Prevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review

Melo, João Marcos Alves; Oliveira, Patrícia Peres de; Souza, Raíssa Silva; Fonseca, Deborah Franscielle da; Gontijo, Thaís Fonseca; Rodrigues, Andrea Bezerra

doi:10.1590/0034-7167-2019-0008

Brasil

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

REVIEW • Rev. Bras. Enferm. 73 (4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0008 linkcopy

Prevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review

Prevención y conducta ante la Extravasación de quimioterápicos antineoplásicos: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to identify and synthesize scientific evidence on prevention and management of extravasation of antineoplastic agents in adult patients by nurses.

Methods: scoping review, according to Joanna Briggs Institute and PRISMA-ScR. Research was conducted in five electronic databases, Cochrane Library and eight catalogs of theses and dissertations. Data collection occurred from April to July 2018, with no time limit. The extracted data were analyzed and synthesized in a narrative way.

Results: a total of 3,110 records were retrieved and 18 studies were kept for review. Most publications (66.6%) had a qualitative approach and addressed both aspects, i.e., prevention and management of extravasation of chemotherapy in adult patients.

Conclusions: the implementation of protocols based on scientific evidence on prevention and management of extravasation of antineoplastic agents is paramount in order to provide patient safety and support to the nursing staff.

Descriptors: Combined Chemotherapy; Antineoplastic Agents; Nursing Care; Extravasation of Therapeutic and Diagnostic Materials; Oncology

Author(s)	Year	Type / Title	Journal or institution	Objective(s)
Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al ⁽⁹⁾	2017	Article / Chemotherapy extravasation: establishing a national benchmark for incidence among cancer centers	Clinical Journal of Oncology Nursing	- To evaluate vesicant extravasation of CT in adult cancer patients (739,812 doses of vesicant and irritant CT infusions were included in the evaluation of 11 cancer services); - To report the incidence of extravasation of vesicants and irritants with potential vesicant.
Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al ⁽¹⁵⁾	2017	Article / Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions	Journal of Infusion Nursing	- To evaluate the predictive validity of thermography to identify extravasation during intravenous antineoplastic therapy.
Custódio CS ⁽¹⁶⁾	2016	Dissertation / Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal	Repository of UnB	- To evaluate changes in peripheral veins used for chemotherapy infusion in breast cancer patients over the course of treatment and to describe care and guidance in choosing venous access for CT infusion.
Freitas KABS ⁽¹⁷⁾	2015	Dissertation / Estratégias para administração segura de antineoplásicos	Institutional Repository of UNESP	- To trace the profile and knowledge in CT of inpatient nurses of a University Hospital and develop strategies for safe administration of antineoplastic drugs.
Harrold K, Gould D, Drey N ⁽¹⁸⁾	2015	Article / The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice	European Journal of Oncology Nursing	- To critically analyze the quality of evidence supporting contemporary practice of extravasation of CT management and to verify whether patient experience is taken into account in relation to extravasation of CT management.
Muthuramalingam S, Gale J, Bradbury J ⁽¹⁹⁾	2013	Article / Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice	International Journal of Clinical Practice	- To report UK case review (102) on the efficacy of Dexrazoxane for the treatment of anthracycline extravasation.
Harrold K, Gould D, Drey N ⁽²⁰⁾	2013	Article / The efﬁcacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report	European Journal of Cancer Care	- To present the results of a historical case series of extravasation of CT administered by saline washout and; evaluate the effectiveness of the procedure based on patient outcome.
Drake D ⁽²¹⁾	2012	Article / Emergency management of anthracycline extravasation	Emergency Medicine Journal	- To establish that intravenous dexrazoxane reduces the risk of tissue necrosis following anthracycline chemotherapy extraction.
Schneider, F; Pedrolo, E. ⁽²²⁾	2011	Article / Extravasamento de drogas antineoplásicas: avaliação do conhecimento da equipe de enfermagem	Revista Mineira de Enfermagem	- To point out the importance of improvement in service and the elaboration of a clinical guideline, so that professionals can identify patients at higher risk of extravasation of CT, promote prevention and damage minimization actions.
Adami NP, de Gutiérrez MG, da Fonseca SM, de Almeida EP ⁽²³⁾	2005	Article / Risk management of extravasation of cytostatic drugs at the adult chemotherapy outpatient clinic of a University Hospital	Journal of Clinical Nursing	- To check the incidence of antineoplastic drug extravasation in outpatients treated at a university hospital for five years and to evaluate the quality of care provided by the nursing staff.
Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al ⁽²⁴⁾	1992	Article / Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach	Cancer Chemotherapy and Pharmacy	- To comparatively evaluate the effectiveness of a conservative approach to treatment using two therapeutic regimens (with or without sodium thiosulfate).
Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS ⁽²⁵⁾	1988	Article / A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation	Journal of Clinical Oncology	- To introduce anthracycline extravasation treatment with 99% topical dimethyl sulfoxide (DMSO) over a three-month period with regular examinations and photographs.

Author(s)	Year	Type/Title	Journal or institution	Objective(s)
Dougherty L, Oakley C ⁽²⁶⁾	2011	Article / Advanced practice in the management of extravasation	Cancer Nursing Practice	- To describe flush-out training for nurses to provide more timely and less inconvenient interventions for patients.

Author(s)	Year	Type/Title	Journal or institution	Objective(s)
Onesti MG, Carella S, Fioramonti P, Scuderi N ⁽²⁷⁾	2017	Article / Chemotherapy Extravasation Management: 21-Year Experience	Annals of Plastic Surgery	- To explore prevention and treatment of extravasation injuries by proposing a standard therapeutic protocol along with a literature review.
Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al ⁽²⁸⁾	2015	Article / Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol	Support Care Cancer	- To observe the extravasation of antineoplastic agents from 169 patients and evaluate the effectiveness of their interdisciplinary management in a single research setting.
de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al ⁽²⁹⁾	2013	Article / Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment	Onkologie	- To review and discuss the practice in the diagnosis and management of extravasation of CT.
Pérez Fidalgo JA, García Fabregat L, Cervantes A, et al ⁽³⁰⁾	2012	Article / Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines	European Journal of Oncology Nursing	- To introduce the European Society for Medical Oncology Guidelines published in cooperation with the European Oncology Nursing Society (EONS).
Wengström Y, Margulies A, European Oncology Nursing Society Task Force ⁽³¹⁾	2008	Article / European Oncology Nursing Society extravasation guidelines.	European Journal of Oncology Nursing	- To introduce European Oncology Nursing Society Guidelines for prevention, detection, and management of extravasation.

Prevention measures of the extravasation of antineoplastic agent in adults
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 ⁽⁹^,¹⁵^,¹⁷^,²²^,²⁶^,²⁸^,³⁰⁾
Advise the patient to report any level of pain, burning, tingling or itching, which suggests perceptive infiltration, i.e., oriented to recognize extravasation ⁽¹⁶^-¹⁸^,²²^,²⁹^-³¹⁾
Avoid puncture in limbs with loss of sensation, surgical manipulation site and previously irradiated limbs ⁽¹⁶^-¹⁷^,²²^,²⁶^,³⁰⁾
Avoid puncturing sites such as wrist, back of the hand and joints ⁽¹⁵^-¹⁷^,²²^,²⁸^-³¹⁾
Avoid using piped peripheral access for more than 24 hours, preferring puncture at the moment ⁽¹⁶^-¹⁷^,²⁹^-³¹⁾
Avoid using rigid devices for the administration of vesicant CT ⁽¹⁷^,²²^,³⁰⁾
Always use as the ideal material for a peripheral venous catheter for CT administration: chemically inert, non-thrombogenic, flexible, radiopaque and transparent ⁽¹⁷^,²²^,³⁰⁾
Secure venous access with means that make the puncture site visible ⁽¹⁵^,²⁰⁾
Constantly assess for risk of peripheral venous extravasation ⁽⁹^,¹⁵^-¹⁹^,²²^,²⁷^-³¹⁾
Check blood flow after puncture and then flush with 10 ml normal saline and check for signs of extravasation ⁽²⁹^-³⁰⁾.
Wash with 10 to 20 ml saline between different anti-neoplastic drug infusions ⁽³⁰^-³¹⁾
Check blood flow before CT is administered and regularly during bolus infusion ⁽³⁰^-³¹⁾
Administer physiological solutions concomitantly with vesicant and / or irritant CT infusion ⁽¹⁶^,³⁰^-³¹⁾
Monitor the punctured access, both to assess its permeability, as well as for the quick visualization of possible reactions from vascular lesions or extravasation ⁽⁹^,¹⁵^-¹⁷^,³⁰^-³¹⁾
Contraindicating the use of bolus CT infusion pumps ⁽¹⁷^,³⁰^-³¹⁾
Training nursing staff and implementing CT overflow prevention protocols are crucial ⁽⁹^,¹⁶^-¹⁷^,²²^,²⁸^-³⁰⁾
Recommend the use of central venous access for administration of vesicants or irritants ⁽⁹^,¹⁶^-¹⁷^,³⁰⁾
Advise patients to obtain central venous access, where indicated, and provide informed consent on the risks and benefits of such access ⁽⁹^,²⁹^-³⁰⁾
Conduct before the extravasation of antineoplastic agents in adults
Use the incidence of extravasation as a quality indicator ⁽⁹^,¹⁸^,³⁰⁾
Train nursing staff and implement conduct protocols in CT extravasations ⁽²⁰^,²²^,²⁶^-²⁸^,³⁰^-³¹⁾
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 ⁽²⁶^,³⁰^-³¹⁾
Stopping CT infusion is the first measure when extravasation occurs or is suspected ⁽⁹^,¹⁷^,²²^,²⁷^,³⁰^-³¹⁾
Beware for: In the event of a suspicious spill, treat it as a real event ⁽⁹^,³⁰⁾
Perform drug aspiration, limb elevation and application of thermal compress (cold or heat) ⁽¹⁷^,²⁰^,²²^,²⁷^,³⁰^-³¹⁾
Demarcate and photograph CT overflow area ⁽¹⁷^,²⁴^-²⁵^,³⁰^-³¹⁾
Apply compress for 20 minutes four times a day for one or two days only for CT classified as Vinca Alkaloids ⁽¹⁷^,²²^,³¹⁾
Apply cold compresses to anthracycline extravasations, tumor antibiotics and alkylating agents. Only on oxaliplatin is heat applied ⁽¹⁷^,²²^-²³⁾
Follow up CT extravasation (nurse and patient provider), whether actual or suspected extravasation ⁽¹⁷^,²⁴^-²⁸^,³⁰^-³¹⁾
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 ⁽⁹^,¹⁷^,²⁸^,³⁰⁾
Start as early as possible (up to 6 hours) dexrazoxane (Savene^®), the only antidote licensed for the treatment of anthracycline extravasation ⁽¹⁹^-²¹^,²⁷^,³⁰^-³¹⁾; 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 ⁽¹⁷^-¹⁹^,²¹^,³⁰⁾
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 ⁽¹⁸^,²⁷^-²⁸^,³⁰⁾
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 ⁽²⁴^,³⁰^-³¹⁾
Administer hyaluronidase by subcutaneous injection (150-900 IU around the extravasation area) in case of Vinca Alkaloid extravasation ⁽²⁸^,³⁰^-³¹⁾ after application of dry heat for a period of seven days (three times daily) ⁽²⁸^,³⁰^-³¹⁾
Administer subcutaneous injection hyaluronidase 150-900 UI around the taxane extravasation area ⁽³⁰⁾, without heat application after paclitaxel extravasation ⁽²⁸⁾
Beware not to use subcutaneous ⁽²⁸^,³⁰⁾ and topical corticosteroids in CT extravasations ⁽¹⁷^,²⁸^,³⁰⁾
Notify the patient's physician and a plastic surgeon should be consulted within 24 hours of detection of vesicant antineoplastic agent extravasation ⁽²⁸^,³⁰^-³¹⁾
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 ⁽⁹^,¹⁶^-³¹⁾
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 ⁽¹⁸^,²⁹^-³¹⁾

vertical_align_top file_download show_chart

more_horizclose
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

Acessibilidade / Reportar erro

[TFN1] Note: CT - chemotherapy.