The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice

Harrold, Karen; Gould, DJ; Drey, Nicholas

doi:10.1111/ecc.12363

Cited by 19 publications

(51 citation statements)

References 43 publications

(96 reference statements)

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“…8,17,164 All reviews agreed that, although immediate treatment is needed for the best outcome, there is no consensus regarding which treatments are the best practice. They all mention saline wash-out with or without hyaluronidase as a frequently studied treatment, but no review could make conclusive statements on its effectiveness compared with other treatments, because of the limited quality of evidence.…”

Section: Discussionmentioning

confidence: 99%

“…The authors commented that the sample size required to properly control for these factors will probably be prohibitively large. Notwithstanding the discussion in this systematic review, 164 the very limited insight on future research provided by the scoping review studies means that further exploration is needed. This is in relation to decisions regarding the study design, treatments to be studied, population to be studied and the outcome measures needed.…”

Section: Future Research On Treatments For Extravasation Injuriesmentioning

confidence: 98%

“…Three reviews, one narrative 8 and two systematic, 17,164 were identified that synthesised the evidence on treatment for extravasation events and injuries. Clifton-Koeppel 8 conducted a broad narrative review of extravasation injuries across a range of patient populations which included a review of initial treatments and subsequent wound care options.…”

Section: Reviewsmentioning

confidence: 99%

“…In 2015, Harrold et al 164 published a systematic review of the management of cytotoxic chemotherapy extravasations. The review focused on strategies aimed at preventing the need for surgical debridement.…”

Section: Reviewsmentioning

confidence: 99%

“…31 One of the systematic reviews (of chemotherapy extravasations) also discussed the challenges of undertaking further research, noting key issues which may preclude the use of a randomised design. 164 These included the sporadic occurrence and low incidence of extravasations, and the complexity involved in controlling the many extraneous variables associated with extravasations: age, sex, comorbidities, type of infusate, site and volume of extravasation and time to intervention. The authors commented that the sample size required to properly control for these factors will probably be prohibitively large.…”

Section: Future Research On Treatments For Extravasation Injuriesmentioning

confidence: 99%

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Treatment of extravasation injuries in infants and young children: a scoping review and survey

Corbett

Marshall

Harden

et al. 2018

Health Technol Assess

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BackgroundExtravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches.ObjectivesTo identify which treatments may be best for treating extravasation injuries in infants and young children.DesignScoping review and survey of practice.PopulationChildren aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries.InterventionsAny treatment for extravasation injury.Main outcome measuresWound healing time, infection, pain, scarring, functional impairment, requirement for surgery.Data sourcesTwelve database searches were carried out in February 2017 without date restrictions, including MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus and EMBASE (Excerpta Medica dataBASE).MethodsScoping review – studies were screened in duplicate. Data were extracted by one researcher and checked by another. Studies were grouped by design, and then by intervention, with details summarised narratively and in tables. The survey questionnaire was distributed to NHS staff at neonatal units, paediatric intensive care units and principal oncology/haematology units. Summary results were presented narratively and in tables and figures.ResultsThe evidence identified in the scoping review mostly comprised small, retrospective, uncontrolled group studies or case reports. The studies covered a wide range of interventions including conservative management approaches, saline flush-out techniques (with or without prior hyaluronidase), hyaluronidase (without flush-out), artificial skin treatments, debridement and plastic surgery. Few studies graded injury severity and the results sections and outcomes reported in most studies were limited. There was heterogeneity across study populations in age, types of infusate, injury severity, location of injury and the time gaps between injury identification and subsequent treatment. Some of the better evidence related to studies of flush-out techniques. The NHS survey yielded 63 responses from hospital units across the UK. Results indicated that, although most units had a written protocol or guideline for treating extravasation injuries, only one-third of documents included a staging system for grading injury severity. In neonatal units, parenteral nutrition caused most extravasation injuries. In principal oncology/haematology units, most injuries were due to vesicant chemotherapies. The most frequently used interventions were elevation of the affected area and analgesics. Warm or cold compresses were rarely used. Saline flush-out treatments, either with or without hyaluronidase, were regularly used in about half of all neonatal units. Most responders thought a randomised controlled trial might be a viable future research design, though opinions varied greatly by setting.LimitationsPaucity of good-quality studies.ConclusionsThere is uncertainty about which treatments are most promising, particularly with respect to treating earlier-stage injuries. Saline flush-out techniques and conservative management approaches are commonly used and may be suitable for evaluation in trials.Future workConventional randomised trials may be difficult to perform, although a randomised registry trial may be an appropriate alternative.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Discussionmentioning

confidence: 99%

Section: Future Research On Treatments For Extravasation Injuriesmentioning

confidence: 98%

Section: Reviewsmentioning

confidence: 99%

Section: Reviewsmentioning

confidence: 99%

Section: Future Research On Treatments For Extravasation Injuriesmentioning

confidence: 99%

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Treatment of extravasation injuries in infants and young children: a scoping review and survey

Corbett

Marshall

Harden

et al. 2018

Health Technol Assess

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Management of noncytotoxic extravasation injuries: A focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline

et al. 2023

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Extravasation is the leakage of intravenous solutions into surrounding tissues, which can be influenced by drug properties, infusion techniques, and patient-related risk factors. Although peripheral administration of vesicants may increase the risk of extravasation injuries, the time and resources required for central venous catheter placement may delay administration of time-sensitive therapies. Recent literature gathered from the growing use of peripheral vasopressors and hypertonic sodium suggests low risk of harm for initiating these emergent therapies peripherally, which may prevent delays and improve patient outcomes. Physiochemical causes of tissue injury include vasoconstriction, pH-mediated, osmolar-mediated, and cytotoxic mechanisms of extravasation injuries. Acidic agents, such as promethazine, amiodarone, and vancomycin, may cause edema, sloughing, and necrosis secondary to cellular desiccation.Alternatively, basic agents, such as phenytoin and acyclovir, may be more caustic due to deeper tissue penetration of the dissociated hydroxide ions. Osmotically active

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Managing Issues: Tumor Lysis, Extravasation, Adverse Effects, and Others

Frigo

Fonseca

Fávero

et al. 2022

The Golden Guide to Oncologic Pharmacy

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The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice

Cited by 19 publications

References 43 publications

Treatment of extravasation injuries in infants and young children: a scoping review and survey

Treatment of extravasation injuries in infants and young children: a scoping review and survey

Management of noncytotoxic extravasation injuries: A focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline

Managing Issues: Tumor Lysis, Extravasation, Adverse Effects, and Others

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