Managing chemotherapy extravasation in totally implantable central venous access: Use of subcutaneous wash-out technique

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.

Tapirira guianensis is Selectively Cytotoxic, Induces Apoptosis to the Glioblastoma and Decreases Tumor Growth and Angiogenesis in vivo

“…Among the various routes of chemotherapy administration, the intravenous way is one of the most used in its administration. However, leakage of the venous network may occur, causing subcutaneous toxicity and causing damage to adjacent tissues, ulcerations and necrosis [35]. The HET-CAM, a variation of the CAM that was initially used to assess the risk of irritation of the skin and mucous membranes caused by exposure to new substances, also allows the measurement of the risk of irritancy of the infusion site, reducing the use of tests in mammals [36].…”

Enhancement of Oncology Nurses' Competency Regarding Management of Intravenous Chemotherapy Extravasation

“…Chemotherapy extravasation is defined as the unintentional leakage of chemotherapeutic agents from the vein into surrounding tissues (Hussin, & Ahmed, 2020). It can cause pain, erythema, edema, burning, blister, and discomfort at the intravenous injection site (Taibi et al,2020).…”

A clinical study of using a phentolamine alcohol wet dressing in the treatment of extravasation after a 20% fat emulsion intravenous infusion - a randomised trial

“…Phentolamine alcohol wet dressing can restore local blood supply and oxygen as soon as possible, improve microcirculation, reduce the occurrence of skin necrosis and improve the efficiency of wet dressing; reduce the risk of deterioration and failure of the drug during transportation and external environmental changes, prevent the volatilization of the drug and ensure the therapeutic effect [8,9,10]. At present, there are few clinical studies concerning the use of a phentolamine alcohol wet dressing to treat extravasation resulting from a milk fat intravenous infusion.…”