Retrospective Study of the Management of Chemotherapeutic Extravasation Injury

Abstract

Despite the now widespread experience with the administration of chemotherapeutic agents in oncology, extravasation injuries still occur. Furthermore, the most appropriate management of such injuries is not known. The authors examined the current treatment options for extravasation injury and the incidence of this problem. All cases of extravasation referred to the plastic surgery service at one institution from 1994 through 1996 were examined. During a 6-year period there were 44 cases of extravasation injury identified in 42 patients. Comparison with a previous study conducted 15 years before at the same institution revealed a significant reduction in the incidence of extravasation injuries during that time (0.01% vs. 0.1%; = 0.00). The site of extravasation was peripheral in 32 cases and central in 12. Paclitaxel and doxorubicin were the two most common drugs involved. The local infusion of antidotes was not performed routinely. Only 26 of the 42 patients were referred to the plastic surgery service for care. Only 10 of those 26 patients required local ulcer excision and closure to achieve a healed wound. The mean time between injury and referral was 40 days. This time did not predict the subsequent need for a surgical procedure. Most patients, including the remaining 16 referred to the plastic surgery service, did not require surgical intervention. All were watched expectantly, and their injuries healed spontaneously. In conclusion, the incidence of extravasation is decreasing, most likely as a result of the diligence in the administration and identification of extravasation injuries as well as the result of the use of more central infusion sites. Most cases can be managed conservatively, with directed surgical treatment of the ulceration when appropriate.

Complicações na rede venosa de mulheres com câncer de mama durante tratamento quimioterápico

“…Ice is used in order to restrict the action of the drug at that site, decreasing its vesicant and/or irritant potential, seeking to inactivate the destructive capacity of the drug. For the drugs used in the protocols studied, this approach is internationally recommended (16) . The use of essential fatty acids was another indicated procedure in the management of extravasation, and the principle for their use is defined by being a compound used for site hydration, avoiding the disruption of the skin and, in the case of injury, can be used to promote a humid environment, assisting in cell proliferation and autolytic debridement, facilitating healing (17) .…”

Contrast Media Extravasation in CT and MRI – A Literature Review and Strategies for Therapy

“…Severe complications occurred in only a single case. In general, depending on the location, toxicity of the administered agent, volume, osmolarity and state of charge (ionic versus non-ionic), extravasation can lead to negligible or even serious complications [17]. Clinical symptoms can range from mild erythema to soft tissue necrosis (▶ Fig.…”

Managing Vesicant Extravasations

“…Inform patients of the risk for vesicant extravasation. Although the risk for vesicant extravasation is very low, estimated to be in the range of 0.01%-6% [1,2], patients need to be informed that extravasation may occur each time they receive a vesicant. When a chemotherapy protocol or treatment plan is initially explained to a patient, there is a tendency to emphasize the more common risks, such as myelosuppression, nausea and vomiting, hypersensitivity, and fatigue.…”