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1
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Belcadi K, Isfaoun Z, El Ansari N, Lakhrissi M, Fejjal N, El Khorassani M, El Kababri M, Hessissen L, Kili A. Hyperbaric Oxygen Therapy in Doxorubicin Extravasation: A Promising Future Treatment?: A Case Report. J Pediatr Hematol Oncol 2025:00043426-990000000-00573. [PMID: 40306310 DOI: 10.1097/mph.0000000000003038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 03/26/2025] [Indexed: 05/02/2025]
Abstract
Doxorubicin extravasation is a serious complication that can lead to severe local necrosis, aesthetic damage, and injury to underlying nerves, tendons, and muscles. Its management has been the subject of numerous studies, but the optimal treatment remains controversial. The limited access to dexrazoxane makes the management even more challenging. We report the case of a 17-month-old infant treated for an alveolar rhabdomyosarcoma of the soft tissues in the gluteal region, who experienced doxorubicin extravasation in the forearm. This incident was successfully managed with initial fasciotomy followed by hyperbaric oxygen therapy. We highlight the beneficial effects of hyperbaric oxygen therapy as a complementary treatment in cases of doxorubicin extravasation, supported by current data from the literature.
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Affiliation(s)
- Khadija Belcadi
- Pediatric Hematology and Oncology Department, Children's Hospital of Rabat
| | - Zineb Isfaoun
- Pediatric Hematology and Oncology Department, Children's Hospital of Rabat
| | - Naoual El Ansari
- Pediatric Hematology and Oncology Department, Children's Hospital of Rabat
| | - Meryem Lakhrissi
- Pediatric Hematology and Oncology Department, Children's Hospital of Rabat
| | - Naoufal Fejjal
- Surgery Department C, Children's Hospital of Rabat. Mohamed V University - Souissi
| | | | - Maria El Kababri
- Pediatric Hematology and Oncology Department, Children's Hospital of Rabat
| | - Laila Hessissen
- Pediatric Hematology and Oncology Department, Children's Hospital of Rabat
| | - Amina Kili
- Pediatric Hematology and Oncology Department, Children's Hospital of Rabat
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2
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Antúnez-Blancat A, Gago-Valiente FJ, García-Iglesias JJ, Merino-Navarro D. The Role of Nursing in the Management of Chemotherapy Extravasation: A Systematic Review Regarding Public Health. Healthcare (Basel) 2024; 12:1456. [PMID: 39057599 PMCID: PMC11276807 DOI: 10.3390/healthcare12141456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
The scientific literature was reviewed with the aim of analysing the state of the art on the role of nursing in the management of chemotherapy extravasation, recognising the possible risk factors and identifying effective training programmes for nurses. WOS, Scopus, and PubMed databases were used to perform the searches. Papers that met the inclusion criteria and that had been published in the last 9 years were selected. The Effective Public Health Practice Project (EPHPP) instrument was applied to the selected studies. In addition, this research was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: 512480). Out of the 23 initially selected articles, a total of 9 articles were eventually included, since they met the eligibility criteria that were established after a more exhaustive analysis, which included reading their abstracts and full texts. The results show that the management of chemotherapy extravasation is closely related to factors that largely depend on the nursing staff. Among the most relevant findings are factors including the identification of the nursing role in the management of extravasation due to chemotherapy; risk factors; and effective training programmes for nursing. Nurses play a crucial role throughout the entire process of treatment, prevention, and health education in chemotherapy treatment. Training programmes for nurses are fundamental, as they increase their professional competence and improve the safety of the patient. Adequate knowledge of chemotherapy treatment and the risk factors of extravasation are basic elements for the prevention of this type of injury, as well as for the improvement of the quality of life of patients under this kind of intravenous therapy.
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Affiliation(s)
- Antonio Antúnez-Blancat
- Department of Nursing, Faculty of Nursing, University of Huelva, 21007 Huelva, Spain; (A.A.-B.); (D.M.-N.)
| | - Francisco-Javier Gago-Valiente
- Department of Nursing, Faculty of Nursing, University of Huelva, 21007 Huelva, Spain; (A.A.-B.); (D.M.-N.)
- Centro de Investigación en Pensamiento Contemporáneo e Innovación para el Desarrollo Social (COIDESO), University of Huelva, 21007 Huelva, Spain
| | - Juan-Jesús García-Iglesias
- Preventive Medicine and Public Health Area, Department of Sociology, Social Work and Public Health, Faculty of Work Science, University of Huelva, 21007 Huelva, Spain;
| | - Dolores Merino-Navarro
- Department of Nursing, Faculty of Nursing, University of Huelva, 21007 Huelva, Spain; (A.A.-B.); (D.M.-N.)
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3
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Yellinedi R, Damalachervu MR, Nuvvula R, Thammineedi SR. Management of Epirubicin Extravasation Injuries of the Hand with Debridement and Flap Cover-A Case Series. Indian J Plast Surg 2023; 56:439-442. [PMID: 38026779 PMCID: PMC10673704 DOI: 10.1055/s-0043-1774787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Chemotherapy extravasation injury is an iatrogenic injury due to extravasation of the drug from the vessel during infusion therapy. Among various chemotherapeutic drugs, DNA binding vesicants like epirubicin and doxorubicin can lead to extensive tissue necrosis following extravasation. They are commonly used in many chemotherapy regimens including those for carcinoma breast. We present our case series in the management of these wounds with aggressive debridement and regional (pedicled groin)/free flaps (superficial circumflex iliac artery perforator, lateral arm) for cover in five patients. All flaps healed well with patient returning to further treatment in 3 to 4 weeks post-surgery with preservation of hand function. Thus, early recognition of the type of drug that has extravasated is crucial. Regional and free flaps are superior to local flaps because there are no extra incisions and grafts on the limb that has already been injured.
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Affiliation(s)
- Rajesh Yellinedi
- Department of Plastic and Reconstructive Surgery, Basavatarakam Indo American Cancer Hospital and Research Institute (BIACH&RI), Hyderabad, Telangana, India
| | - Mukunda Reddy Damalachervu
- Department of Plastic and Reconstructive Surgery, Basavatarakam Indo American Cancer Hospital and Research Institute (BIACH&RI), Hyderabad, Telangana, India
| | - Rambabu Nuvvula
- Department of Plastic and Reconstructive Surgery, Basavatarakam Indo American Cancer Hospital and Research Institute (BIACH&RI), Hyderabad, Telangana, India
| | - Subramanyeshwar Rao Thammineedi
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute (BIACH&RI), Hyderabad, Telangana, India
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Hamblin MR. Photobiomodulation Therapy for Treatment of Extravasation Injuries in Cancer Chemotherapy. Photobiomodul Photomed Laser Surg 2023; 41:1-2. [PMID: 36629901 DOI: 10.1089/photob.2022.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg-Doornfontein Campus, Doornfontein, South Africa
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5
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Zhou Y, Lan Y, Zhang Q, Song J, He J, Peng N, Peng X, Yang X. Totally implantable venous access ports: A systematic review and meta-analysis comparing subclavian and internal jugular vein punctures. Phlebology 2022; 37:279-288. [DOI: 10.1177/02683555211069772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Totally implantable venous access port (TIVAP) is a completely closed intravenous infusion system that stays in the human body for a long time. It is used for the infusion of strong irritating or hyperosmotic drugs, nutritional support treatment, blood transfusion and blood specimen collection, and other purposes. There are two common ways of TIVAP: internal jugular vein implantation and subclavian vein implantation. However, the postoperative complications of the two implantation methods are quite different, and there is no recommended implantation method in the relevant guidelines. Therefore, we conducted a meta-analysis to evaluate the difference in complications of the two implantation methods, and choose the better implantation method. Methods Computer search in PubMed, Embase, Web of Science, and Cochrane Library database was conducted for randomized controlled trials (RCTs) from the establishment of the database to October 2021. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies. RevMan5.4 software was used for meta-analysis. Results A total of 1086 patients in five studies were finally included. The results of meta-analysis showed that there was no significant difference in the incidence of infection (RR = 0.80, 95% CI: 0.43–1.48, p = .47), catheter blockage (RR = 0.72, 95% CI: 0.15–3.46, p = .68), port squeeze (RR = 1.07, 95% CI: 0.14–8.02, p = .95), catheter-related thrombosis (RR = 0.86, 95% CI: 0.22–3.38, p = 0.83), catheter displacement (RR = 0.50, 95% CI: 0.22–1.12, p = .09), extravasation (RR = 0.12, 95% CI: 0.01–2.15, p = .15), and catheter rupture (RR = 3.77, 95% CI: 0.16–89.76, p = .41) between the two implantation paths. Conclusions There is little difference in the complication rate of TIVAP between internal jugular vein insertion and subclavian vein insertion. Due to the small number of included studies, there are certain limitations, and more studies need to be included for analysis in the future.
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Affiliation(s)
- Ya Zhou
- Department of Oncology, Chongqing General Hospital, Chomgqing, China
| | - Yanqiu Lan
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Qiang Zhang
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Jifang Song
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Juan He
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Na Peng
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Xingqiao Peng
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Xinxin Yang
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
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6
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Yong L, Jianxi G, Yanfang Z, Jian K. Complications from port-a-cath system implantation in adults with malignant tumors: A 10-year single-center retrospective study. J Interv Med 2021; 5:15-22. [PMID: 35586285 PMCID: PMC8947993 DOI: 10.1016/j.jimed.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
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7
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Moyle P, Soh C, Healy N, Malata C, Forouhi P. Extravasation of Epirubicin chemotherapy from a port-a-cath causing extensive breast necrosis: Sequential imaging findings and management of a breast cancer patient. Radiol Case Rep 2021; 16:3509-3514. [PMID: 34552682 PMCID: PMC8441109 DOI: 10.1016/j.radcr.2021.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/19/2021] [Indexed: 10/25/2022] Open
Abstract
Extravasation of chemotherapy is rare with an estimated incidence of 0.01%-7% but can cause significant morbidity, delay in cancer treatment and potential mortality. We present a case of 55-year-old woman with a metastatic right axillary lymph node with no identifiable breast primary, commenced on chemotherapy as per multidisciplinary team decision. Extravasation of 25 mls of Epirubicin chemotherapy at the porta-a-cath (site) caused extensive inflammatory change in the breast parenchyma and chest wall with a necrotic ulcerating skin-defect. Even with ensuring port or peripheral catheter patency and position, extravasation can occur. This is the first case report to describe the use of MRI to help plan management, identifying the extent of the tissue damage and vascular compromise which could impair healing. In this case the necrotic ulcer was managed with surgical debridement and human ADM matrix (Matriderm dermal matrix) which has not been described in the literature previously.
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Affiliation(s)
- Penelope Moyle
- Radiology Department, Addenbrooke's Hospital, Cambridge, University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Breast Unit, Department of Surgery, Addenbrooke's Hospital, Cambridge, University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Chien Soh
- Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nuala Healy
- Radiology Department, Addenbrooke's Hospital, Cambridge, University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Breast Unit, Department of Surgery, Addenbrooke's Hospital, Cambridge, University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charles Malata
- Cambridge Breast Unit, Department of Surgery, Addenbrooke's Hospital, Cambridge, University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,School of Medicine, Anglia Ruskin University, Cambridge and Chelmsford, UK
| | - Parto Forouhi
- Cambridge Breast Unit, Department of Surgery, Addenbrooke's Hospital, Cambridge, University Hospitals NHS Foundation Trust, Cambridge, UK
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8
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Mieczkowska K, Deutsch A, Amin B, Mir A, Abraham R, Balagula Y, Blasiak R, Mann RE, Patel P, Musaev T, Zhu TH, Kalnicki S, Packer SH, McLellan BN. Mitomycin extravasation injury: A case series. JAAD Case Rep 2021; 15:69-72. [PMID: 34409144 PMCID: PMC8361222 DOI: 10.1016/j.jdcr.2021.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Karolina Mieczkowska
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Alana Deutsch
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Bijal Amin
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Adnan Mir
- Dermpath Diagnostics, White Plains, New York
| | - Renu Abraham
- Patient Safety Committee, Montefiore Medical Center, Bronx, New York
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Blasiak
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Ranon E Mann
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Parth Patel
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tagai Musaev
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tian Hao Zhu
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York
| | - Stuart H Packer
- Department of Medical Oncology, Albert Einstein College of Medicine, Bronx, New York
| | - Beth N McLellan
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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10
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Mas V, Simon AL, Presedo A, Mallet C, Ilharreborde B, Jehanno P. Upper limb extravasation of cytotoxic drugs: results of the saline washout technique in children. J Child Orthop 2020; 14:230-235. [PMID: 32582391 PMCID: PMC7302410 DOI: 10.1302/1863-2548.14.200020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Extravasation of cytotoxic vesicant drugs is a surgical emergency (within six hours) since this incident can lead to severe skin and soft-tissue damage. Outcomes after the saline washout procedure have been extensively described in adults, but rarely in children. The aim of this study was to evaluate the outcome of early saline washout procedure for upper limb cytotoxic drug extravasation in children. METHODS All consecutive children with vesicant drug extravasation were retrospectively reviewed. The saline washout procedure was performed. Cosmetic aspect, residual pain and range of movement were analyzed as well as time to surgery and chemotherapy resumption at last follow-up. RESULTS Between 2014 and 2018, 13 cytotoxic vesicant drug extravasations occurred (mean age 8 years (sem 5)), including 11 treated by the saline washout procedure. At mean follow-up of 11 months (sem 7), the patients had no or low pain and ranges of movement were fully conserved. Two patients (one within the six hours' delay) had soft-tissue necrosis leading to extensive reconstructive surgery. CONCLUSION The saline washout procedure is safe and easy and significantly reduces the incidence of extensive skin damage. Early referral to a specialized department is essential. However, the key parameter remains prevention by educating medical staff and nurses about these injuries and by training them for early and urgent management. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Virginie Mas
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France,Department of Orthopaedic Surgery and Hand Emergencies, Hôpital Privé des Peupliers, Paris, France
| | - Anne Laure Simon
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France,Correspondence should be sent to Anne Laure Simon, Department of Pediatric Orthopaedics, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris University, 48 Bd Sérurier, 75019 Paris, France. E-mail:
| | - Ana Presedo
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Cindy Mallet
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Pascal Jehanno
- Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris University, Paris, France,Department of Orthopaedic Surgery, Hôpital Privé Nord Parisien, Sarcelles, France
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11
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Taibi A, Bardet M S, Durand Fontanier S, Deluche E, Fredon F, Christou N, Usseglio J, Mathonnet M. Managing chemotherapy extravasation in totally implantable central venous access: Use of subcutaneous wash-out technique. J Vasc Access 2020; 21:723-731. [PMID: 32056485 DOI: 10.1177/1129729820905174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Totally implanted venous access is widely used in chemotherapy administration. With over 1 million intravenous chemotherapy infusions given worldwide each day, complications are frequent. Accidental cases of extravasation in the presence of a catheter are rare yet very serious and may require discontinuation of chemotherapy. The aim of this study was to evaluate the feasibility and efficacy of the subcutaneous wash-out technique for chemotherapy extravasation treatment. METHODS We retrospectively reviewed the medical charts of patients who had received chemotherapy and sustained extravasation in our hospital between October 2013 and October 2016. Subcutaneous wash-out treatments were carried out exclusively, without the application of antidotes or the use of specific antidotes. RESULTS We documented seven cases of chemotherapy extravasation. Two cases were treated with antidotes and suffered necrosis in the following weeks. The five patients treated using subcutaneous wash-out had no necrosis and had a steady decrease in the inflammatory reaction of the cutaneous and subcutaneous soft tissues. For these five patients, chemotherapy was restarted within 1 month following extravasation. CONCLUSION This study would argue for the feasibility and effectiveness of subcutaneous wash-out in the treatment of chemotherapy extravasations.
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Affiliation(s)
- Abdelkader Taibi
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | | | - Sylvaine Durand Fontanier
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Elise Deluche
- Oncology Department, Dupuytren University Hospital, Limoges, France
| | - Fabien Fredon
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Niki Christou
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Julie Usseglio
- Reconstructive and Aesthetic Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Muriel Mathonnet
- Visceral Surgery Department, Dupuytren University Hospital, Limoges, France
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12
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Clinical Applications of Hyaluronidase. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1148:255-277. [PMID: 31482503 DOI: 10.1007/978-981-13-7709-9_12] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hyaluronidases are enzymes that degrade hyaluronic acid, which constitutes an essential part of the extracellular matrix. Initially discovered in bacteria, hyaluronidases are known to be widely distributed in nature and have been found in many classes including insects, snakes, fish and mammals. In the human, six different hyaluronidases, HYAL1-4, HYAL-P1 and PH-20, have been identified. PH-20 exerts the strongest biologic activity, is found in high concentrations in the testicles and can be localized on the head and the acrosome of human spermatozoa. Today, animal-derived bovine or ovine testicular hyaluronidases as well as synthetic hyaluronidases are clinically applied as adjuncts to increase the bioavailability of drugs, for the therapy of extravasations, or for the management of complications associated with the aesthetic injection of hyaluronic acid-based fillers. Further applications in the fields of surgery, aesthetic medicine, immunology, oncology, and many others can be expected for years to come. Here, we give an overview over the molecular and cellular mode of action of hyaluronidase and the hyaluronic acid metabolism, as well as over current and potential future clinical applications of hyaluronidase.
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13
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Haydock MM, Sigdel S, Pacioles T. Gemcitabine-induced skin necrosis. SAGE Open Med Case Rep 2018; 6:2050313X18809268. [PMID: 30397477 PMCID: PMC6207959 DOI: 10.1177/2050313x18809268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/04/2018] [Indexed: 11/18/2022] Open
Abstract
Since its emergence as a chemotherapy agent, gemcitabine has been associated with cutaneous adverse reactions. Rash is reported to be the most common cutaneous adverse effect. Other reported cutaneous reactions in the literature include bullous dermatosis, pseudocellulitis, subacute cutaneous lupus alopecia, and palmar–plantar erythrodysesthesia. Skin necrosis is a very rare adverse effect of this otherwise well-tolerated chemotherapeutic agent. In searching the literature, only one other case has been reported. In our report, we present a 74-year-old male with adenocarcinoma of the pancreas, status-post pancreaticoduodenectomy (Whipple procedure), who developed a rare case of skin necrosis of the lower leg 2 weeks after completing six cycles of monotherapy gemcitabine treatment.
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Affiliation(s)
| | - Saroj Sigdel
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Toni Pacioles
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
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14
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Maly C, Fan KL, Rogers GF, Mitchell B, Amling J, Johnson K, Welch L, Oh AK, Chao JW. A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1743. [PMID: 29876181 PMCID: PMC5977944 DOI: 10.1097/gox.0000000000001743] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/07/2018] [Indexed: 02/07/2023]
Abstract
Intravenous therapy is a common practice among many specialties. Intravenous therapy extravasation is a potential complication to such therapy. Hospitals without a dedicated wound care team trained in these interventions will often default to plastic surgical consultation, making an understanding of available interventions essential to the initial evaluation and management of these injuries. The goal of this article was to provide plastic surgeons and health care providers with a general overview of the acute management of intravenous infiltration and extravasation injuries. Though the decision for surgical versus nonsurgical management is often a clear one for plastic surgeons, local interventions, and therapies are often indicated and under-utilized in the immediate postinfiltration period. Thorough knowledge of these interventions should be a basic requirement in the armamentarium of plastic surgery consultants.
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Affiliation(s)
- Connor Maly
- Georgetown University School of Medicine, Washington, D.C
| | - Kenneth L Fan
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C
| | - Gary F Rogers
- Division of Plastic Surgery, Children's National Health System, Washington, D.C
| | | | - June Amling
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C.,Division of Nursing, Children's National Health System, Washington, D.C
| | - Kara Johnson
- Division of Nursing, Children's National Health System, Washington, D.C
| | - Laura Welch
- Division of Nursing, Children's National Health System, Washington, D.C
| | - Albert K Oh
- Division of Plastic Surgery, Children's National Health System, Washington, D.C
| | - Jerry W Chao
- Division of Plastic Surgery, Children's National Health System, Washington, D.C.,Division of Plastic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, D.C
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15
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Langer SW, Sehested M, Jensen PB. Anthracycline Extravasation: A Comprehensive Review of Experimental and Clinical Treatments. TUMORI JOURNAL 2018; 95:273-82. [DOI: 10.1177/030089160909500301] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An accidental extravasation of anthracycline-containing chemotherapy is a feared complication that may lead to necrosis and severe tissue destruction. For four decades, much effort has been done to prevent and treat this devastating condition. Savene™ has recently been proved to be very effective, and is the only approved treatment against anthracyline extravasation. It is thus now widely recommended. The present article represents a comprehensive review of, and historical insight to, the experimental and clinical studies of surgical and non-surgical treatments of extravasation during forty years of clinical anthracycline treatment.
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Affiliation(s)
- Seppo W Langer
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maxwell Sehested
- Experimental Pathology Unit, Copenhagen University Hospital, Biocentre, Copenhagen, Denmark
- TopoTarget A/S, Symbion Science Park, DK-2100 Copenhagen, Denmark
| | - Peter Buhl Jensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- TopoTarget A/S, Symbion Science Park, DK-2100 Copenhagen, Denmark
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Aguirre VJ, Barnett D, Burdett N, Joshi R, Viana FF. Video-assisted thoracoscopy in the management of intrapleural extravasation of cytotoxic chemotherapy. Thorac Cancer 2017; 8:363-364. [PMID: 28371390 PMCID: PMC5494449 DOI: 10.1111/1759-7714.12430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/09/2017] [Indexed: 11/29/2022] Open
Abstract
The extravasation of cytotoxic agents into subcutaneous tissue is a serious complication of chemotherapy. Unfortunately, if such extravasation occurs into the pleural space, limited data is available to guide appropriate management. We present the first report in the literature of video‐assisted thoracoscopy combined with a topoisomerase II inhibitor and iron chelator, dexrazoxane, in the successful management of this complication.
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Affiliation(s)
- Victor J Aguirre
- Cardiothoracic Surgical Unit, Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dylan Barnett
- Cardiothoracic Surgical Unit, Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nikki Burdett
- Cardiothoracic Surgical Unit, Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rohit Joshi
- Cardiothoracic Surgical Unit, Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Fabiano F Viana
- Cardiothoracic Surgical Unit, Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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17
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Risk management of onco-hematological drugs: how and how fast can we improve? TUMORI JOURNAL 2016; 102:15-29. [PMID: 27581596 DOI: 10.5301/tj.5000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Medication errors in oncology may cause severe damage to patients, professionals, and the environment. The Italian Ministry of Health issued Raccomandazione 14 to provide guidelines for prevention of errors while using antineoplastic drugs. This work aimed at analyzing Raccomandazione 14 through the different viewpoints of the hospital pharmacist, the nurse, the oncologist, and the hospital director. METHODS Twenty-seven Italian healthcare organizations participated in a self-assessment survey evaluating compliance with Raccomandazione 14 within the oncology, hematology, and pharmacy departments. RESULTS The self-assessment results showed a general acknowledgement of the need for centralized management of anticancer agents. The specific responsibility of the pharmacist on the centralized management of anticancer drugs from preparation to disposal emerged as a critical point. The nurse, beyond the skills in drug administration and prevention of extravasation, also plays a fundamental role in educating and supporting the patient. The physicians, who are attentive to scientific, clinical, and regulatory criteria in prescribing and monitoring the therapies, are called upon to improve awareness on the importance of sharing standardized procedures with other professionals, to minimize medication error occurrence. The implementation of a complete computerized management from prescribing to drug administration and follow-up was highlighted. Multidisciplinary groups were constituted across the nation by professionals dedicated to the implementation of electronic health records and drug history and medical reconciliation processes. CONCLUSIONS Our analysis of the Ministerial Raccomandazione 14 urges implementation of the resources for ensuring quality and safety during prescription, preparation, and administration of anticancer drugs.
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Abstract
Oxaliplatin extravasation has been associated with local pain and inflammation which may be severe and lead to complications including necrosis. Recent case reports suggest that oxaliplatin may be better classified as an irritant when extrava-sated. The optimal management of oxaliplatin extravasation however remains uncertain. Cold compress may cause local vasoconstriction and reduce cellular injury. However, it may potentially precipitate or worsen peripheral neuropathy. Warm compress may increase drug removal by local vasodilation and avoid peripheral neuropathy. However, it may potentially increase cellular uptake and hence injury. Further research into this area is needed.
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Gilbar PJ, Carrington CV. The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags. J Oncol Pharm Pract 2016; 12:113-8. [PMID: 16984750 DOI: 10.1177/1078155206070448] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Study objective. The aim of this retrospective study was to determine the incidence of vinca alkaloid extravasation following administration via syringes or mini-bags. Methods. An electronic survey was sent to pharmacy departments at hospitals throughout Australia. The survey was designed to collect data on the administration methods of vinca alkaloids (vincristine, vinblastine, vinorelbine) and the corresponding documented incidence of extravasation. The questionnaire requested the following information: how the drugs were prepared for administration (syringe or mini-bag); volume of each product; number of items supplied; and the number of cases of extravasation reported for each product. Results. Questionnaires were sent to 228 hospital pharmacy departments in Australia. Sixty-eight questionnaires were received (29.8%), including responses from most major cancer centres. Data represented a range of 3 to 120 months (mean: 38 months) of clinical experience. The reported incidence of vincristine extravasation from syringes was 0.03% (11/37 084) and 0.041% (3/7255) with mini-bags. One case of vinblastine extravasation was reported with syringes 0.013% (1/7913), none from mini-bags (0/1421). Vinorelbine data were difficult to interpret as cases may represent phlebitis rather than extravasation. The reported incidence from vinorelbine syringes was 0.029% (2/6914) and 0.146% (8/5475) with mini-bags. Excluding vinorelbine data, the reported vinca alkaloid extravasation episodes from syringes (0.027%) and mini-bags (0.035%) were found to be similar and infrequent. Conclusion. The data suggest that vinca alkaloids can be given safely as low volume, short infusions via mini-bags. Policies and practices that ensure the same careful monitoring of infusional therapy as is recommended with administration by syringe may further reduce the incidence of untoward effects. Mini-bags should be used for the administration of vinca alkaloids and this practice will prevent the inadvertent intrathecal administration of vinca alkaloids via syringes.
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Affiliation(s)
- Peter J Gilbar
- Department of Pharmacy, Toowoomba Health Services, PMB 2, Toowoomba 4350, Australia.
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20
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Yorulmaz A, Sahin EB, Sener M, Kulcu Cakmak S. Acyclovir-induced bullous reaction in a patient with metastatic breast cancer. Cutan Ocul Toxicol 2016; 36:85-87. [DOI: 10.3109/15569527.2016.1140180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention and management of chemotherapy extravasation. World J Clin Oncol 2016; 7:87-97. [PMID: 26862492 PMCID: PMC4734939 DOI: 10.5306/wjco.v7.i1.87] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/04/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy extravasation remains an accidental complication of chemotherapy administration and may result in serious damage to patients. We review in this article the clinical aspects of chemotherapy extravasation and latest advances in definitions, classification, prevention, management and guidelines. We review the grading of extravasation and tissue damage according to various chemotherapeutic drugs and present an update on treatment and new antidotes including dexrazoxane for anthracyclines extravasation. We highlight the importance of education and training of the oncology team for prevention and prompt pharmacological and non-pharmacological management and stress the availability of new antidotes like dexrazoxane wherever anthracyclines are being infused.
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Nurgat ZA, Smythe M, Al-Jedai A, Ewing S, Rasheed W, Belgaumi A, Ahmed SO, Ashour M, Al Agil A, Siddiqui K, Aljurf M. Introduction of vincristine mini-bags and an assessment of the subsequent risk of extravasation. J Oncol Pharm Pract 2015; 21:339-347. [PMID: 24821691 DOI: 10.1177/1078155214531803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Numerous international organisations have advocated the preparation of vincristine in small volume intravenous bags in order to eliminate inadvertent intrathecal administration. However, the risk of extravasation is a significant deterrent, and adoption of this practice has been variable and only hesitantly accepted in the clinical setting. PURPOSE We carried out a study with the aims of establishing the incidence of reported extravasation of vincristine administration to paediatric and adult patients in mini-bags; here we describe motivating factors and barriers faced by clinical staff. The secondary aim was to support the need for change and implementation of the international recommendations. METHODS Chemotherapy-certified nurses completed a survey spanning August 2009 to August 2011, to ascertain the incidence of extravasation associated with the administration of vincristine in mini-bags. RESULTS This period captured 421 occasions of vincristine administration in 25-ml or 50-ml mini-bags (in 0.9% sodium chloride). The median age of patients was 13 years (range 2.5 months to 99 years). Vincristine was administered through peripheral lines (26.4%), portacath (52.0%), PICC line (15.9%) and Hickman line (5.7%). The majority of infusions were over at least 10 minutes (50.1%). There were no cases of extravasation reported. CONCLUSIONS The administration of vincristine in small volume intravenous bags was safe, practical, and feasible in all patient groups. The successful implementation of the international recommendations for vincristine administration in mini-bags to eliminate potential inadvertent intrathecal administration was dependent on stakeholder buy-in.
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Affiliation(s)
- Z A Nurgat
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Adult Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Smythe
- Department of Nursing Quality, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Al-Jedai
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - S Ewing
- Adult Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Department of Nursing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - W Rasheed
- Adult Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Belgaumi
- Pediatric Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - S O Ahmed
- Adult Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Ashour
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Pediatric Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Al Agil
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia Pediatric Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - K Siddiqui
- Pediatric Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Aljurf
- Adult Leukemia Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Trouve C, Le Meunier F, Solomalalarivelo F, Delentaigne Delogivieres X, Drouard M, Suguenot R, Lecuyer E, Bentayeb H, Rault I, Douadi Y, Dayen C. [A pleural transudate with a 0 g/L protein level]. Rev Mal Respir 2015; 32:535-8. [PMID: 26072010 DOI: 10.1016/j.rmr.2014.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 07/08/2014] [Indexed: 11/26/2022]
Affiliation(s)
- C Trouve
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - F Le Meunier
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - F Solomalalarivelo
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - X Delentaigne Delogivieres
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - M Drouard
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - R Suguenot
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - E Lecuyer
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - H Bentayeb
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - I Rault
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - Y Douadi
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France
| | - C Dayen
- Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, avenue Michel-de-l'Hospital, 023211 Saint-Quentin, cedex France.
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Harrold K. Managing cytotoxic chemotherapy extravasation: use of saline washout. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:S36-7. [PMID: 25904536 DOI: 10.12968/bjon.2015.24.sup8.s36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Florence Nightingale Foundation scholar Karen Harrold received funding to support her PhD exploring the patient experience of saline washout as a management strategy for chemotherapy extravasation. She discusses the focus of her thesis, the completion of phase one and looks ahead to phase two.
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Affiliation(s)
- Karen Harrold
- Chemotherapy & IV Access Advanced Nurse Practitioner, Mount Vernon Cancer Centre, Middlesex
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25
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Molas-Ferrer G, Farré-Ayuso E, doPazo-Oubiña F, deAndrés-Lázaro A, Guell-Picazo J, Borrás-Maixenchs N, Corominas-Bosch L, Valverde-Bosch M, Creus-Baró N. Level of adherence to an extravasation protocol over 10 years in a tertiary care hospital. Clin J Oncol Nurs 2015; 19:E25-30. [PMID: 25840394 DOI: 10.1188/15.cjon.e25-e30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extravasation of chemotherapy is an undesirable complication related to the administration of antineoplastic therapy. Establishing the real incidence is difficult. Because of the importance of a quick intervention after an extravasation, every hospital should have an extravasation protocol. OBJECTIVES The purpose of this study was to determine the degree of observance of an extravasation protocol by nursing staff and to determine extravasation incidence. METHODS This descriptive, longitudinal, retrospective study was set in a tertiary-level hospital. The researchers reviewed 117 extravasation notification forms received by the pharmacy department during a 10-year period. Nursing actuation, particularly observance of the extravasation protocol, was analyzed. FINDINGS Protocol adherence was 89%. Twelve deviations from the protocol in the application of recommended measures were detected. An antidote was used in 41 patients, and temperature measures were applied in 14 cases. Ninety-nine patients had at least one episode of reported follow-up. No cases of necrosis or skin ulcers were described, except by one patient, who developed a delayed skin ulcer to vinorelbine. Drugs most frequently reported were etoposide, carboplatin, and paclitaxel. Nursing staff should be continuously trained in extravasation protocol because a rapid actuation can prevent skin lesions.
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Management of the extravasation of anti-neoplastic agents. Support Care Cancer 2015; 23:1459-71. [DOI: 10.1007/s00520-015-2635-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/26/2015] [Indexed: 02/06/2023]
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Di Costanzo G, Loquercio G, Marcacci G, Iervolino V, Mori S, Petruzziello A, Barra P, Cacciapuoti C. Use of allogeneic platelet gel in the management of chemotherapy extravasation injuries: a case report. Onco Targets Ther 2015; 8:401-4. [PMID: 25709472 PMCID: PMC4332310 DOI: 10.2147/ott.s68469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The allogeneic platelet (PLT) gel offers to be a valid supportive measure in the management of chemotherapy extravasation injuries. We report a case of a 58-year-old patient with multiple myeloma enrolled for high-dose chemotherapy and autologous stem cell transplantation. As pretransplant therapy, the patient received induction therapy with bortezomib, adriblastina, and desametazone. A port was inserted in the vein on the back of the hand. After three cycles, the patient reported rapid development of redness, pain, and necrotic tissue in the left hand, and a diagnosis of extravasation was addressed. The patient presented a raw area on the back of the hand caused by cytotoxic/chemotherapeutic drug leakage because of the malposition of venous access devices. Skin ulcer was debrided, and the wound was reconstructed with a combination of local random rotational flap and abdomen skin graft. Two weeks later, a 20% skin flap necrosis was observed. In the context of wound healing, topical plasma-rich PLT gel is able to accelerate the regeneration and repair of tissue, so it was set out to assess PLT gel efficacy in this case. The PLT gel was applied topically once every 5 days, for a duration of 60 days on average. There were no adverse reactions observed during the topical therapy. Complete wound healing was observed after 12 PLT-rich plasma applications. No ulcer recurrence was noted in the patient during the follow-up period of 2–19 months.
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Affiliation(s)
- Gaetano Di Costanzo
- Transfusion Service, Department of Haematology, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy
| | - Giovanna Loquercio
- Transfusion Service, Department of Haematology, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy
| | - Gianpaolo Marcacci
- Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy
| | - Vincenzo Iervolino
- Transfusion Service, Department of Haematology, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy
| | - Stefano Mori
- Department of Surgery, Melanoma - Soft Tissues - Head and Neck - Skin Cancers, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy
| | - Arnolfo Petruzziello
- Transfusion Service, Department of Haematology, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy
| | - Pasquale Barra
- Transfusion Service, Department of Haematology, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy
| | - Carmela Cacciapuoti
- Transfusion Service, Department of Haematology, National Cancer Institute "G Pascale" Foundation, IRCCS, Naples, Italy
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A simple diagnostic test to confirm correct placement of intravenous catheters before chemotherapy. J Vasc Access 2015; 16:218-22. [PMID: 25634149 DOI: 10.5301/jva.5000333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the feasibility and effectiveness of using a single injection of diluted sodium bicarbonate, while monitoring exhaled carbon dioxide changes, to reliably confirm correct placement of intravenous (IV) catheters. METHODS The study was conducted in the oncology day care clinic at a tertiary care center and included a selected group of patients with various oncological conditions who required IV chemotherapy. In each patient a newly inserted peripheral IV catheter or newly accessed central line was deemed positively intravascular if they had good blood return or most probably intravascular if there was no blood return but they flushed easily. This clinical diagnosis of correct positioning, was correlated with the results of a single injection of dilute sodium on the exhaled carbon dioxide, and with the ability of a blinded observer to report whether sodium bicarbonate or saline was injected. RESULTS A total of 67 patients were enrolled in the study; 56 had positively intravascular IV catheter while 11 had most probably intravascular IV catheter. A single injection of 20 mL 4.2% sodium bicarbonate had a positive and clinically detectable response that was diagnosed with high sensitivity and specificity. CONCLUSIONS IV injection of 20 mL of 4.2% sodium bicarbonate with exhaled carbon dioxide monitoring can be used to reliably confirm correct intravascular placement of a catheter intended to be used for chemotherapy.
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Górska N, Szostak E, Drużbicki K, Mikuli E, Inaba A, Hirao Y. A comprehensive study on crystal structure, thermal behavior, and molecular dynamics of [Sr(DMSO)4(NO3)2]. J COORD CHEM 2014. [DOI: 10.1080/00958972.2014.964225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Natalia Górska
- Faculty of Chemistry, Jagiellonian University, Kraków, Poland
| | | | - Kacper Drużbicki
- Faculty of Chemistry, Jagiellonian University, Kraków, Poland
- Frank Laboratory of Neutron Physics, The Joint Institute for Nuclear Research, Dubna, Russia
| | - Edward Mikuli
- Faculty of Chemistry, Jagiellonian University, Kraków, Poland
| | - Akira Inaba
- Graduate School of Science, Osaka University, Toyonaka, Japan
| | - Yasukazu Hirao
- Graduate School of Science, Osaka University, Toyonaka, Japan
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Abstract
The following is a reprint from Chapter 8 in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Fourth Edition) by Martha Polovich, PhD, RN, AOCN®, MiKaela Olsen, MS, RN, AOCNS®, and Kristine B. LeFebvre, MSN, RN, AOCN® (Eds.).
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Vasconcelos I, Schoenegg W. Massive breast necrosis after extravasation of a full anthracycline cycle. BMJ Case Rep 2013; 2013:bcr-2013-201179. [PMID: 24142568 DOI: 10.1136/bcr-2013-201179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 57-year-old woman with invasive breast cancer was referred for adjuvant chemotherapy after undergoing breast conservative therapy and axillary dissection. A port was inserted in the contralateral subclavian vein and epirubicin, cyclophosphamide and 5-fluorouracil was the treatment of choice. After the first cycle, the patient was sent home. The following day, she reported rapidly developing redness and pain in the right breast and diagnosis of epirubicin extravasation was made. She was hospitalised, the port was surgically removed and approximately two-thirds of the breast underwent tissue necrosis. The necrotic tissue was resected and a skin graft was harvested from the thigh. She was offered DIEP-flap reconstruction 8 months later. There were no complications, except for marginal necrosis of the flap. Necrosectomy was performed and resolved through an advancement flap.
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Affiliation(s)
- Ines Vasconcelos
- Private Practice Senology Dr. Schoenegg, Kurfürstendamm, Berlin, Germany
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35
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Conde-Estévez D, Mateu-de Antonio J. Treatment of anthracycline extravasations using dexrazoxane. Clin Transl Oncol 2013; 16:11-7. [PMID: 23949792 DOI: 10.1007/s12094-013-1100-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/31/2013] [Indexed: 02/07/2023]
Abstract
Extravasation of cytotoxic agents is a true medical emergency. Dexrazoxane is the only licensed drug for the treatment of anthracycline extravasations. Dexrazoxane proved to be effective and moderately well tolerated. However, alternative approaches for the management of anthracycline extravasations are available such as topical DMSO and cooling. There appears to be general agreement about dexrazoxane usefulness when extravasations involve large volumes of anthracycline and/or central venous access device. Nevertheless, the non-invasive combination of DMSO and cooling is the most commonly described therapy, particularly in small anthracycline extravasations. Further research is still needed to establish unequivocal situations where dexrazoxane must be initiated.
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Affiliation(s)
- D Conde-Estévez
- Department of Pharmacy, Hospital Universitari del Mar. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain,
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Uzunoglu S, Cosar R, Cicin I, Ibis K, Demiralay E, Benlier E, Erdogan B, Kandulu H, Ozen A, Altaner S. Carnitine or dimethyl sulfoxide, or both, for the treatment of anthracycline extravasation in rats. J Plast Surg Hand Surg 2013; 47:339-43. [PMID: 23710793 DOI: 10.3109/2000656x.2013.767201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to compare the efficacy of topical dimethyl sulfoxide (DMSO), intralesional and systemic carnitine as monotherapy and in combination against ulceration in rats induced by intradermal doxorubicin extravasation. Sixty-nine 3-month-old male Wistar albino rats, weighing between 200-225 g, were used in this study. Rats were applied monotherapy or a combination of topical DMSO, intraperitoneal or intralesional carnitine. Control groups received saline or no drug. The necrotic area was measured and extravasated neutrophil leukocytes were counted in healthy tissue adjacent to necrotic areas. Monotherapy with topical and systemic carnitine did not significantly reduce the size of necrotic areas. However, topical DMSO had reduced necrotic areas and inflammatory cells significantly and the addition of systemic carnitine to topical DMSO had increased the efficacy. DMSO is an effective, safe, and easy-to-apply treatment for doxorubicin-induced extravasation. Further clinical studies are needed to evaluate the use of carnitine in combination with DMSO.
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de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, Mayer-Steinacker R, Bokemeyer C, Jordan K. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. ACTA ACUST UNITED AC 2013; 36:127-35. [PMID: 23486002 DOI: 10.1159/000348524] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel. MATERIAL AND METHODS A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined. RESULTS Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended. CONCLUSION We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.
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Affiliation(s)
- Maike de Wit
- Klinik für Innere Medizin - Hämatologie und Onkologie, Vivantes Klinikum Neukölln, Berlin, Germany.
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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 (Engl) 2013; 22:169-78. [PMID: 23320981 DOI: 10.1111/ecc.12023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/30/2022]
Abstract
This report presents the results from a historical case series of cytotoxic drug extravasations managed by saline washout; its purpose is to assess the efficacy of the procedure based on patient outcome. Eighty-nine patients were identified as having experienced a vesicant or exfoliant extravasation from incident reports filed over a 10-year period, from 1 April 2001 to 31 March 2011. Outcome was measured against the need for further surgical treatment being required. Of the 89 cases assessed for efficacy of saline washout one patient experienced a wound infection, which was treated effectively with oral antibiotics. There were no other complications reported and no patients required further treatment with surgical debridement. The majority of patients had no deferral of treatment as chemotherapy could be continued in their unaffected arm immediately following saline washout procedure. For patients where cannulation in their opposite arm for continuation of treatment was not advisable chemotherapy was delayed between 3 and 7 days. Hospitalisation as a result of the extravasation or subsequent treatment was not required in any of the 89 cases. Results indicate that saline washout technique is a safe and effective management strategy for the treatment of both vesicant and exfoliant chemotherapy extravasation.
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Affiliation(s)
- K Harrold
- Chemotherapy Unit, Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
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Ashitate Y, Vooght CS, Hutteman M, Oketokoun R, Choi HS, Frangioni JV. Simultaneous Assessment of Luminal Integrity and Vascular Perfusion of the Gastrointestinal Tract Using Dual-Channel Near-Infrared Fluorescence. Mol Imaging 2012. [DOI: 10.2310/7290.2011.00048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Anastomotic complications such as stenosis and leakage in the gastrointestinal (GI) tract can cause high patient morbidity and mortality. To identify the potential preconditions of these complications intraoperatively, we explored the use of two 700 nm near-infrared (NIR) fluorophores administered intraluminally: (1) chlorella, an over-the-counter herbal supplement containing high concentrations of chlorophyll, and (2) methylene blue (MB). In parallel, we administered the 800 nm NIR fluorophore indocyanine green (ICG) intravenously to assess vascular function. Dual-channel, real-time intraoperative imaging and quantitation of the contrast to background ratio (CBR) were performed under normal conditions or after anastomosis or leakage of the stomach and intestines in 35 kg Yorkshire pigs using the Fluorescence-Assisted Resection and Exploration (FLARE) imaging system. Luminal integrity could be assessed with relatively high sensitivity with either chlorella or MB, although chlorella provided significantly higher CBR. ICG angiography provided assessment of blood perfusion of normal, ischemic, and anastomotic areas of the GI tract. Used simultaneously, 700 nm (chlorella or MB) and 800 nm (ICG) NIR fluorescence permitted independent assessment of luminal integrity and vascular perfusion of the GI tract intraoperatively and in real time. This technology has the potential to identify critical complications, such as anastomotic leakage, intraoperatively, when correction is still possible.
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Affiliation(s)
- Yoshitomo Ashitate
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Carrie S. Vooght
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Merlijn Hutteman
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Rafiou Oketokoun
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hak Soo Choi
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - John V. Frangioni
- From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo, Japan; and Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Recovery of symptomatic extravasation of liposomal doxorubicin after dexrazoxane treatment. Anticancer Drugs 2012; 23:139-40. [PMID: 21934601 DOI: 10.1097/cad.0b013e32834be51a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A patient with metastatic ovarian cancer was treated with liposomal doxorubicin and carboplatin. She had an extravasation during liposomal doxorubicin infusion. Initially, she was treated conservatively with cold compresses and topical treatment. However, because of worsening of symptoms, she received dexrazoxane once daily for 3 days after which complete recovery occurred. This is the first casereport on symptomatic extravasation of liposomal doxorubicin treated with dexrazoxane.
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Venable RO, Saba CF, Endicott MM, Northrup NC. Dexrazoxane treatment of doxorubicin extravasation injury in four dogs. J Am Vet Med Assoc 2012; 240:304-7. [PMID: 22256846 DOI: 10.2460/javma.240.3.304] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 4 dogs were treated with dexrazoxane for known or suspected doxorubicin extravasation. Records were retrospectively reviewed. Doses and number of doses of dexrazoxane were variable. Dexrazoxane was administered within 2 hours after known extravasation in 3 dogs and 48 hours after suspected extravasation in 1 dog. Additional medical treatments included tissue cooling in all dogs, topically administered dimethyl sulfoxide ointment in 3, and orally administered piroxicam in 1. CLINICAL FINDINGS Mild erythema and edema at the extravasation site developed within 1 to 6 days after extravasation in the 3 dogs that received dexrazoxane within 2 hours after extravasation. Extensive tissue necrosis occurred in the dog treated 48 hours after suspected extravasation. TREATMENT AND OUTCOME Only the dog with severe tissue necrosis required surgical intervention. Lesions in the other 3 dogs resolved with medical management alone. All dogs survived the event. CLINICAL RELEVANCE To date, use of dexrazoxane in the management of doxorubicin extravasation has not been reported in dogs. Treatment was successful in 3 of 4 patients. The most effective dosage and timing of administration are unknown; however, there is evidence to suggest that administration within 6 hours after the event is warranted. Further studies are needed to confirm efficacy and to optimize use of this drug in the prevention and treatment of anthracycline extravasation injury in veterinary patients.
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Affiliation(s)
- Rachel O Venable
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
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Hahn JC, Shafritz AB. Chemotherapy extravasation injuries. J Hand Surg Am 2012; 37:360-2. [PMID: 22154720 DOI: 10.1016/j.jhsa.2011.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 09/27/2011] [Accepted: 10/17/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Jesse C Hahn
- Department of Orthopaedic Surgery, University of Vermont College of Medicine, Burlington, VT, USA
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Conde-Estévez D, Mateu-de Antonio J. [Update in the management of extravasations of cytocytostatic agent]. FARMACIA HOSPITALARIA 2011; 36:34-42. [PMID: 21798785 DOI: 10.1016/j.farma.2011.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 01/24/2011] [Accepted: 01/27/2011] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To present current developments in the specific management of extravasations of antineoplastic agents after the extravasation. METHOD We conducted a search in PubMed, Medline and IDIS-Iowa to identify papers written in English or Spanish that described new specific measures for the management of extravasations. We also reviewed the references given in these papers and recent tertiary sources related to oncology or cytostatic agents. The search covered the period between 1997 and 2010. RESULTS There are only specific measures for the treatment of extravasations of 22 cytostatic agents. These measures are presented for each cytostatic agent, according their drug group. CONCLUSIONS Although currently there is no general consensus on the specific management of antineoplastic agents after extravasation, this review outlines the information collected and published so far, so that it may be of use to any national health centre where cytostatic drugs are prescribed, handled or administered.
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Affiliation(s)
- D Conde-Estévez
- Servicio de Farmacia, Hospital del Mar (Parc de Salut Mar), Barcelona, España.
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Thakur JS, Chauhan CGS, Diwana VK, Chauhan DC, Thakur A. Extravasational side effects of cytotoxic drugs: A preventable catastrophe. Indian J Plast Surg 2011; 41:145-50. [PMID: 19753254 PMCID: PMC2740528 DOI: 10.4103/0970-0358.44923] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In addition to their therapeutic effects on malignant cells, cytotoxic agents have the potential of causing destruction of healthy, normal cells. Extravasation of the drug can produce extensive necrosis of the skin and subcutaneous tissue. Management of these extravasational effects differs from one centre to another and prevention is usually strongly emphasized. We analyzed our management of 12 patients referred to us over five years with extravasation of cytotoxic drugs and reviewed the literature for different approaches with regard to prophylaxis and management of extravasational effects.
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Yao M, Li Y, Hossu M, Joly AG, Liu Z, Liu Z, Chen W. Luminescence of Lanthanide–Dimethyl Sulfoxide Compound Solutions. J Phys Chem B 2011; 115:9352-9. [DOI: 10.1021/jp202350p] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mingzhen Yao
- Department of Physics, The University of Texas at Arlington, Arlington, Texas 76019-0059, United States
| | - Yuebin Li
- Department of Physics, The University of Texas at Arlington, Arlington, Texas 76019-0059, United States
- School of Physics, Huazhong University of Science and Technology, Wuhan, People's Republic of China 430074
| | - Marius Hossu
- Department of Physics, The University of Texas at Arlington, Arlington, Texas 76019-0059, United States
| | - Alan G. Joly
- Pacific Northwest National Laboratory, Richland, Washington 99352, United States
| | - Zhongxin Liu
- Department of Physics, The University of Texas at Arlington, Arlington, Texas 76019-0059, United States
- Department of Material and Chemical Engineering, Hainan University, Haikou, People's Republic of China 570228
| | - Zuli Liu
- School of Physics, Huazhong University of Science and Technology, Wuhan, People's Republic of China 430074
| | - Wei Chen
- Department of Physics, The University of Texas at Arlington, Arlington, Texas 76019-0059, United States
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Abstract
OBJECTIVE To present a clinical update on the prevention, detection, and evidence-based management of vesicant chemotherapy extravasations. DATA SOURCES Journal articles, published and unpublished case reports, personal experience. CONCLUSION In the 4 years that have elapsed since the publication of the original article, much more is known about vesicant chemotherapy extravasation, and effective evidence-based treatments now are available. The antidotes sodium thiosulfate for mechlorethamine extravasations and hyaluronidase for plant alkaloid extravasations are recommended by the manufacturers of these vesicants and cited in nursing guidelines. The anthracycline extravasation treatment dexrazoxane for injection, the first and only extravasation treatment with proven effectiveness, is now available as Totect (dexrazoxane; TopoTarget USA, Rockaway, NJ, USA) in the US and Savene (SpePharm, Amsterdam, The Netherlands) in Europe. IMPLICATIONS FOR NURSING PRACTICE Nurses who administer vesicant chemotherapy agents need to be aware of the most current evidence (or lack of evidence) for various types of extravasation treatment. Well-informed nurses are patient advocates and instrumental in detecting, managing, and documenting extravasations. Most importantly, nurses play a key role in preventing vesicant chemotherapy extravasations.
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Murphy F. The ongoing challenges with renal vascular access. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2011; 20:S6, S8, S10 passim. [PMID: 21471869 DOI: 10.12968/bjon.2011.20.sup11.s6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Renal vascular access is pivotal in the care of the haemodialysis patient; however, it remains a significant challenge to maintain vascular access in the dialysis population. There are a number of renal vascular accesses in use: arteriovenous fistula, arteriovenous graft, and central venous catheter, with the arteriovenous fistula being the ideal choice. Poor vascular access can lead to serious consequences for patients, resulting in morbidity and even mortality. There are also significant cost implications for healthcare providers in terms of hospital admissions, and other associated costs for patients who are admitted late for vascular access referral or as a result of associated complications of vascular access. The nurse and other members of the healthcare team are fundamental in the management of a patient's renal vascular access.
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MESH Headings
- Arteriovenous Shunt, Surgical/adverse effects
- Arteriovenous Shunt, Surgical/methods
- Arteriovenous Shunt, Surgical/nursing
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/methods
- Catheterization, Central Venous/nursing
- Catheters, Indwelling/adverse effects
- Humans
- Kidney Failure, Chronic/nursing
- Kidney Failure, Chronic/therapy
- Renal Dialysis/nursing
- Specialties, Nursing/methods
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Affiliation(s)
- Fiona Murphy
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Yao M, Chen W. Hypersensitive luminescence of Eu3+ in dimethyl sulfoxide as a new probing for water measurement. Anal Chem 2011; 83:1879-82. [PMID: 21319747 DOI: 10.1021/ac200072s] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dimethyl sulfoxide (DMSO) is a well-known organic solvent that can be used for biological applications. DMSO is miscible with water, and it is very common that the two solvents are mixed for some applications. It is important to detect water in DMSO, and this has been done using the luminescence decay lifetimes from Eu(3+) ions. We observed that the emissions of Eu(3+) in DMSO are very strong and very sensitive to water. The emission band from the (5)D(0) → (7)F(2) transition has two peaks at 613 and 617 nm, respectively, and these two peaks change in the opposite ways when water is added into DMSO. The intensity ratio of the two peaks follows nearly perfect linear dependence on the water concentration added in DMSO. This linear relationship provides a new and convenient method for water measurement in DMSO.
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Subcutaneous wash-out procedure (SWOP) for the treatment of chemotherapeutic extravasations. J Plast Reconstr Aesthet Surg 2011; 64:240-7. [DOI: 10.1016/j.bjps.2010.04.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/21/2010] [Accepted: 04/23/2010] [Indexed: 11/20/2022]
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