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Related Categories: Certified Registered Nurse Infusion (CRNI), Conscious Sedation, Heparin Administration, Commercial Infusion Pumps, Home Infusion, IV Fluids, Intravenous Therapy Humor, Nursing Consultants, Nursing Societies, PICC Lines, Professional Associations, Starting An Intravenous IV Line, Venepuncture, Steroid Therapy
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See also: Extravasation Abstracts.
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Nursing Malpractice Cases Involving Intravenous Extravastations:
Extravasation Follows Chemotherapy Administration. Potential Complication or Nursing Negligence:
Iacano v. St. Peter's Medical Center, 334 N. j. Super. 547 – NJ (2000)
Summary: Intravenous therapy has inherent risks and potential complications. When you introduce chemotherapeutic drugs and known vesicants, those risks increase dramatically. In this case, a known risk, extravasation, occurred following administration. The question arises, could the nurses have acted sooner to prevent the extravasation and resulting tissue damage.
http://www.nursefriendly.com/nursing/clinical.cases/040130.htm
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Compounds and Methods that Reduce the Risk of Extravasation Injury Associated with the Use of Vesicant Antineoplastic Agents, Office of Technology Administration, Baylor College of Medicine:"The majority of anti-cancer drugs are administered intravenously. Estimates of the frequency of extravasation of these drugs vary widely, ranging from 0.5% to more than 6%. The severity of the injury resulting from extravasation is dependent on the specific drug administered and its concentration, the amount of drug extravasated, the length of tissue exposure to the drug and the site of extravasation. The drugs associated with severe local necrosis are: Chromomycin A, Dactinomycin, Daunorubicin, Doxorubicin, Mechloretamine, Mithramycin, Mitomycin C, Streptozotocin, Vinblastine and Vincristine. Extravasation injury is most commonly caused by the anthracyclines, Daunorubicin and Doxorubicin. Necrosis may develop within days after the extravasation but necrotic ulcers usually develop over 7 to 10 days after the extravasation, sometimes enlarging over several months thereafter. Currently there is no consensus as to what should be done once extravasation has occurred. Antidotal therapy is in dispute and some clinicians maintain that the area must be excised and grafting done immediately."
Office of Technology Administration, Baylor College of Medicine
One Baylor Plaza,
Houston, Texas 77030 Phone 713-798-6821 - Fax 713-798-1252
http://www.bcm.tmc.edu/research/OTA/techs/tech-96-30.html
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Extravasation of Chemotherapy, Prevention and Management of, BC Cancer Agency:"The agents listed as vesicants can cause extensive necrosis. Doxorubicin, daunorubicin, epirubicin and mitomycin bind to DNA, recycle locally and may cause a progressive slough of tissue over several weeks, requiring excision and skin grafting.
In order to avoid problems of this kind, great care must be taken to assure that these agents are given into an intact vein with a good free flow of blood. Drug may leak from sites of previous recent punctures or from veins which are occluded from any cause such as tight clothing, obstructing masses or clotting. Therefore, the insertion site should not be distal to a recent venipuncture or in an arm with compromised circulation. It is preferable to select, if possible, a large vein which is not adjacent to a joint or structures which may be particularly troublesome should a tissue slough occur (such as the wrist or hand). A large vein in the mid-forearm would be ideal, if available."
Executive and Provincial Offices
Suite 400, East Tower
555 West 12th Avenue
Vancouver, BC V5Z 3X7
(604) 877-6000
(604) 877-6146 (fax)
E-mail: webmaster@bccancer.bc.ca
http://www.bccancer.bc.ca/HPI/DrugDatabase/Appendices/Appendix2/ExtravasationofChemotherapyPreventionandManagementofPolicyIII20.htm
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Appendix 2 - Extravasation of Chemotherapy, Cancer Care Ontario:"A number of agents used in cancer chemotherapy are extremely irritating if they extravasate or infiltrate into the tissues rather than remaining within the vasculature. Chemotherapy agents can be divided into the following categories:"
Cancer Care Ontario
620 University Avenue
Toronto, Ontario
Canada
M5G 2L7
Main number: 416.971.9800
Main fax: 416.971.6888
Email enquiries: publicaffairs@cancercare.on.ca
http://www.cancercare.on.ca/access_173.htm
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Extravasation Injuries, Health Sciences Centre (Winnipeg):"Extravasation injuries, more commonly known as “IV burns” are one of the most difficult complications that nurses in most areas have to deal with. They can be caused by leakage of cytotoxic drugs, intravenous nutrition, solutions of calcium, potasium, bicarbonate, and even 10% dextrose outside the vein into which they are delivered. They can cause skin necrosis but can also lead to significant scarring around tendons, nerves, and joints, especially on the dorsum of the hand or in the antecubital fossa. Extravasation may cause full thickness skin loss above the area of injury and may require skin grafting."
Health Sciences Centre
820 Sherbrook Street Winnipeg, Manitoba, Canada R3A 1R9
telephone 204-774-6511
http://www.hsc.mb.ca/nursingpractice/january_01.htm
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What is Extravasation? National Extravasation Information Service (UK), (Includes pictures, photographs):"The leakage of intravenous drugs from the vein into the surrounding tissue.(1)
Extravasation injury usually refers to the damage caused by leakage of solutions from the vein to the surrounding tissue spaces during intravenous administration.
Once an extravasation has occurred, damage can continue for months and involve nerves, tendons and joints. If treatment is delayed, surgical debridement, skin grafting, and even amputation may be the unfortunate consequences.(2)"
Mr A Stanley, Principal Oncology Pharmacist
St Chad's Unit, Dudley Road Hospital
Birmingham B18 7QH.
info@extravasation.org.uk
http://www.extravasation.org.uk/Definition.htm
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Diagnosis Of Extravasation Injury, National Extravasation Information Service (UK):"It is important when diagnosing extravasation that a misdiagnosis is not made. This is because the treatment is physiologically traumatic to the body and may involve the administration of drugs which, in their own right, could cause or potentiate extravasation.
Early detection of extravasation is crucial. Common misdiagnoses are made because the observer is not differentiating discoloration reactions in the vein, venous shock, flare or phlebitis reactions of the vein wall and / or anaphylaxis. This is complicated further as some cytotoxics are highly coloured agents and if the vein in question is particularly superficial then a bright red solution injected into the vein may cause local discoloration. Furthermore, cytotoxics are often administered cool, at best at room temperature. They are then administered fairly rapidly into blood at a temperature of 37°C. The greater the thermal gradient between the drug solution and the blood the greater the stress on the vein and often contraction and / or venus spasm is observed due to the thermal shock."
Mr A Stanley, Principal Oncology Pharmacist
St Chad's Unit, Dudley Road Hospital
Birmingham B18 7QH.
info@extravasation.org.uk
http://www.extravasation.org.uk/Diagnosis.htm
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Prevention or Minimisation of the Problems of Extravasation, National Extravasation Information Service (UK):"The position, size and age of the venepuncture site are the factors which have greatest bearing on the likelihood of problems occurring. However, if the following points are borne in mind, the likelihood of extravasation can be significantly reduced."
Mr A Stanley, Principal Oncology Pharmacist
St Chad's Unit, Dudley Road Hospital
Birmingham B18 7QH.
info@extravasation.org.uk
http://www.extravasation.org.uk/Prevent.htm
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Evaluation and Treatment of Chemotherapy Extravasation Injuries, Elizabeth Kassner, MS, RN, CPNP, CPON, National Extravasation Information Service (UK):"Extravasation of chemotherapeutic vesicant agents can result in significant tissue damage, alteration in limb function, and pain. Quality of life for long-term survivors can be severely impacted by negative sequelae from vesicant extravasation. Currently, there is no known preventive therapy. Early detection and intervention are paramount to halt tissue damage and reduce the chance of permanent disability or disfigurement. This article provides an overview of known chemotherapeutic vesicants (mechlorethamine, mitomycin-C, doxorubicin, daunomycin, vincristine and vinblastine), associated theories of tissue destruction, assessment techniques for peripheral intravenous sites, vascular access devices and central venous lines, current treatment strategies, and investigational therapies. A brief discussion of the legal implications of extravasation injuries and recommended key points for medical record documentation are included."
Mr A Stanley, Principal Oncology Pharmacist
St Chad's Unit, Dudley Road Hospital
Birmingham B18 7QH.
info@extravasation.org.uk
http://www.extravasation.org.uk/Eval.htm
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Extravasation: Does Your Knowledge
Match Your Patient's Needs?
Esther Csapo Rastegari, RN, BSN, EdM, Nursingspectrum.com:"Vesicant extravasation can lead to short-term complications, such as blistering, ulceration, infection, impaired venous access, delay in receiving prescribed infusion therapy, tissue necrosis, and eschar formation.
As a result of tissue damage, the patient may need surgical interventions, such as debridement, excision, amputation, and skin grafting. In addition, long-term sequelae, including joint stiffness, neuropathy, deformity, disability, and even death, may result."
http://nsweb.nursingspectrum.com/cfforms/GuestLecture/Extravasation.cfm
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Management Of Extravasation Injury In Neonates, World Wide Wounds:"This article describes a technique for the treatment of extravasation injuries in neonates, in which the affected area is covered with a sterile amorphous hydrogel enclosed in an impermeable plastic bag or sleeve. The authors discuss potential advantages of this technique over alternative methods for treating such injuries, by reference to selected case histories.
Introduction: Extravasation injuries are a potentially serious consequence of all intravenous therapy, but they are generally associated with the administration of antineoplastic agents or osmotically active solutions containing 10 per cent glucose, calcium chloride or calcium gluconate."
http://www.worldwidewounds.com/1997/october/Neonates/NeonatePaper.html
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