Paravasation von Zytostatika

Mader, Ines; Fürst-Weger, Patrizia; Mader, Robert M.; Semenitz, Elisabeth I.; Terkola, Robert; Wassertheurer, Sabine M.

doi:10.1007/978-3-7091-3799-4

Cited by 14 publications

(5 citation statements)

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“…Each oncology department should formulate strict guidelines to reduce the incidence of extravasation. The most important approach is prevention [15,16]. The book edited by Mader et al [16] serves as reference book and is a solid basis for the development of guidelines in each oncology department as well as for documentation of an extravasation in patient files.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Anthracycline Extravasation with Dexrazoxane – Clinical Experience

Frost¹,

Gmehling²,

Azémar³

et al. 2006

Oncol Res Treat

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Accidental extravasation is a severe complication when administering anthracyclines. We describe 3 cases of extravasation with 3 different anthracyclines. Patients and Methods: One patient came from another hospital for a second opinion after an epirubicin extravasation. Only surgical debridement of the necrotic tissue was possible. The other two extravasations occurred during treatment with doxorubicin and doxorubicin- EMCH, respectively, in our department. Both patients were treated with dexrazoxane within 6 h of the event. Results: The 2 patients treated with dexrazoxane recovered completely without any sequelae. Conclusions: Treatment of antracycline extravasation with dexrazoxane is potentially useful and safe.

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Section: Discussionmentioning

confidence: 99%

Treatment of Anthracycline Extravasation with Dexrazoxane – Clinical Experience

Frost¹,

Gmehling²,

Azémar³

et al. 2006

Oncol Res Treat

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“…Die Pr ä ventionsma ß nahmen haben den gr ö ß ten Stellenwert, Paravasate zu vermeiden. Die gewebssch ä digende Potenz der Zytostatika sowie die Expositionsdauer sind die entscheidenden Faktoren f ü r die Beurteilung der vorliegenden Gewebssch ä digung [11] . Nicht zu vergessen sind dabei die patientenassoziierten Risikofaktoren wie fragile Venen bzw.…”

Section: Diskussionunclassified

“…Die H ä ufi gkeitsangaben in der Literatur zum Auftreten von Paravasaten schwanken zwischen 0,1 -6,5 % [2,14] . Bis jetzt wurde als Sofortma ß nahme das Stoppen der Infusion, die Aspiration des Paravasats und die lokale Infi ltration mit substanzspezifi schen Antidota empfohlen, deren Wirkung aber nicht endg ü ltig erwiesen ist [4,11] . Sie k ö nnen zu ausgedehnten Haut-und Weichteilnekrosen f ü hren, Sehnen, Nerven und Gef ä ß e destruieren und somit zu einer Funktionseinschr ä ngung der Hand f ü hren, was eine plastische De-…”

Section: Introductionunclassified

Sofortige offene chirurgische Behandlung von Zytostatika-Paravasaten der oberen Extremität

Telisselis¹,

Heers²,

Plock³

et al. 2009

Handchir Mikrochir plast Chir

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Extravasations of cytostatic agents can create necrosis of soft tissues in the hand and forearm. The early emergency subcutaneous "wash-out" with liposuction is the treatment of choice to avoid the development of soft-tissue defects. The objective of this study was to evaluate the open surgical debridement as a possible alternative method since the liposuction device is not commonly available in every hospital. In our study 10 patients were treated for extravasations of cytostatic drugs with a high potential for necrosis by emergency open debridement. All patients were evaluated prospectively by photography and clinical examination. 9 patients out of ten had a primary wound healing, one displayed a wound dehiscence with pre-existing MRSA infection. Another patient developed a seroma postoperatively which was treated by puncture. The mean functional outcome was good. The Eemergency open surgical treatment is a simple, in every hospital suitable therapy to prevent soft-tissue necrosis after extravasation of cytostatic drugs.

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“…DMSO muss an der Luft abtrocknen (in der Zeit keinen Verband anlegen). Zur Kälteapplikation sollte ein zeitliches Intervall eingehalten werden(12).Dexrazoxane (Zinecard®):Dexrazoxane wird normalerweise in der Behandlung der anthrazyklin-induzierten Kardiomyopathie eingesetzt. Dexrazoxane, ein Chelator verhindert die Formation von Anthrazyklin-Eisen-Komplexen.…”

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“…i.v. Einsatz von Natriumthiosulfat nicht notwendig erscheint(12).Steroide: Der Einsatz von Steroiden ist umstritten und kann aus rein pharmakologischer Sicht nicht empfohlen werden, da bei einer Paravasation kein entzündlicher Prozess vorliegt(12). Bei einer Paravasation von Vinca-Alkaloiden und Etoposid ist der Einsatz von Steroiden aufgrund der Nekroseverstärkung sogar kontraindiziert.…”

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Paravasation von Zytostatika: Prävention und Therapie

Jordan

Grothe

Schmoll

2005

Dtsch med Wochenschr

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Based on the potential to cause local tissue injury drugs are classified as vesicant, irritant and non-irritant. The frequency of extravasation is considered to be between 0.6 % and 6 %. More frequently an inflammatory reaction is caused by thrombophlebitis or a local hypersensitivity reaction following chemotherapy administration rather than by an extravasation. A number of factors are known to increase the risk of extravasation. By the consideration of these risk factors preventive guidelines for the safe administration of chemotherapeutic agents have been published. Central venous devices significantly reduce the risk of extravasation. To date there are no generally approved treatment guidelines for the management of extravasations. Treatment is mostly empirical. Nevertheless some general measures are to be recommended: Firstly, aspiration of the extravasated fluids should be attempted. Furthermore local supportive care such as intermittent topical warming or cooling is at least palliative and to a certain degree reduces the extent of the injury. Beside these non pharmacological therapies the beneficial effects of Dimethylsulfoxid (DMSO) -- or Hyaluronidase-administration dependent on the type of paravasation have been proven. The use of sodium bicarbonate, sodium thiosulfate or corticosteroids is no longer recommended. In the case of extravasation rapid and correct management is crucial for the benefit of any treatment. Therefore, written guidelines for both the handling of cytotoxic agents and also the management of an extravasation should be present in all Departments where cytotoxic agents are administered. In addition to these guidelines an extravasation kit including all necessary materials and drugs to treat extravasations should be available.

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Paravasation von Zytostatika

Cited by 14 publications

References 0 publications

Treatment of Anthracycline Extravasation with Dexrazoxane – Clinical Experience

Treatment of Anthracycline Extravasation with Dexrazoxane – Clinical Experience

Sofortige offene chirurgische Behandlung von Zytostatika-Paravasaten der oberen Extremität

Paravasation von Zytostatika: Prävention und Therapie

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