Beware of each individual's risk factors (threadlike and/or fragile veins, obesity, multiple previous venous punctures, presence of disseminated skin diseases (e.g., eczema or psoriasis), patient movement and level of consciousness (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1515 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article...
,1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2626 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp
http://cancernursingpractice.rcnpublishi...
,2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
|
Advise the patient to report any level of pain, burning, tingling or itching, which suggests perceptive infiltration, i.e., oriented to recognize extravasation (1616 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016.
17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. -1818 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363
https://doi.org/10.1111/ecc.12363...
,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2929 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Avoid puncture in limbs with loss of sensation, surgical manipulation site and previously irradiated limbs (1616 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. -1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2626 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp
http://cancernursingpractice.rcnpublishi...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
|
Avoid puncturing sites such as wrist, back of the hand and joints (1515 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article...
16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. -1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Avoid using piped peripheral access for more than 24 hours, preferring puncture at the moment (1616 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. -1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2929 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Avoid using rigid devices for the administration of vesicant CT (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
|
Always use as the ideal material for a peripheral venous catheter for CT administration: chemically inert, non-thrombogenic, flexible, radiopaque and transparent (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
|
Secure venous access with means that make the puncture site visible (1515 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article...
,2020 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023
https://doi.org/10.1111/ecc.12023...
)
|
Constantly assess for risk of peripheral venous extravasation (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1515 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article...
16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016.
17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015.
18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363
https://doi.org/10.1111/ecc.12363...
-1919 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103
https://doi.org/10.1111/ijcp.12103...
,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2727 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248
https://doi.org/10.1097/SAP.000000000000...
28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Check blood flow after puncture and then flush with 10 ml normal saline and check for signs of extravasation (2929 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
-3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
). |
Wash with 10 to 20 ml saline between different anti-neoplastic drug infusions (3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Check blood flow before CT is administered and regularly during bolus infusion (3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Administer physiological solutions concomitantly with vesicant and / or irritant CT infusion (1616 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Monitor the punctured access, both to assess its permeability, as well as for the quick visualization of possible reactions from vascular lesions or extravasation (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1515 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article...
16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. -1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Contraindicating the use of bolus CT infusion pumps (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Training nursing staff and implementing CT overflow prevention protocols are crucial (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1616 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. -1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
-3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
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Recommend the use of central venous access for administration of vesicants or irritants (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1616 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. -1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
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Advise patients to obtain central venous access, where indicated, and provide informed consent on the risks and benefits of such access (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,2929 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
-3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
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Conduct before the extravasation of antineoplastic agents in adults
|
Use the incidence of extravasation as a quality indicator (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1818 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363
https://doi.org/10.1111/ecc.12363...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
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Train nursing staff and implement conduct protocols in CT extravasations (2020 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023
https://doi.org/10.1111/ecc.12023...
,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2626 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp
http://cancernursingpractice.rcnpublishi...
27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248
https://doi.org/10.1097/SAP.000000000000...
-2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
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Remember that if an extravasation occurs, the degree of damage depends on the type of drug, the concentration of the drug, the site and how long a drug develops its potential for damage (2626 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp
http://cancernursingpractice.rcnpublishi...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Stopping CT infusion is the first measure when extravasation occurs or is suspected (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2727 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248
https://doi.org/10.1097/SAP.000000000000...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
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Beware for: In the event of a suspicious spill, treat it as a real event (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
|
Perform drug aspiration, limb elevation and application of thermal compress (cold or heat) (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2020 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023
https://doi.org/10.1111/ecc.12023...
,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,2727 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248
https://doi.org/10.1097/SAP.000000000000...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Demarcate and photograph CT overflow area (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2424 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf
https://link-springer-com.ez18.periodico...
-2525 Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol[Internet].1988[cited 2018 20 Dec];6(11):1732-5. Available from:https://doi.org/10.1200/JCO.1988.6.11.1732
https://doi.org/10.1200/JCO.1988.6.11.17...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Apply compress for 20 minutes four times a day for one or two days only for CT classified as Vinca Alkaloids (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
,3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Apply cold compresses to anthracycline extravasations, tumor antibiotics and alkylating agents. Only on oxaliplatin is heat applied (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2222 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
-2323 Adami NP, de Gutiérrez MG, da Fonseca SM, de Almeida EP. Risk management of extravasation of cytostatic drugs at the adult chemotherapy outpatient clinic of a University Hospital. J Clin Nurs [Internet]. 2005 [cited 2018 Sep 28];14(7):876-82. Available from: https://doi.org/10.1111/j.1365-2702.2005.01124.x
https://doi.org/10.1111/j.1365-2702.2005...
)
|
Follow up CT extravasation (nurse and patient provider), whether actual or suspected extravasation (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2424 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf
https://link-springer-com.ez18.periodico...
25 Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol[Internet].1988[cited 2018 20 Dec];6(11):1732-5. Available from:https://doi.org/10.1200/JCO.1988.6.11.1732
https://doi.org/10.1200/JCO.1988.6.11.17...
26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp
http://cancernursingpractice.rcnpublishi...
27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248
https://doi.org/10.1097/SAP.000000000000...
-2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
|
Follow up the extravasation by phone or in person. On day 1, after the event and at least weekly (or more often as needed). Follow-up should continue for a period of three weeks to six weeks, or until complete resolution of extravasation is complete (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
|
Start as early as possible (up to 6 hours) dexrazoxane (Savene®), the only antidote licensed for the treatment of anthracycline extravasation (1919 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103
https://doi.org/10.1111/ijcp.12103...
20 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023
https://doi.org/10.1111/ecc.12023...
-2121 Drake D. BET3: Emergency management of anthracycline extravasation. Emerg Med J [Internet]. 2012 [cited 2018 Sep 28]; 29(9):777-9. Available from:http://dx.doi.org/10.1136/emermed-2012-201686.4
http://dx.doi.org/10.1136/emermed-2012-2...
,2727 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248
https://doi.org/10.1097/SAP.000000000000...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
); administer intravenously into a vein in an area away from the extravasation site at a dose of 1000 mg/m2 day and two to 500 mg/m2 on day three (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015.
18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363
https://doi.org/10.1111/ecc.12363...
-1919 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103
https://doi.org/10.1111/ijcp.12103...
,2121 Drake D. BET3: Emergency management of anthracycline extravasation. Emerg Med J [Internet]. 2012 [cited 2018 Sep 28]; 29(9):777-9. Available from:http://dx.doi.org/10.1136/emermed-2012-201686.4
http://dx.doi.org/10.1136/emermed-2012-2...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
)
|
Start topical DMSO as early as possible (99%), preferably within 10 minutes if mitomycin C is spilled. It should be applied every 8 hours for 7 days (1818 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363
https://doi.org/10.1111/ecc.12363...
,2727 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248
https://doi.org/10.1097/SAP.000000000000...
-2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
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Use sodium thiosulfate 0.17 M (solution by mixing 4 mL sodium thiosulfate with 6 mL sterile water for injection) as a subcutaneous injection immediately if mechlorethamine is extravasated. Subcutaneous injection of 2 ml solution made from 4 ml sodium thiosulfate + 6 ml sterile water (2424 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf
https://link-springer-com.ez18.periodico...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
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Administer hyaluronidase by subcutaneous injection (150-900 IU around the extravasation area) in case of Vinca Alkaloid extravasation (2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
) after application of dry heat for a period of seven days (three times daily) (2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
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Administer subcutaneous injection hyaluronidase 150-900 UI around the taxane extravasation area (3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
), without heat application after paclitaxel extravasation (2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
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Beware not to use subcutaneous (2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
) and topical corticosteroids in CT extravasations (1717 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ,2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
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Notify the patient's physician and a plastic surgeon should be consulted within 24 hours of detection of vesicant antineoplastic agent extravasation (2828 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
,3030 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
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Document photographically (authorized in writing by the patient) and record the date, time, name of the extravasated drug, signs and symptoms, description of venous access, extravasation site, and the evolution of the case of CT extravasation (99 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445
http://dx.doi-org.ez18.periodicos.capes....
,1616 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016.
17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015.
18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363
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19 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103
https://doi.org/10.1111/ijcp.12103...
20 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023
https://doi.org/10.1111/ecc.12023...
21 Drake D. BET3: Emergency management of anthracycline extravasation. Emerg Med J [Internet]. 2012 [cited 2018 Sep 28]; 29(9):777-9. Available from:http://dx.doi.org/10.1136/emermed-2012-201686.4
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22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6...
23 Adami NP, de Gutiérrez MG, da Fonseca SM, de Almeida EP. Risk management of extravasation of cytostatic drugs at the adult chemotherapy outpatient clinic of a University Hospital. J Clin Nurs [Internet]. 2005 [cited 2018 Sep 28];14(7):876-82. Available from: https://doi.org/10.1111/j.1365-2702.2005.01124.x
https://doi.org/10.1111/j.1365-2702.2005...
24 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf
https://link-springer-com.ez18.periodico...
25 Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol[Internet].1988[cited 2018 20 Dec];6(11):1732-5. Available from:https://doi.org/10.1200/JCO.1988.6.11.1732
https://doi.org/10.1200/JCO.1988.6.11.17...
26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp
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27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248
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28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf
https://link.springer.com/content/pdf/10...
29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
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Maintain an emergency overflow kit (containing at least procedure gloves, low-permeability apron, absorbent pads, respiratory and eye protection, soap, identified waste container) always available where antineoplastic agents are administered (1818 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363
https://doi.org/10.1111/ecc.12363...
,2929 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524
https://doi.org/10.1159/000348524...
30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294
https://doi.org/10.1093/annonc/mds294...
-3131 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003
https://doi.org/10.1016/j.ejon.2008.07.0...
)
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