Chemotherapy is the use of chemicals to treat disease. Paul Erlich, considered to be the father of chemotherapy, coined this word to describe a specific chemical utilized in the treatment of parasites. Extravasation is the major complication of chemotherapeutic drugs.
Extravasation is the accidental infiltration of vesicant or irritant chemotherapeutic drugs from the vein into the surrounding tissues at the I/V site. A vesicant is an agent that can produce a blister and /or tissue destruction. An irritant is an agent that is capable of producing venous pain at the site of and along the vein with or without an inflammatory reaction. Injuries that may occur as a result of extravasation include sloughing of tissue , infection, pain ,and loss of mobility of an extremity.
Prevention of extravasation
- Nursing responsibilities for the prevention of extravasation include the following
- Knowledge of drug s with vesicant potential
- Skill in drug administration
- Identification of risk factors e.g. multiple vene punctures
- Anticipation of extravasation and knowledge of management protocol
- New venepuncture site daily if peripheral access is used
- Central venous access for 24 hrs vesicants infusion
- Administration of drug in a quiet, unhurried environment
- Testing vein patency without using chemotherapeutic agents
- Providing adequate drug dilution
- Careful observation of access site and extremity throughout the procedure
- Ensuring blood return from I/V site before, during, and after vesicant drug infusion.
- Educating patients regarding symptoms of drug infiltration , e.g. pain, burning, stinging sensation at I/V site.
Extravasation management at peripheral site
According to agency policy and approved antidote should be readily available. The following procedure should be initiated…
- Stop the drug
- Leave the needle or catheter in place
- Aspirate any residual drug and blood in the I/V tubing, needle or catheter, and suspected infiltration site
- Instill the I/V antidote
- Remove the needle
- If unable to aspirate the residual drug from the IV tubing , remove needle or catheter
- Inject the antidote sub-cutaneously clockwise into the infiltrated site using 25 gauge needle; change the needle with each new injection
- Avoid applying pressure to the suspected infiltration site
- Apply topical ointment if ordered
- Cover lightly with an occlusive sterile dressing
- Apply cold or warm compresses as indicated
- Elevate the extremity
- Observe regularly for pain, erythema, induration, and necrosis
- Documentation of extravasation management.
- All nursing personnel should be alert and prepared for the possible complication of anaphylaxis.