Regimen of 5-Fluorouracil and Cisplatin Increases the Incidence of Extravasation in Patients Undergoing Chemotherapy

The Clinical and Economic Burdens of Infiltration and Extravasation with Peripheral Intravenous Catheters: A Contemporary Narrative Review

“…Chemotherapy is another important risk factor for extravasation and it is estimated that about half of all chemotherapy is infused with a PIVC in the U.S [40]. The rate of chemotherapyrelated extravasation with PIVCs has been reported to range from 0% to 4.2% [40][41][42][43][44][45] (Table 3). However, in the two studies reporting 0% extravasation (Table 3), patients in fact exhibited persistent abnormalities, such as subcutaneous edema, which is an early sign of chemotherapy extravasation [44,45].…”

“…Modifiable and non-modifiable risk factors for chemotherapy extravasation from a PIVC include certain patient characteristics and anatomy (e.g., older age, small, and/or fragile veins, circulatory problems, obesity, excessive patient movement, impaired level of consciousness), procedural (e.g., size of cannula, multiple insertions, indwelling site, failure to secure the venipuncture site, untrained or inexperienced staff etc.) and product/infusion-related factors (e.g., duration and/or volume of solution, vesicants and irritants) (Table 3) [9,20,[40][41][42]46].…”

“…French prospective study at an infectious disease unit (n = 509) 4.5% [15] Chinese retrospective study at a hospital (n = 694,043) b 0.038% German prospective study of patients undergoing contrast-enhanced CT (n = 3,514) 0.71% [55] Australian retrospective analysis of CT/PET study (n = 296) 1.3% [57] Study pooling PET and CT scans from U.S. and Australia (n = 863) 6.7% [58] A quality improvement CT/PET study (n = 5,541) 6.2% d [56] U.S. study -national benchmark rate from 11 cancer centers (739,812 infusions) 0.09% [40] Retrospective study at a U.S. community cancer center (12,872 infusions) 0.17% [41] Japanese cross-sectional observational study of patients undergoing chemotherapy (n = 12,475) 0.18% [42] Japanese cross-sectional observational study of patients undergoing chemotherapy (n = 24) 4.2% [43] Japanese prospective study of outpatient chemotherapy (n = 41) 0% [45] Japanese prospective study of outpatient chemotherapy (n = 63) 0% [44] SLR of 7 studies on complications after PIVC-infused vasopressors (n = 1,382) 3.4% [32] Dutch retrospective study on PIVC-infused norepinephrine (n = 14,385) 0.035% [33] U.S. retrospective study of long-term use of vasopressors by midlines (n = 248) 0.004% [34] Australian retrospective study of critically ill patients receiving vasopressors (n = 212) 13% [35] Rwandan prospective cohort study of critically ill patients receiving vasopressors (n = 64) 2.9% [36] a Adjusted complication rate. b Study includes different drugs including hypotonic or hypertonic drugs, contrast media, strong acid or alkali drugs, antineoplastic agents, inotropic agents, and other drugs.…”

“…Timely and appropriate treatment of infiltration or extravasation can help limit adverse effects, and often depends on the type of infusate used. Inappropriate treatment of extravasation is related to more frequent skin surgery, and treatment delays are associated with serious tissue-related harms [9,42,71,72]. Thus, effective monitoring during PIVC administration is critical to provide the best care for patients.…”

“…While evidence generally shows that surgical intervention is rare with contrast extravasation [53,54,82], if severe contrast extravasation is left untreated, there is a risk of ischemia from venous congestion and low arterial gradient causing necrosis, serious neurovascular compromise, or even limb loss [66]. Similarly, if chemotherapy extravasation is left untreated or if treatment is delayed, blistering, peeling, sloughing of skin, tissue necrosis, and nerve and tendon damage, as well as functional and sensory impairment of the affected area, can occur [9,42,72].…”