Incidence, risk factors, and assessment of induration by ultrasonography after chemotherapy administration through a peripheral intravenous catheter

Abstract

AimsFollowing chemotherapy, induration may occur. This study was conducted to survey induration incidence and risk factors, and investigation for actual condition of induration.MethodsA cohort study was conducted for survey of incidence and risk factors, and a cross‐sectional observation study was conducted to examine actual condition of induration. The sites of chemotherapy administration were recorded, and these were observed on the next treatment day. Clinical nurses judged the presence or absence of induration by palpation. The sites were observed using ultrasonography. To investigate the risk factors associated with the induration, logistic regression analysis was performed using independent variables based on univariate analysis or previous reports.ResultsIn total, 69 patients were analyzed. The induration incidence was 17.4%, and three abnormal conditions were confirmed: subcutaneous edema, thrombosis, and thickening of the vessel wall. Breast cancer, non‐vesicant drug, vein diameter, and fosaprepitant use were included in the logistic regression model. Breast cancer: odds ratio (OR) 9.25; 95 CI 1.91.–44.71; non‐vesicant drug: OR 1.37; 95 CI 0.13–14.95; vein diameter: OR 0.40; 95% CI 0.16–0.97; fosaprepitant use: OR 0.16; 95% CI, 0.18–10.32.ConclusionsThe induration incidence was 17.4%. Risk factors for induration following chemotherapy administration were breast cancer and smaller vein diameter. Abnormal cases of subcutaneous tissue were confirmed, including subcutaneous edema, thrombosis, and thickening of the vessel wall. Induration may be prevented by selecting larger diameter vessels using ultrasonography when catheterizing for chemotherapy.

Changes in the subcutaneous tissue of catheterization site from the precatheterization state to the onset of anticancer drug‐induced induration: A case report

“…Reports about peripheral intravenous catheterization‐induced induration are few; however, the condition of the subcutaneous tissue (thrombus, subcutaneous edema, and vessel wall thickening) in this case was the same as in a previous report. In that report, the induration sites were observed using ultrasonography, wherein the observation was only conducted on the next treatment day in patients who were receiving chemotherapy via peripheral intravenous catheters 3 …”

“…injection site. 2,3 A previous study reported the incidence of induration after chemotherapy as 17.4%. If induration is found by physicians or nurses, inserting catheter to the affected site is avoided.…”

Characteristics of expert nurses' assessment of insertion sites for peripheral venous catheters in elderly adults with hard‐to‐find veins

“…Vein stiffness (which is very similar to induration) was only noted by the expert nurses in this study. Palpation is the only assessment method for induration in a clinical setting (Abe-Doi et al, 2020). Expert nurses are more likely to observe vein stiffness because, compared to newly graduated nurses, the former tend to use tactile input to a greater extent than visual information (Forsberg & Engström, 2018).…”

“…According to Marsh, Webster, Larsen, Cooke, et al (2018a), phlebitis was the most common cause of a PVC failure (17%), followed by occlusion/infiltration (14%) and dislodgement (10%); moreover, those complications were statistically more significant among female patients. Female patients are also more likely to experience an infiltration or extravasation (Abe‐Doi, Murayama, Komiyama, & Sanada, 2020; Hwang, Shin, Choi, & Park, 2018).…”

Damage to subcutaneous tissue at the catheterization site during chemotherapy: A prospective observational study using ultrasonography

“…This same study also reported that subcutaneous edema in the catheterization site can occur immediately after chemotherapy with some specific drugs (Murayama et al, 2019). In a cross‐sectional observational study of 69 participants using ultrasonography, the incidence of abnormal findings (e.g., subcutaneous edema, thickened vessel walls, thrombi) on the next treatment day following chemotherapy administration, without catheter failure, was 8.7% (Abe‐Doi et al, 2020a). This finding suggests that tissue damage may remain at the catheterization site over time, even when chemotherapy administration was completed without clear signs of extravasation.…”