I. Pathogenesis: chemotherapy drugs enter the perivascular tissue causing tissue degeneration, necrosis and even ulcer formation.
Clinical manifestations: congestion, pain, swelling and even ulceration at the injection site.
First aid measures.
1, immediate termination of the injection.
2, local procaine + saline subcutaneous injection, can slow down the absorption of chemotherapy drugs and analgesia.
3.Local ice packs to limit the damaged area.
4, local obvious swelling with magnesium sulfate wet compress to eliminate swelling.
5.If ulceration or blistering has occurred, surgical treatment should be performed.
6.Physiotherapy can be used to promote recovery after the acute period of inflammation.
Preventive measures.
1, first select the blood vessel from the distal end.
2, multi-site alternate injection to facilitate vascular recovery; confirm vascular patency before adding chemotherapy drugs, and reduce vascular irritation by flushing with saline after chemotherapy; if there is no special requirement, the injection speed should be adjusted faster.
Personal practical experience: prevention of chemotherapy drug extravasation is important, and skilled puncture technique and reasonable selection of blood vessels are the keys to prevent its occurrence.
II. Pathogenesis.
When chemotherapy drugs are used in clinical practice, sometimes there is extravasation of chemotherapy drugs, which may cause serious and permanent damage to tumor patients.
1, drug factors: such as the PH value of the drug is too high or too low, high osmotic pressure, configuration of drug concentration is too high.
2, vascular factors: frequent collection of blood specimens, or intravenous injection can increase vascular fragility, vascular embolism, post-axillary lymph node dissection, tumor compression, superior vena cava compression sign, etc. cause an increase in upstream vascular resistance, in these cases if peripheral intravenous chemotherapy may be extravasated.
3.Operational factors: unskilled puncture technique, inappropriate choice of vessels for multiple punctures at one administration, inaccurate needle fixation, inaccurate pressure on the needle eye after needle extraction, etc.
4, other factors: such as lymphedema, large infusion volume, uncooperative patient and pierced blood vessels, needle slippage, low patient platelet count, bent intravenous injection site, etc.
Once the drug is extravasated, it causes damage to the organism through the following mechanisms.
1, drug and tissue cell DNA binding: such as anthracyclines after exudation embedded in the DNA chain, caused by the chronic, severe tissue reaction, necrosis. Because there is a chain reaction of normal cells phagocytosis of necrotic cells, the healing is slow.
2.Inhibit the production of inflammatory cells, resulting in local necrosis that does not heal.
3, causing damage to fibroblasts and difficulty in tissue repair.
III. Clinical manifestations.
The clinical stage is divided into three phases: local tissue inflammatory reaction period, venous inflammatory reaction period, tissue necrosis period, symptoms according to the degree of damage to the drug, the way divided into three types of clinical manifestations.
1, herpetogenic: severe, leakage can cause local tissue necrosis, such as anthracyclines (adriamycin, epi-amycin, etc.), antibiotics (erythromycin, actinomycin D, mitomycin, mitomycin, gentamycin, etc.), plant alkaloids (vincristine, vincristine, vincristine, novobiene, etc.), nitrogen mustard, aminoglutethimide, medensin, etc.
2, irritation: moderate, leakage can cause burns or mild inflammation without necrosis of the drug. Such as carazolamide, azuremidine, pediculosis, wymond, streptomycin, propamidine hydrazone, etc.
3, non-herpetogenic: mild damage, no obvious herpetogenic or irritating effects of drugs. Such as cyclophosphamide, cetiapide, methotrexate, bleomycin, fluorouracil, cytarabine, cisplatin, mitoxantrone, menatase, etc.
First-aid principle: Once the chemotherapy drug extravasation is found, intravenous chemotherapy should be stopped immediately, and the degree and extent of drug extravasation should be judged, and corresponding treatment should be taken according to the type of chemotherapy drug.
V. First-aid measures.
1.Emergency treatment: when exudation is found, immediately stop the drip and aspirate the drug.
2. Local use of antidote: counteract the damaging effect of the drug, inactivate the leaking drug, and accelerate the absorption and excretion of the drug. Local seal: hormone + lidocaine topical; cold compress: ice bag for 24h, maximum 3 days, drug wet compress: hydrocao, MgSO4, 2-4% NaHCO3; herbal wet compress: Jinhuang San
Liushenwan + honey.
3.Elevate the affected limb, ulcer, necrotic skin for debridement and drug exchange or skin implant, after 24h of leakage, infrared, ultrashort wave and other physical therapy is feasible, and functional exercise after the inflammation subsides.
VI. Preventive measures.
1, according to the drug selection of blood vessels: herpetic, irritating chemotherapeutic drugs should not be players dorsal foot small vessels, long-term chemotherapy patients, the establishment of a systematic intravenous use plan to protect large veins: routine blood collection and injection of non-chemotherapy drugs selected small veins, preferably through intravenous cannulation chemotherapy.
2, improve professional skills, skilled puncture technique, strive to see blood in one needle, correctly fix the needle after successful puncture to avoid slipping and puncturing the vessel wall, accurately press the eye of the needle for 2~5min after needle extraction (with bleeding tendency to increase the time of pressure).
3.Before injecting herxing agent, make correct judgment on the use of blood vessels.
(1) Rational use of drugs: correct method of drug administration, concentration and speed of input.
(2) correct method of drug administration: the needle with chemotherapeutic solution should not be used to directly puncture the vessel or pull out the needle, the tube can be flushed and administered in the middle before and after the drug is used; blood is drawn back while pushing the drug in the static push to ensure that the drug is in the vessel, concentration: should not be too high, speed: should not be too fast.
4.Strengthen the patient’s cooperation: provide targeted education to the patient before chemotherapy, reduce the patient’s activities when febrifuge drip is administered, and report to the nurse promptly if there is any abnormal feeling during chemotherapy.
Seven, personal practical experience: medical oncologists must be familiar with the pharmacology and toxicity of each chemotherapy drug, and the treatment of drug extravasation should be fast and accurate to minimize the degree of damage, and then the chemotherapy consent form must be signed before chemotherapy to prevent medical disputes.
Detoxification methods for intravenous extravasation of common anticancer drugs.
1.Nitrogen mustard: 4ml of 10% sodium thiosulfate mixed with 6ml of sterile water for injection, 5-6ml of local sedation, multiple subcutaneous injections at the site of extravasation; repeat for several hours. Detoxification mechanism: accelerate alkylation.
2. mitomycin: same method as above. Another vitamin C1ml is injected locally. Detoxification mechanism: direct inactivation.
3. Adriamycin.
(1) 50-200mg hydrocortisone sodium succinate topical sedation and 1% hydrocortisone cream topical application.
(2) 8.4% sodium bicarbonate 5ml + demi 4mg topical sedation, multiple subcutaneous injections at extravasation sites. Detoxification mechanism: reduce inflammation.
(4) Zojirushi: 8.4% sodium bicarbonate 5ml + Demi 4mg topical sedation, multiple subcutaneous injections at extravasated sites. Detoxification mechanism: reduce drug binding to DNA and reduce inflammation.
5.Actinomycin D: the same method as mitomycin. Detoxification mechanism: reduce drug binding to DNA.
6.Carazolam: 8.4% sodium bicarbonate 5ml local sedation. Mechanism of detoxification: chemical inactivation.
7.Vincristine, vincristine, pedipalpine 8.4% sodium bicarbonate 5ml or hyaluronidase 1-6ml injected subcutaneously in multiple places at the site of extravasation every few hours and applied with heat. The use of corticosteroids and local cold compresses can aggravate toxicity. Detoxification mechanism: chemical precipitation; accelerating the absorption and dispersion of extravasated drugs.
Application of antidote after extravasation of antineoplastic drugs Drug antidote use Mechanism of antidote Nitrogen mustard 10% sodium thiosulfate 4ml local subcutaneous or intradermal injection Inactivation by alkalinization mitomycin radionuclide D 10% sodium thiosulfate 4m vitamin C 1ml (50mg/ml) local subcutaneous or intradermal injection Sedation direct inactivation direct inactivation Adriamycin hydrocortisone 50~100mg Local subcutaneous or intradermal injection to reduce inflammatory response 8, 4% sodium bicarbonate 5mg sedation to reduce binding to DNA Dimethyl sulfoxide + vitamin E topical application to scavenge free radicals Norepinephrine 10mg intradermal injection to prevent ADM toxicity through β2 receptors Vincristine hyaluronidase 1ml subcutaneous injection diluted anticancer drug saline 1ml subcutaneous injection diluted anticancer drug hydrocortisone 25mg Subcutaneous injection to reduce inflammatory response cisplatin 10% sodium thiosulfate 5~10ml local injection to inactivate via alkalinization pegylated glycosides hyaluronidase 1~2ml local injection to dilute anticancer drug