Pharmacological management of anticancer agent extravasation: A single institutional guideline

Abstract

Although the risk of extravasation of a chemotherapy (anticancer) medication is low, the complications associated with these events can have a significant impact on morbidity and health care costs. Institutions that administer anticancer agents should ideally have a current guideline on the proper management of the inadvertent administration of these toxic medications into tissues surrounding blood vessels. It is imperative that the health care team involved in administering drugs used to treat cancer be educated on the risk factors, preventative strategies and treatment of anticancer extravasations, as well as practice safe and proper administration techniques. Anticancer agents are generally divided into classes based on their ability to cause tissue damage. The review of current published guidelines and available literature reveals a lack of consensus on how these medications should be classified. In addition, many recently approved drugs for the treatment of cancer may lack data to support their classification and management of extravasation events. The treatment of the majority of extravasations of anticancer agents involves nonpharmacological measures, potentially in the ambulatory care setting. Antidotes are available for the extravasation of a minority of vesicant agents in order to mitigate tissue damage. Due to the limited data and lack of consensus in published guidelines, a working group was established to put forth an institutional guideline on the management of anticancer extravasations.

Extravasamento de trastuzumabe emtansina: manejo em paciente oncológico

“…In a review study for the formulation of an institutional guideline by a group at the University of Illinois Hospital and Health Sciences System, antibody-drug conjugates as irritants that may have vesicating properties, however, there is still a need to more data and studies to support the classification of these new compounds used in the treatment of oncological diseases. 9 In the episode of extravasation with trastuzumab emtansine reported in this study, initially, the patient had a burning sensation at the puncture site, edema and local hyperemia. It appears that six days after the episode, there were the appearance of new symptoms, such as increased hyperemia, the presence of blisters, pain and heat, which were managed in another health service through antibiotic treatment with ciprofloxacin 500mg.…”

“…It is also necessary to photograph the puncture site with the authorization of the patient and family, as well as its evolution over the management of injuries caused by extravasation, and all procedures and procedures performed must be described in detail in the patient's medical record. [8][9] It was mentioned, in a study of eight patients carried out in Austria, very positive results regarding prevention of tissue necrosis by using the technique Subcutaneous Wash-Out Procedure (SWOP) after the immediate withdrawal of the CVC in cases whose detection of extravasation it was early. It is this technique consists in the subcutaneous administration of saline solution for local rinsing and removal of leaked substance, however, requires staff training to be carried out.…”

“…Indicate it is already cold compresses to other chemotherapy and its local effect the reduction of symptoms, local vasoconstriction, thus limiting the diffusion of the drug to surrounding tissues, reducing the injured area. 5,[7][8][9] It is clear, however, that there is still no scientific evidence that cold compresses really help reduce the formation of lesions. 5 It is noteworthy, in relation to the case exposed in this study, that the leakage identification occurred after the end of the medication infusion during irrigation with 0.9% saline, however, it was not described in the medical record if, during the medication infusion , there was a professional responsible for observing the procedure throughout the administration, as recommended in the package insert and in the scientific bibliography on the prevention and management of EAD.…”

“…However, it is intended for the use of hot compresses for a limited number of chemotherapeutic agents, such as vinca alkaloids, etoposide, teniposide and oxaliplatin, with cold compresses being indicated for other chemotherapeutic agents, such as trastuzumab emtansine. 5,[7][8][9] It is warned that the use of topical Dexamethasone and other corticosteroids (topical or systemic) is not recommended for the management of EAD and, with regard to the extravasation of alkaloid from the vinca, its use has demonstrated an increase in the area of necrosis at the extravasation site. 10 It is inferred, therefore, that there is no indication for its use in the extravasation of trastuzumab emtansinein the scientific literature, and the belief that its use would be beneficial due to the interruption of the acute inflammatory process is not justified in the management of EAD.…”

“…An exception is made to this non-recommendation with regard to the extravasation of oxaliplatin in which there appears to be a positive impact on your administration of Dexamethasone 8mg oral or intravenous for up to 14 days. 9 Chemotherapy treatment evolves in oncology, constantly changing, with the emergence of new drugs being frequent and, like the conjugate trastuzumab emtansine, there is little in the literature on the management of adverse reactions from complications from extravasation, being important, for the nursing professional, to know the different classes of chemotherapy and how to proceed in case of overflow of these drugs. It is essential, therefore, that the protocols established for the prevention and management of EAD are updated and built based on updated scientific evidence and the best clinical evidence available in the literature.…”