Management of the extravasation of anti-neoplastic agents

Boulanger, Jim; Ducharme, Anique; Dufour, Annick; Fortier, Stephanie; Almanric, Karine

doi:10.1007/s00520-015-2635-7

Cited by 50 publications

(78 citation statements)

References 42 publications

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“…A standardised interdisciplinary approach to manage extravasations of cytotoxic agents should be implemented in the hospital quality management system [4, 17]. A task force quickly accumulates the necessary expertise to handle even complex situations and raises the awareness for this complication in the entire institution.…”

Section: Discussionmentioning

confidence: 99%

Extravasation emergencies: state-of-the-art management and progress in clinical research

Pluschnig

Haslik

Bartsch

et al. 2016

memo

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SummaryIn cancer treatment, extravasation is defined as an inadvertent instillation or leakage of cytotoxic drugs into the perivascular space during infusion. As a dreaded complication of chemotherapy, extravasation has gained increasing attention in recent years. Classified according to their subcutaneous toxicity, three types of cytotoxins have been established: vesicants, irritants and nonvesicant drugs. Vesicant cytotoxic drugs may induce tissue damage, ulceration and tissue necrosis. Although we have established measures to manage extravasation emergencies, prevention is of paramount importance. This may be achieved within hospitals through regular training and education, which is best provided by a specialised and experienced task force including all disciplines involved in cancer therapy. Moreover, clinical and translational studies contribute to a better management of chemotherapy-induced extravasation as shown by our group in recent years. We were able to demonstrate that the evaluation of blood flow by indocyanine green angiography in the extravasation area predicts the extent of damage and the need of future surgical intervention. When a Port-a-Cath® extravasation is detected early, a subcutaneous wash-out procedure was found to be beneficial, corroborated by the analytical evaluation of the removed cytotoxic compound epirubicin. In another study, the tissue distribution of platinum was quantified at the anatomic level in cryosections of various tissues. This novel knowledge complements and supports our current efforts to handle extravasations better. On the other hand, a number of new drugs (chemotherapy, monoclonal antibodies, checkpoint inhibitors etc.) with many open issues to reliably classify their tissue toxicity still require our attention.

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Section: Discussionmentioning

confidence: 99%

Extravasation emergencies: state-of-the-art management and progress in clinical research

Pluschnig

Haslik

Bartsch

et al. 2016

memo

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“…1,2,18,19,[165][166][167] All were limited in their applications to different patient groups and few reported on the potential harms or side effects that may occur from a particular course of treatment. In addition, the criteria on which studies were included and an assessment of the quality of these studies were not reported in any of the published guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,18,19,[165][166][167] Two of the references 165,166 reported on the same set of guidelines but both were available only as conference abstracts, limiting the information that could be extracted from them. Of the remaining five references, one was a general document which included guidelines for all types of extravasation injuries, 2 one focused on a paediatric population, 19 and the remaining three limited their scope according to the type of fluid extravasated.…”

Section: Guidelinesmentioning

confidence: 99%

“…In 2015, Boulanger et al 167 published a guideline on the management of antineoplastic agent extravasations to inform clinical practice in Quebec. Studies were identified using a search of PubMed, although few eligibility criteria were stated.…”

Section: Bellin Et Al'smentioning

confidence: 99%

“…Of the remaining five references, one was a general document which included guidelines for all types of extravasation injuries, 2 one focused on a paediatric population, 19 and the remaining three limited their scope according to the type of fluid extravasated. 1,18,167 Great Ormond Street Hospital published a set of guidelines online, which cover the prevention, recognition and management of extravasation injuries. 2 The guidelines emphasised the need for immediate management of extravasation injuries by immediately stopping the infusion and aspirating the area of the wound, but the device should not be flushed.…”

Section: Guidelinesmentioning

confidence: 99%

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Treatment of extravasation injuries in infants and young children: a scoping review and survey

Corbett

Marshall

Harden

et al. 2018

Health Technol Assess

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BackgroundExtravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches.ObjectivesTo identify which treatments may be best for treating extravasation injuries in infants and young children.DesignScoping review and survey of practice.PopulationChildren aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries.InterventionsAny treatment for extravasation injury.Main outcome measuresWound healing time, infection, pain, scarring, functional impairment, requirement for surgery.Data sourcesTwelve database searches were carried out in February 2017 without date restrictions, including MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus and EMBASE (Excerpta Medica dataBASE).MethodsScoping review – studies were screened in duplicate. Data were extracted by one researcher and checked by another. Studies were grouped by design, and then by intervention, with details summarised narratively and in tables. The survey questionnaire was distributed to NHS staff at neonatal units, paediatric intensive care units and principal oncology/haematology units. Summary results were presented narratively and in tables and figures.ResultsThe evidence identified in the scoping review mostly comprised small, retrospective, uncontrolled group studies or case reports. The studies covered a wide range of interventions including conservative management approaches, saline flush-out techniques (with or without prior hyaluronidase), hyaluronidase (without flush-out), artificial skin treatments, debridement and plastic surgery. Few studies graded injury severity and the results sections and outcomes reported in most studies were limited. There was heterogeneity across study populations in age, types of infusate, injury severity, location of injury and the time gaps between injury identification and subsequent treatment. Some of the better evidence related to studies of flush-out techniques. The NHS survey yielded 63 responses from hospital units across the UK. Results indicated that, although most units had a written protocol or guideline for treating extravasation injuries, only one-third of documents included a staging system for grading injury severity. In neonatal units, parenteral nutrition caused most extravasation injuries. In principal oncology/haematology units, most injuries were due to vesicant chemotherapies. The most frequently used interventions were elevation of the affected area and analgesics. Warm or cold compresses were rarely used. Saline flush-out treatments, either with or without hyaluronidase, were regularly used in about half of all neonatal units. Most responders thought a randomised controlled trial might be a viable future research design, though opinions varied greatly by setting.LimitationsPaucity of good-quality studies.ConclusionsThere is uncertainty about which treatments are most promising, particularly with respect to treating earlier-stage injuries. Saline flush-out techniques and conservative management approaches are commonly used and may be suitable for evaluation in trials.Future workConventional randomised trials may be difficult to perform, although a randomised registry trial may be an appropriate alternative.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Dermatologic Adverse Effects of Anticancer Therapy I: General Principles

Dang

Liu

Kwong

2021

Dermato-Oncology Study Guide

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Management of the extravasation of anti-neoplastic agents

Abstract: Several strategies must be established to ensure that extravasation is recognized and properly managed. Given the evidence available at this time, the Comité de l'évolution des pratiques en oncologie (CEPO) has made recommendations for clinical practice in Quebec.

Cited by 50 publications

References 42 publications

Extravasation emergencies: state-of-the-art management and progress in clinical research

Extravasation emergencies: state-of-the-art management and progress in clinical research

Treatment of extravasation injuries in infants and young children: a scoping review and survey

Dermatologic Adverse Effects of Anticancer Therapy I: General Principles

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