Safe management of chemotherapy: infusion-related complications

Managing Chemotherapy Extravasation Across Transitions of Care: A Clinical Nurse Specialist Initiative

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.

Delayed presentation of doxorubicin extravasation into pleural space: Case report and review of literature

INTRODUCTION

Intrathoracic extravasation of anthracyclines is a dangerous and very rare complication of chemotherapy administration. While management of extravasation into soft tissues has been established, the data on treatment of mediastinal and intrapleural anthracycline extravasation is limited.

CASE REPORT

We present a case of a 52-year-old woman with intrapleural doxorubicin extravasation who presented to the hospital 24-hrs after chemotherapy infusion with chest pain and shortness of breath.

MANAGEMENT & OUTCOME

The patient underwent urgent surgical intervention and received IV dexrazoxane 36-hrs after the event. Her pain improved, but she continued to have chest soreness and pleural effusion at the site of extravasation even 3 months later.

DISCUSSION

We conducted review of literature using Medline/PubMed and Google Scholar databases and identified 7 cases of intrapleural and mediastinal anthracycline extravasation. No data is currently available regarding the outcome of delayed management of intrapleural anthracycline extravasation with dexrazoxane. Prevention and confirmation of adequate port catheter placement is the most important step to avoid such cases. Catheter misplacement should be suspected in any patient presenting with post procedural chest pain and should trigger a thorough evaluation prior to any chemotherapy administration.