration sites for known agents, and recommend antidotes for particular extravasation cases, they fail to provide specific recommendations for the administration of individual taxanes, or a classification system for antineoplastic agents as vesicants, irritants, or inert compounds. There is also a lack of prescribing information regarding such recommendations. The lack of a formal classification system further complicates the accurate delineation of vesicant antineoplastic agents and subsequent appropriate intravenous administration and extravasation management. There are several factors that make the classification of taxanes as vesicants or irritants challenging. Comprehensive preclinical data describing potential mechanisms of tissue damage or vesicant-like properties are lacking. Furthermore, most case reports of taxane extravasation fail to include the parameters surrounding administration, such as the concentration of medication and duration of infusion, making it difficult to set parameters for vesicant potential. Subsequently, many practitioners default to central venous administration of taxanes without evidence that such administration minimizes the risk of extravasation or improves outcomes thereof. Here, we review briefly the data surrounding taxane extravasation and potential vesicant or irritant properties, classify the taxanes, and propose a spectrum for antineoplastic agent potential to cause tissue injury that warrants clinical intervention if extravasation occurs.
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Affiliation(s)
- Meagan S Barbee
- Department of Pharmaceutical Services, Emory Healthcare, and Mercer University College of Pharmacy and Health Sciences, 1364 Clifton Road NE, B712, Atlanta, GA 30322, USA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - R Donald Harvey
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
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Abstract
The following is a reprint from Chapter 8 in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Fourth Edition) by Martha Polovich, PhD, RN, AOCN®, MiKaela Olsen, MS, RN, AOCNS®, and Kristine B. LeFebvre, MSN, RN, AOCN® (Eds.).
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13
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Abstract
OBJECTIVE Extravasation is a potential complication associated with intravenous therapy administration. Inadvertent leakage of medications with vesicant properties can cause severe tissue necrosis, which can lead to devastating long-term consequences. Recognizing potential agents is an essential step in mitigating the risk of extravasation. DATA SOURCE A literature search was carried out using PubMed with the following key words: extravasation, soft tissue injury, phlebitis, and infiltration, from January 1961 through January 2014. STUDY SELECTION AND DATA EXTRACTION The publications were screened manually and reviewed to identify reports for medications that included synonyms of the International Nonproprietary Name, while excluding antineoplastic agents, radiographic contrast material, investigational or nonmarketed drugs, and animal data, to yield 70 articles. Furthermore, reference citations from publications were also reviewed for relevance and yielded 4 articles. DATA SYNTHESIS We discovered 232 cases of extravasation involving 37 agents (in order of frequency): phenytoin, parenteral nutrition, calcium gluconate, potassium chloride, calcium chloride, dopamine, dextrose solutions, epinephrine, sodium bicarbonate, nafcillin, propofol, norepinephrine, mannitol, arginine, promethazine, vancomycin, tetracycline, dobutamine, vasopressin, sodium thiopental, acyclovir, amphotericin, ampicillin, cloxacillin, gentamicin, metronidazole, oxacillin, penicillin, amiodarone, albumin, furosemide, lipids, lorazepam, immunoglobulin, morphine, and sodium valproate. Potential properties contributing to extravasation include the following: pH, osmolarity, diluent, vasoactive properties, and inactive ingredients. Antidotes and supportive care agents used in the management of these cases of extravasation include hyaluronidase, phentolamine, terbutaline, topical anesthetics (such as lidocaine and prilocaine cream), topical antimicrobials (such as silver sulfadiazine and chlorhexidine), topical debridement agents (collagenase ointment), topical steroids, and topical vasodilators (nitroglycerin). CONCLUSION Data on the management of noncytotoxic extravasations is sparse, consisting primarily of case reports and anecdotal evidence. Fortunately, this adverse outcome is preventable and identification of vesicant agents plays a pivotal role. The intent of this review is to provide a reference identifying noncytotoxic vesicants and the management of extravasations associated with specific agents.
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Affiliation(s)
- Ann Le
- Stanford Hospital and Clinics, Stanford, CA, USA
| | - Samit Patel
- Stanford Hospital and Clinics, Stanford, CA, USA
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Ripamonti CI, Bossi P, Santini D, Fallon M. Pain related to cancer treatments and diagnostic procedures: a no man's land? Ann Oncol 2014; 25:1097-106. [PMID: 24625453 DOI: 10.1093/annonc/mdu011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While guidelines are available for the management of cancer-related pain, little attention is given to the assessment and treatment of pain caused by treatments and diagnostic procedures in cancer patients. METHODS We evaluated the literature on pain related to cancer treatment and diagnostic procedures within a critical analysis. RESULTS The data available are sparse, suggesting that little attention has been directed at this important aspect of oncology. This points to potentially suboptimal patient management. CONCLUSIONS Appropriate studies are necessary in order to understand the incidence and appropriate management of pain, both during and/or after oncological treatments and diagnostic procedures. At the same time, Health Care Professionals should have heightened awareness of the causes and treatment of pain with the aim of anticipating and managing pain most appropriately for each individual patient. This is clearly an important component of holistic patient care before, during, and after oncological treatment.
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Affiliation(s)
- C I Ripamonti
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - P Bossi
- Head and Neck Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - D Santini
- Medical Oncology Unit, Università Campus Bio-Medico, Rome, Italy
| | - M Fallon
- St Columba's Hospice Chair of Palliative Medicine, IGMM, University of Edinburgh, Edinburgh, UK
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16
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Abstract
Reference to the concept of comfort measures is growing in the nursing and medical literature; however, the concept of comfort measures is rarely defined. For the comfort work of nurses to be recognized, nurses must be able to identify and delineate the key attributes of comfort measures. A concept analysis using Rodgers' evolutionary method (2000) was undertaken with the goal of identifying the core attributes of comfort measures and thereby clarifying this concept. Health care literature was accessed from the CINAHL and PubMed databases. No restrictions were placed on publication dates. Four main themes of attributes for comfort measures were identified during the analysis. Comfort measures involve an active, strategic process including elements of "stepping in" and "stepping back," are both simple and complex, move from a physical to a holistic perspective and are a part of supportive care. The antecedents to comfort measures are comfort needs and the most common consequence of comfort measures is enhanced comfort. Although the concept of comfort measures is often associated with end-of-life care, this analysis suggests that comfort measures are appropriate for nursing care in all settings and should be increasingly considered in the clinical management of patients who are living with multiple, chronic comorbidities.
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Affiliation(s)
- Irene Oliveira
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Canada.
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17
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Boschi R, Rostagno E. Extravasation of antineoplastic agents: prevention and treatments. Pediatr Rep 2012; 4:e28. [PMID: 25396033 PMCID: PMC4227315 DOI: 10.4081/pr.2012.e28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/02/2011] [Indexed: 11/22/2022] Open
Abstract
The extravasation of antineoplastic agents is an unwanted and distressing situation that can easily occur. It may cause severe and irreversible local injuries. Left untreated, vesicant chemotherapy extravasation can potentially cause tissue necrosis, functional impairment and permanent disfigurement. This article provides a review of current literature regarding recommendations on the prevention and treatment of extravasation of antineoplastic agents.
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Griffiths P, Richardson A, Blackwell R. Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review. Eur J Oncol Nurs 2012; 16:238-46. [DOI: 10.1016/j.ejon.2011.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/31/2011] [Accepted: 06/12/2011] [Indexed: 11/29/2022]
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Venable RO, Saba CF, Endicott MM, Northrup NC. Dexrazoxane treatment of doxorubicin extravasation injury in four dogs. J Am Vet Med Assoc 2012; 240:304-7. [PMID: 22256846 DOI: 10.2460/javma.240.3.304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 4 dogs were treated with dexrazoxane for known or suspected doxorubicin extravasation. Records were retrospectively reviewed. Doses and number of doses of dexrazoxane were variable. Dexrazoxane was administered within 2 hours after known extravasation in 3 dogs and 48 hours after suspected extravasation in 1 dog. Additional medical treatments included tissue cooling in all dogs, topically administered dimethyl sulfoxide ointment in 3, and orally administered piroxicam in 1. CLINICAL FINDINGS Mild erythema and edema at the extravasation site developed within 1 to 6 days after extravasation in the 3 dogs that received dexrazoxane within 2 hours after extravasation. Extensive tissue necrosis occurred in the dog treated 48 hours after suspected extravasation. TREATMENT AND OUTCOME Only the dog with severe tissue necrosis required surgical intervention. Lesions in the other 3 dogs resolved with medical management alone. All dogs survived the event. CLINICAL RELEVANCE To date, use of dexrazoxane in the management of doxorubicin extravasation has not been reported in dogs. Treatment was successful in 3 of 4 patients. The most effective dosage and timing of administration are unknown; however, there is evidence to suggest that administration within 6 hours after the event is warranted. Further studies are needed to confirm efficacy and to optimize use of this drug in the prevention and treatment of anthracycline extravasation injury in veterinary patients.
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Affiliation(s)
- Rachel O Venable
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
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Abstract
OBJECTIVE To present a clinical update on the prevention, detection, and evidence-based management of vesicant chemotherapy extravasations. DATA SOURCES Journal articles, published and unpublished case reports, personal experience. CONCLUSION In the 4 years that have elapsed since the publication of the original article, much more is known about vesicant chemotherapy extravasation, and effective evidence-based treatments now are available. The antidotes sodium thiosulfate for mechlorethamine extravasations and hyaluronidase for plant alkaloid extravasations are recommended by the manufacturers of these vesicants and cited in nursing guidelines. The anthracycline extravasation treatment dexrazoxane for injection, the first and only extravasation treatment with proven effectiveness, is now available as Totect (dexrazoxane; TopoTarget USA, Rockaway, NJ, USA) in the US and Savene (SpePharm, Amsterdam, The Netherlands) in Europe. IMPLICATIONS FOR NURSING PRACTICE Nurses who administer vesicant chemotherapy agents need to be aware of the most current evidence (or lack of evidence) for various types of extravasation treatment. Well-informed nurses are patient advocates and instrumental in detecting, managing, and documenting extravasations. Most importantly, nurses play a key role in preventing vesicant chemotherapy extravasations.
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Chanes DC, da Luz Gonçalves Pedreira M, de Gutiérrez MGR. Antineoplastic agents extravasation from peripheral intravenous line in children: a simple strategy for a safer nursing care. Eur J Oncol Nurs 2011; 16:17-25. [PMID: 21440502 DOI: 10.1016/j.ejon.2011.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 10/14/2010] [Accepted: 01/16/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The antineoplastic agents infusion through peripheral lines may lead to several adverse events such as extravasation that is one of the most severe acute reactions of this sort of treatment. The extravasation prevention and management must be part of a safe and evidence-based nursing care. Due to this fact, two algorithms were developed with the purpose of guiding nursing care to children who undergo chemotherapy through peripheral line. The objectives of this study were to determine the content validity of both algorithms with pediatric oncology nurses in Brazil and United States of America, and to verify the agreement between the evaluations of both groups. METHODS AND SAMPLE A descriptive validation study was carried out through the Delphi Technique that has the following steps: development of the data collection instrument, application to the specialists, data analysis, algorithms' review, re-evaluation by the specialists, final data analysis and content validity determination. RESULTS The data analysis was descriptive and based on the specialists agreement consensus equal or higher than 80% in every step of the algorithms. The process showed that the agreement with both instruments ranged from 92.8% to 99.0%. CONCLUSION The algorithms are valid for application in nursing care with the main purpose of preventing and managing the antineoplastic agents' extravasation.
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Gozzo TDO, Panobianco MS, Clapis MJ, de Almeida AM. Dermatological toxicity in women with breast cancer undergoing chemotherapy treatment. Rev Lat Am Enfermagem 2010; 18:681-7. [PMID: 20922313 DOI: 10.1590/s0104-11692010000400004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 05/03/2010] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the occurrence of skin toxicity caused by drugs used in the protocol of neoadjuvant and adjuvant chemotherapy among women with breast cancer. Patient records of 72 women who were subject to this therapy between 2003 and 2006 were assessed. Of the 558 cycles of chemotherapy, 152 adverse events were registered. There were 37 registrations of dermatological toxicity, of those, 20 were extravasations that affected 17 women. Nine reports of hardened local injury, local fibrosis, pain, and hyperemia were registered during neoadjuvancy. In adjuvancy, among the 11 extravasations registered there were reports of hardened local injury, fibrosis and local pain. Lack of follow-up records for both periods was observed. Registration of the events and reports by the nursing team are essential to monitor the sites of venous puncture during the chemotherapy treatment, besides measuring and making a photographic record of the site.
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Criado PR, Brandt HRC, Moure ERD, Pereira GLS, Sanches Júnior JA. Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte II. An Bras Dermatol 2010; 85:591-608. [DOI: 10.1590/s0365-05962010000500002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Indexed: 01/16/2023] Open
Abstract
Os eventos e reações envolvendo quimioterapia são frequentes na prática oncológica. Agentes quimioterápicos são uma modalidade de tratamento amplamente utilizada. Efeitos colaterais podem variar de frequência e também ser confundidos com outras manifestações tegumentares do tratamento oncológico. Este artigo objetiva expor as informações sobre reações cutâneas à quimioterapia, em especial, aqueles para os quais o dermatologista é requisitado a emitir parecer e a comentar sobre a segurança e a viabilidade da readministração de uma droga específica. Os autores descrevem os aspectos associados a esses eventos, fazendo uma análise detalhada de cada um deles.
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Abstract
Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. Consequences range from local irritation to amputation. While immediate action using appropriate measures (ie, dilution, extraction, antidotes, and supportive treatments) can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures. However, timely surgical intervention, when necessary, can prevent more serious adverse outcomes. Clinicians should be prepared to act promptly when an event occurs. Thorough incident documentation helps determine whether infusion care meets the standard of practice and is a keystone to medicolegal defense.
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Schulmeister L. Vesicant Chemotherapy Extravasation Antidotes and Treatments. Clin J Oncol Nurs 2009; 13:395-8. [DOI: 10.1188/09.cjon.395-398] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Kathy Froiland
- GlaxoSmithKline, 200 North 16th Street, Philadelphia, PA 19102, USA.
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Abstract
Anthracycline chemotherapy agents bind to DNA and cause cell death when they extravasate into healthy tissue. Although many approaches to managing extravasations have been studied and reported, data from two prospective clinical trials suggest that Totect (dexrazoxane for injection, TopoTarget USA, Inc.) is an effective anthracycline extravasation treatment. Only 1 of 54 patients with doxorubicin or epirubicin biopsy-confirmed extravasations treated with Totect developed tissue necrosis. Because nurses are on the forefront of extravasation prevention and management, they need to be knowledgeable about this new agent and how it is administered.
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