Management of extravasation in cancer patients: what is the evidence?
Extravascular escape of intravenously administered cytotoxic drugs can result in serious local soft tissue injury.
Injury can range from simple phlebitis to chemical
cellulitis, or in extreme cases, frank tissue necrosis that
necessitates skin grafting or, in rare circumstances, may require
amputation. Published vesicant extravasation incidence rates range
from 0.01 per cent to 6.5 per cent.1
Purpose
Access to evidence-based protocols may minimise the risk of
extravasation and lead to timely recognition, management and
decreased morbidity should extravasation occur.
The aim of this work is to provide clinicians with a current and
evidence-based extravasation management protocol on the eviQ Cancer Treatments Online
website.
Method
A systematic literature review was undertaken including CINAHL,
Medline, Embase, Cochrane, Clinical Evidence, EBMR Pubmed and
Google Scholar, hospital based protocols and professional
organisations. The current evidence and recommendations were
debated at eviQ reference committee meetings.
Results
A safe administration of intravenous chemotherapy protocol and
an extravasation management protocol was developed by clinicians.
These protocols cover prevention, the recognition of extravasation,
the possible treatments with antidotes, an immediate management
quick-links table, immediate management flow charts, an assessment
chart and patient information. Over the past five months
these protocols have received 6,815 visits on the eviQ website from
all Australian states and territories with an average time spent on
each page of 1 minute 39 seconds.
Numerous questions remain unanswered about the issues
surrounding extravasation management. Although several drugs and
substances have been evaluated as vesicant extravasation antidotes
and treatments, data on their safety and efficacy are limited and
largely based on the results of animal studies and case reports. In
addition, local and international protocols have conflicting
recommendations and show a wide variation in clinical practice.
This has highlighted the importance of collecting case reports
systematically on extravasation injuries.
In 2011 eviQ will undertake a two phased study. The first phase
will be to collect extravasation case reports through a
standardised data collection form available on eviQ. Reporting will
be voluntary and all information de-identified. Information
collected will include demographics, location and types of
extravasation injuries, contributing factors, types of catheters
used, fluid and medications, antidotes and treatment outcomes which
will be followed longitudinally. The second phase of the
project will be to undertake either a cohort or case series
analysis of the data.
Conclusion
It is envisaged that collecting information on the management of
extravasation injuries through a standardised central reporting
database will help to measure the effectiveness of interventions,
improve patient outcomes on an ongoing basis, and build on the
current evidence.
Some of the resources, protocols and assessment tools for
extravasation management available on eviQ
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- Polovich, M; White, J. & Kelleher, L.(eds) 2005.
"Chemotherapy and Biotherapy Guideline". 2nd Ed. Oncology Nursing
Society. Pittsburgh.
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