Chemotherapy drug extravasation is the accidental leakage of an infusion from a blood vessel into surrounding tissues, such as subcutaneous fat, connective tissue or muscle, during perfusion or treatment. The consequences depend on the local drug effect, and some anticancer cytotoxic agents have been shown to have extremely serious consequences; they can cause severe tissue damage within hours, days, and months.
The incidence of peripheral intravenous chemotherapy drug extravasation is reported to be 0.1%-6% in China and 5% in foreign countries, however, it is more than that in actual clinical treatment. This article provides an overview of the clinical manifestations, risk factors and management of chemotherapeutic drug extravasation, as follows.
Clinical manifestations
1. During the infusion process, it is often manifested as burning pain or local swelling along the vascular pathway.
2. Inflammatory reactions such as redness, swelling, heat and pain at the site of extravasation injection, some of which may appear in the direction of the vascular pathway as a string-like rash, or even small and large blisters and clusters of vesicles.
3.Purple erythema is hard, localized purple ulceration, necrosis, and gradual spread of subcutaneous tissue necrosis from the center to the outside, with obvious epidermal hyperplasia and irregularity at the edges.
4.The subcutaneous tissue is damaged and the activity is restricted.
5. Swelling of neck and axillary lymph nodes.
Risk factors
1.Patient individual factors
①Injection site. The incidence and degree of extravasation injury varies from one injection site to another. The peripheral veins on the back of the hand, the back of the foot and the inside of the elbow are relatively fragile. Extravasation is more likely to occur if the vein has been punctured multiple times, or if the vein is smaller, more fragile or closer to nerves, tendons and arteries (e.g., the hand).
② Age. The damage caused by extravasation is more severe in older patients.
(③) History of cardiovascular disease. Patients with atherosclerosis or patients with thin blood vessels have severe damage caused by extravasation. The damage caused by extravasation is more severe in patients with increased venous pressure caused by thrombosis, right heart insufficiency, mediastinal tumors or superior vena cava syndrome caused by other causes. Conditions such as lower extremity lymphedema after lymph node dissection, radiation therapy or thrombophlebitis, venous spasm, or systemic vascular diseases such as Raynaud’s syndrome are not conducive to the application of simple intravenous drug delivery.
④Other. Defective nerve function such as reduced sensitivity due to diabetes or chemotherapy-induced polyneuropathy may delay the timely detection of extravasation, which may lead to greater tissue damage.
2.Drug problems
There are three categories of chemotherapy drugs according to their damage to subcutaneous tissues: herpetic chemotherapy drugs, irritating chemotherapy drugs, and non-irritating chemotherapy drugs. Herpetogenic chemotherapy drugs are the most likely to cause venous extravasation in clinical practice, with the most serious consequences.
3.Health care personnel
Since the intravenous built-in tube is a risk factor associated with extravasation, chemotherapy must be managed by experienced medical personnel.
4.Factors related to intravenous infusion method
①Application of central venous catheters and intravenous indwelling tube systems can reduce drug extravasation from damaged veins.
(ii) Displacement of the catheter tip.
③Shoulder joint movement.
④Puncture needle misalignment.
Treatment measures
1.Emergency treatment
Once drug extravasation occurs, nursing staff should immediately stop drug injection and keep the needle, pump back 3mlL~5mL with syringe, then dilute 3mL with 0.9% sodium chloride solution, take ice (except for plant alkali anticancer drugs, such as vincristine, vincristine, vincristine, etc.) and apply cold compress, elevate the injection site and brake the affected limb.
2.Local treatment
①Local closure, along the edge of exudate redness and swelling protrusion, subcutaneously inject phentolamine 1mg + 2% lidocaine 3mL + saline 6mL with a 10mL syringe for 1 week, then wet dressing with magnesium sulfate + scopolamine and change the dressing regularly.
② local wet dressing, chemotherapy drugs occurring local extravasation wet dressing should be based on the nature of chemotherapy drugs to choose a different wet dressing in order to achieve the desired purpose and effect, foam-type chemotherapy drug extravasation early local treatment preferred ice, and plant alkali chemotherapy drugs, such as vincristine, onychomycetes, etc., local ice can aggravate skin toxicity, local ice should not be used.
③ local hot compresses, periwinkle alkaloids are given hot compresses after extravasation, in order to achieve control of toxin absorption to reduce toxic reactions, corticosteroids are prohibited as well as cold compresses, so as not to aggravate toxicity and cause serious consequences.
④ Local cold compress, after extravasation of non-vinca alkaloids, apply saline 100mL plus scopolamine 100mg, gentamicin 16U, soaked sterile gauze cold compress, thus playing a role in controlling inflammation and reducing toxicity.
At present, chemotherapy modalities are widely used in clinical practice, and chemotherapeutic drugs are updated rapidly and in a wide variety, with different toxic side effects. How to minimize the level of pain and the risk of chemotherapy drug extravasation in patients deserves the attention of medical personnel.