Vesicant Extravasation Part I: Mechanisms, Pathogenesis, and Nursing Care to Reduce Risk

Carmel Sauerland

Constance Engelking

Rita Wickham

Dominick Corbi

ONF 2006, 33(6), 1134-1141. DOI: 10.1188/06.ONF.1134-1141

Purpose/Objectives: To review the literature regarding the incidence, current practice, guideline recommendations, nursing management, and knowledge gaps relevant to vesicant extravasation.

Data Sources: Published research articles, books, case reports, and national guidelines.

Data Synthesis: Vesicant extravasation is a relatively rare but significant complication of chemotherapy administration. Extravasation may have a range of consequences that can cause serious physical and quality-of-life effects. Knowledge of risk factors and preventive measures can reduce patient risk. Data-based and empirical management strategies such as immediate local measures (agent withdrawal, comfort measures, and medical interventions) may minimize risk for extravasation, as well as lead to timely recognition and management and decreased morbidity should extravasation occur.

Conclusions: Vesicant extravasation and sequelae constitute a complex patient problem that clinicians should strive to prevent or to minimize injury should it occur. To this end, clinicians must demonstrate awareness of risks and use specialized knowledge while administering vesicant agents.

Implications for Nursing: Only nurses knowledgeable about extravasation and skilled in associated techniques should assume responsibility for vesicant administration.

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    References

    Andris, D.A., & Krzywda, E.A. (1997). Catheter pinch-off syndrome: Recognition and management. Journal of Intravenous Nursing, 20, 233-237.

    Baur, M., Kienzer, H.R., Rath, T., & Dittrich, C. (2000). Extravasation of oxaliplatin (Eloxatin®)—Clinical course. Onkologie, 23, 468-471.

    Berghammer, P., Pohnl, R., Baur, M., & Dittrich, C. (2001). Docetaxel extravasation. Supportive Care in Cancer, 9, 131-134.

    Boyle, D.M., & Engelking, C. (1995). Vesicant extravasation: Myths and realities. Oncology Nursing Forum, 22, 57-67.

    Bozkurt, A.K., Uzel, B., Akman, C., Ozguroglu, M., & Molinas Mandel, N. (2003). Intrathoracic extravasation of antineoplastic agents: Case report and systematic review. American Journal of Clinical Oncology, 26, 121-123.

    Camp-Sorrell, D. (2004). Access device guidelines: Recommendations for nursing practice and education. Pittsburgh, PA: Oncology Nursing Society.

    Curran, C.F., & Luce, J.K. (1990). Extravasation of doxorubicin from vascular access devices. Selective Cancer Therapeutics, 6, 103-107.

    Davies, A.G., Russell, W.C., & Thompson, J.P. (2003). Extravasation and tissue necrosis secondary to central line infusions [Letter]. Anaesthesia, 58, 820-821.

    Debets, J.M., Wils, J.A., & Schlangen, J.T. (1995). A rare complication of implanted central-venous access devices: Catheter fracture and embolization. Supportive Care in Cancer, 3, 432-434.

    Dorr, R.T. (1990). Antidotes to vesicant chemotherapy extravasations. Blood Reviews, 4, 41-60.

    D'Silva, K., Dwivedi, A.J., Shetty, A., & Ashare, R. (2005). Pinch-off syndrome: A rare complication of totally implantable venous devices [Letter]. Breast Journal, 11, 83-84.

    El Saghir, N.S., & Otrock, Z.K. (2004). Docetaxel extravasation into the normal breast during breast cancer treatment [Case reports]. Anti-Cancer Drugs, 15, 401-404.

    Ener, R.A., Meglathery, S.B., & Styler, M. (2004). Extravasation of systemic hemato-oncological therapies. Annals of Oncology, 15, 858-862.

    Foo, K.F., Michael, M., Toner, G., & Zalcberg, J. (2003). A case report of oxaliplatin extravasation [Letter]. Annals of Oncology, 14, 961-962.

    Goodman, M., & Riley, M. (1997). Chemotherapy: Principles of administration. In S. Groenwald, M.H. Frogge, M. Goodman, & C.H. Yarbro (Eds.), Cancer nursing: Principles and practice (4th ed., pp. 356-357). Sudbury, MA: Jones and Bartlett.

    Gorski, L.A. (2003). Central venous access device occlusions. Part 2: Nonthrombotic causes and treatment. Home Healthcare Nurse, 21, 168-171.

    Hackert, T., Tjaden, C., Kraft, A., Sido, B, Dienemann, H., & Buchler, M.W. (2000). Intrapulmonal dislocation of a totally implantable venous access device. World Journal of Surgical Oncology, 3(19), 1-6. Retrieved June 6, 2005, from http://www.wjso.com/content/3/1/19

    Hadaway, L.C. (2002). IV infiltration: Not just a peripheral problem. Nursing 2002, 32(8), 36-42.

    Hadaway, L.C. (2004). Preventing and managing peripheral extravasation. Nursing 2004, 34(5), 66-67.

    Heitmann, C., Durmus, C., & Ingianni, G. (1998). Surgical management after doxorubicin and epirubicin extravasation. Journal of Hand Surgery (British and European Volume), 23B, 666-668.

    Kennedy, J.G., Donahue, J.P., Hoang, P., & Boland, P.J. (2003). Vesicant characteristics of oxaliplatin following antecubital extravasation. Clinical Oncology, 15, 237-239.

    Kretzschmar, A., Pink, D., Thuss-Patience, P., Dorken, B., Reichart, P., & Eckert R. (2003). Extravasations of oxaliplatin. Journal of Clinical Oncology, 21, 4068-4069.

    Langer, S.W., Sehested, M., & Jensen, P.B. (2000). Treatment of anthracycline extravasation with dexrazoxane. Clinical Cancer Research, 6, 3680-2386.

    Lauvin, R., Miglianico, L., & Hellegouarc'h, R. (1995). Skin cancer occurring 10 years after the extravasation of doxorubicin [Letter]. New England Journal of Medicine, 332, 754.

    Lemmers, N.W., Gels, M.E., Sleijfer, D.T., Plukker, J.T., van der Graaf, W.T., de Langen, Z.J., et al. (1996). Complications of venous access ports in 132 patients with disseminated testicular cancer treated with polychemotherapy. Journal of Clinical Oncology, 14, 2916-2922.

    Lipson, J., Dibble, S., & Minarik, P. (Eds.). (1996). Culture and nursing care: A pocket guide. San Franciso: University of California, San Francisco, Nursing Press.

    Loth, T.S., & Eversmann, W.W., Jr. (1991). Extravasation injuries in the upper extremity. Clinical Orthopaedics and Related Research, 272, 248-254.

    Luke, E. (2005). Mitoxantrone-induced extravasation. Oncology Nursing Forum, 32, 27-29.

    Marders, J. (2005). Sounding the alarm for IV infiltration. Nursing 2005, 35(4), 18, 20.

    Mayo, D.J. (1998). Fibrin sheath formation and chemotherapy extravasation: A case report. Supportive Care in Cancer, 6, 51-56.

    Peterson, J., & Blendowski, C. (2001). Tips for administering chemotherapy. In R. Gates & R. Fink (Eds.), Oncology nursing secrets (2nd ed., pp. 67-77). Philadelphia: Hanley and Belfus.

    Polovich, M., White, J., & Kelleher, L. (Eds.). (2005). Chemotherapy and biotherapy guidelines and recommendations for practice (2nd ed.). Pittsburgh, PA: Oncology Nursing Society.

    Raymond, E., Faivre, S., Woynarowski, J.M., & Chaney, S.G. (1998). Oxaliplatin: Mechanism of action and antineoplastic activity. Seminars in Oncology, 25(2, Suppl. 5), 4-12.

    Rivory, L.P. (2002). New drugs for colorectal cancer—Mechanisms of action. Australian Prescriber. Retrieved October 9, 2006, from http://www.australianprescriber.com/magazine/25/5/108/10/

    Rudolph, R., & Larson, D.L. (1987). Etiology and treatment of chemotherapeutic agent extravasation injuries: A review. Journal of Clinical Oncology, 5, 1116-1126.

    Schrijvers, D.L. (2003). Extravasation: A dreaded complication of chemotherapy. Annals of Oncology, 14(Suppl. 3), 26-30.

    Schulmeister, L., & Camp-Sorrell, D. (2000). Chemotherapy extravasation from implanted ports. Oncology Nursing Forum, 27, 531-538.

    Schummer, W., Schummer, C., Bayer, O., Muller, A., Bredle, D., & Karzai, W. (2005). Extravasation injury in the perioperative setting. Anesthesia and Analgesia, 100, 722-727.

    Scuderi, N., & Onesti, M.G. (1994). Antitumor agents: Extravasation, management, and surgical treatment. Annals of Plastic Surgery, 32, 39-44.

    Shetty, P.C., Mody, M.K., Kastan, D.J., Sharma, R.P., Burke, M.W., Venugopal, C., et al. (1997). Outcome of 350 implanted chest ports placed by interventional radiologists. Journal of Vascular and Interventional Radiology, 8, 991-995.

    Skeel, R.T. (1999). Handbook of cancer chemotherapy (5th ed.). New York: Lippincott Williams and Wilkins.

    Stanford, B.L., & Hardwicke, F. (2003). A review of clinical experience with paclitaxel extravasations. Supportive Care in Cancer, 11, 270-277.

    Starkhammar, H., Bengtsson, M., & Morales, O. (1992). Fibrin sleeve formation after long term brachial catheterisation with an implantable port device. A prospective venographic study. European Journal of Surgery, 158, 481-484.

    Steele, C. (1998). Extravasation. In J. Yasko (Ed.), Nursing management of symptoms associated with chemotherapy (4th ed., pp. 191-224). Bala Cynwyd, PA: Meniscus Health Care Communications.

    Vargel, I., Erdem, A., Ertoy, D., Pinar, A., Erk, Y., Altundag, M.K., et al. (2002). Effects of growth factors on doxorubicin-induced skin necrosis: Documentation of histomorphological alterations and early treatment by GM-CSF and G-CSF. Annals of Plastic Surgery, 49, 646-653.

    Viale, P.H. (2003). Complications associated with implantable vascular access devices in the patient with cancer. Journal of Infusion Nursing, 26, 97-102.

    Wickham, R. (1989). Extravasation from venous access devices. Outpatient Chemotherapy, 3(4), 3-4, 8, 10-11.