Extravasation: A dreaded complication of chemotherapy

Department of Medical Oncology, AZ Middelheim, Antwerp, Belgium.
Annals of Oncology (Impact Factor: 7.04). 02/2003; 14 Suppl 3(suppl 3):iii26-30. DOI: 10.1093/annonc/mdg744
Source: PubMed
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Available from: Dirk Schrijvers, Jun 11, 2014
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    • "Chronic progression of the damage occurs because the cytotoxic agents cannot be metabolized locally or removed from the area by lymphatic circulation (Langstein et al., 2002). Recent articles report that skin ulceration and skin necrosis may follow 1 to 3 weeks after an extravasation injury and that can lead to necrosis of underlying fascia, tendon and periosteum (Ener et al., 2004; Thakur et al., 2008) According to several studies injections of antidotes, like hyaluronidase, DMSO, sodium thiosulphate etc., are beneficial only within the first few hours after injury (Bertelli et al., 1995; Schrijvers, 2003; Tsavaris et al., 1992). Yet immediate resection of the infiltrated tissues (Bowers and Lynch, 1978; Laughlin et al., 1979; Preuss and Partoft, 1987) is not always justified because of uncertainty regarding the volume and area of excision required (Larson, 1982). "
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    ABSTRACT: Late presentation of extravasation injuries from chemotherapeutic agents is not uncommon. Twenty-four patients with extravasation injuries presented with upper limb extravasation but without any skin necrosis between the second and the fourteenth day following injury day. We flushed out the infiltrated area with 300-500 ml of normal saline through multiple stab incisions. All 24 patients responded well to the procedure and no further complications occurred. The average time for the complete healing of the wounds was 15 days. All the patients were able to continue their chemotherapy treatment without delay. Patients were followed up for a mean period of 13 months. They all recovered with no functional deficit and only mild scarring. Early recognition and immediate treatment of extravasation injuries are of paramount importance. In cases with no evidence of skin necrosis, a delayed wash-out procedure appears to be very effective in removing the extravasated drug and minimizing further tissue damage.
    Full-text · Article · Jan 2011
    • "Cytotoxic agents have been classified as irritants or vesicants [Table 2].[178] "
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    ABSTRACT: In addition to their therapeutic effects on malignant cells, cytotoxic agents have the potential of causing destruction of healthy, normal cells. Extravasation of the drug can produce extensive necrosis of the skin and subcutaneous tissue. Management of these extravasational effects differs from one centre to another and prevention is usually strongly emphasized. We analyzed our management of 12 patients referred to us over five years with extravasation of cytotoxic drugs and reviewed the literature for different approaches with regard to prophylaxis and management of extravasational effects. This study was done in the department of plastic surgery of a medical college. Five years of retrospective data were studied of patients referred to our department with extravasation of cytotoxic drugs. We managed 12 cases referred to our department with extravasation of cytotoxic drugs. Mitomycin C was used in seven cases (58.33%), vincristine in two cases (16.66%), 5-Florouracil in another two cases while doxorubicin was responsible for extravasational side effects in one case (8.33%). The size of necrosis ranged from 3.75 cm(2) to 25 cm(2) with average size of 9.6 cm(2). In terms of the area involved, the dorsum of the hand was involved in five cases (41.66%), the wrist in another five cases (41.66%), and the cubital fossa in the remaining two cases (16.66%). All cases were treated with daily debridement of necrotic tissue, saline dressing, and split skin grafting. Extravasation of cytotoxic drugs further increases the suffering of cancer patients. This catastrophe can only be avoided by vigilance and immediate application of antidotes. Once the local toxicity of the drugs takes effect, morbidity is unavoidable.
    No preview · Article · Jul 2008 · Indian Journal of Plastic Surgery
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    • "Intracellular microtubule toxins and topoisomerase inhibitors interfere with mitosis and do not bind to DNA (Schrijvers, 2003). Microtubule toxins include vinca alkaloids (vincristine, vinblastine, and vinorelbine), which inhibit microtubule formation, and taxanes (paclitaxel and docetaxel), which enhance microtubule stabilization. "
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    ABSTRACT: To review the literature regarding the incidence, current practice, guideline recommendations, nursing management, and knowledge gaps relevant to vesicant extravasation. Published research articles, books, case reports, and national guidelines. Vesicant extravasation is a relatively rare but significant complication of chemotherapy administration. Extravasation may have a range of consequences that can cause serious physical and quality-of-life effects. Knowledge of risk factors and preventive measures can reduce patient risk. Data-based and empirical management strategies such as immediate local measures (agent withdrawal, comfort measures, and medical interventions) may minimize risk for extravasation, as well as lead to timely recognition and management and decreased morbidity should extravasation occur. Vesicant extravasation and sequelae constitute a complex patient problem that clinicians should strive to prevent or to minimize injury should it occur. To this end, clinicians must demonstrate awareness of risks and use specialized knowledge while administering vesicant agents. Only nurses knowledgeable about extravasation and skilled in associated techniques should assume responsibility for vesicant administration.
    Full-text · Article · Dec 2006 · Oncology Nursing Forum
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