Vesicant Extravasation Part I: Mechanisms, Pathogenesis, and Nursing Care to Reduce Risk

Sauerland, Carmel; Engelking, Constance; Wickham, Rita; Corbi, Dominick

doi:10.1188/06.onf.1134-1141

Cited by 103 publications

(109 citation statements)

References 30 publications

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“…COFEN Resolution Nº 210/1998 (10) states that it is duty of the nurse "to plan, organize, supervise, medications (11) .…”

Section: Resultsmentioning

confidence: 99%

“…Documentation must be performed when there is suspicion of extravasation or if it is confirmed and must cover all actions taken by the nurse, as well as the responses to these interventions (11) .…”

Section: Resultsmentioning

confidence: 99%

“…For better documentation and evaluation of actions, the nurse can make use of the photographic record of the area where the extravasation occurred or was suspected (11)(12) .…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Dermatological Toxicity in Women With Breast Cancer Undergoing Chemotherapy Treatment

Gozzo

Panobianco

Clapis

et al. 2010

Rev. Latino-Am. Enfermagem

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Dermatological Toxicity in Women With Breast Cancer Undergoing Chemotherapy TreatmentThis study aimed to analyze the occurrence of skin toxicity caused by drugs used in the protocol of neoadjuvant and adjuvant chemotherapy among women with breast cancer.Patient records of 72 women who were subject to this therapy between 2003 and 2006 were assessed. Of the 558 cycles of chemotherapy, 152 adverse events were registered.There were 37 registrations of dermatological toxicity, of those, 20 were extravasations that affected 17 women. Nine reports of hardened local injury, local fibrosis, pain, and hyperemia were registered during neoadjuvancy. In adjuvancy, among the 11 extravasations registered there were reports of hardened local injury, fibrosis and local pain. Lack of follow-up records for both periods was observed. Registration of the events and reports by the nursing team are essential to monitor the sites of venous puncture during the chemotherapy treatment, besides measuring and making a photographic record of the site.

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“…COFEN Resolution Nº 210/1998 (10) states that it is duty of the nurse "to plan, organize, supervise, medications (11) .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Dermatological Toxicity in Women With Breast Cancer Undergoing Chemotherapy Treatment

Gozzo

Panobianco

Clapis

et al. 2010

Rev. Latino-Am. Enfermagem

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“…Cytotoxic extravasations are beyond the scope of this review, and their management has been extensively reviewed elsewhere. 1 …”

Section: Definitions Classifications Of Injury and Risk Factors Formentioning

confidence: 99%

“…5 In a retrospective study of 42 documented pediatric extravasations, only 33% of patients received an appropriate antidote, although 81% of patients qualified for treatment. 5 Specific guidelines are available for radiographic contrast and chemotherapy extravasations, 1,6 but comprehensive evidence-based management recommendations for each specific extravasation are lacking. Thus, our main purpose was to evaluate the primary literature for available interventions for the management of extravasations and to provide recommendations based on treatment literature for specific therapeutic modalities for noncytotoxic medications.…”

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confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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Extravasations are common manifestations of iatrogenic injury that occur in patients requiring intravenous delivery of known vesicants. These injuries can contribute substantially to patient morbidity, cost of therapy, and length of stay. Many different mechanisms are behind the tissue damage during extravasation injuries. In general, extravasations consist of four different subtypes of tissue injury: vasoconstriction, osmotic, pH related, and cytotoxic. Recognition of high-risk patients, appropriate cannulation technique, and monitoring of higher risk materials remain the standard of care for the prevention of extravasation injury. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. The best therapeutic agent for treatment of vasopressor extravasation is intradermal phentolamine. Topical vasodilators and intradermal terbutaline may provide relief. Intradermal hyaluronidase has been effective for hyperosmotic extravasations, although its use largely depends on the risk of tissue injury and the severity of extravasation. Among the hyperosmotic agents, calcium extravasation is distinctive because it may present as an acute tissue injury or may possess delayed clinical manifestations. Extravasation of acidic or basic materials can produce significant tissue damage. Phenytoin is the prototypical basic drug that causes a clinical manifestation known as purple glove syndrome (PGS). This syndrome is largely managed through preventive and conservative treatment measures. Promethazine is acidic and can cause a devastating extravasation, particularly if administered inadvertently through the arteriolar route. Systemic heparin therapy remains the accepted treatment option for intraarteriolar administration of promethazine. Overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports. More research is needed to improve knowledge of patient risk, prompt recognition of the extravasation, and time course for tissue injury, and to develop prevention and treatment strategies for extravasation injuries.

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Navigating venous access: A guide for hospitalists

Simonov

Pittiruti

Rickard

et al. 2015

Journal of Hospital Medicine

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Venous access is the foundation for safe and effective hospital-based care. Inpatient providers must have a deep knowledge of the different types of venous access devices (VADs), their relative indications, contraindications, and appropriateness. However, such knowledge is difficult to come by and usually only gleaned through years of clinical experience. To bridge this gap, we provide an in-depth summary of the relevant anatomical considerations, physical characteristics, advantages, and disadvantages of VADs commonly used in the hospital setting. In doing so, we seek to improve the safety and share the science of vascular access with frontline clinicians. To aid decisionmaking, we conclude by operationalizing the available data through algorithms that outline appropriate vascular access for the hospitalized patient. Reliable venous access is fundamental for the safe and effective care of hospitalized patients. Venous access devices (VADs) are conduits for this purpose, providing delivery of intravenous medications, accurate measurement of central venous pressure, or administration of life-saving blood products. Despite this important role, VADs are also often the source of hospital-acquired complications. Although inpatient providers must balance the relative risks of VADs against their benefits, the evidence supporting such decisions is often limited. Advances in technology, scattered research, and growing availability of novel devices has only further fragmented provider knowledge in the field of vascular access. 1 It is not surprising, then, that survey-based studies of hospitalists reveal important knowledge gaps with regard to practices associated with VADs.2 In this narrative review, we seek to bridge this gap by providing a concise and pragmatic overview of the fundamentals of venous access. We focus specifically on parameters that influence decisions regarding VAD placement in hospitalized patients, providing key takeaways for practicing hospitalists. METHODSTo compile this review, we systematically searched Medline (via Ovid) for several keywords, including: peripheral intravenous catheters, ultrasound-guided peripheral catheter, intraosseous, midline, peripherally inserted central catheter, central venous catheters, and vascular access device complications. We concentrated on full-length articles in English only; no date restrictions were placed on the search. We reviewed guidelines and consensus statements (eg, from the Center for Disease Control [CDC] or Choosing Wisely criteria) as appropriate. Additional studies of interest were identified through content experts (M.P., C.M.R.) and bibliographies of included studies.

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Vesicant Extravasation Part I: Mechanisms, Pathogenesis, and Nursing Care to Reduce Risk

Abstract: Only nurses knowledgeable about extravasation and skilled in associated techniques should assume responsibility for vesicant administration.

Cited by 103 publications

References 30 publications

Dermatological Toxicity in Women With Breast Cancer Undergoing Chemotherapy Treatment

Dermatological Toxicity in Women With Breast Cancer Undergoing Chemotherapy Treatment

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Navigating venous access: A guide for hospitalists

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