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Lisa Schulmeister describes evidence-based treatment for tissue necrosis, which can result when vesicant chemotherapy agents extravasate from the vein
Summary
Vesicant chemotherapy agents can cause varying degrees of tissue necrosis when they extravasate from the vein or are inadvertently administered into the tissue. Deoxyribonucleic acid (DNA) binding vesicants, such as anthracyclines, bind to the DNA of healthy tissue. Left untreated, these injuries progress over time and often require surgical intervention. Evidence-based treatment is topical cooling and administration of Savene (dexrazoxane). Non-DNA binding agents, such as plant alkaloids, usually remain localised and are metabolised in the tissue. Local heat application is recommended. To help prevent or treat extravasation injuries, oncology nurses should be aware of current guidelines for vesicant chemotherapy extravasation management, and be prepared to implement new antidotes and treatments in their clinical practice.
Keywords
Chemotherapy, extravasation, vesicants
Vesicant chemotherapy drugs can cause blistering, sloughing of the skin and local tissue damage when they extravasate from the vein or are inadvertently administered into the tissue. Extravasation may occur as a result of probing or inadvertently piercing a vein during peripheral intravenous (IV) cannula insertion, which allows vesicant chemotherapy to seep into the surrounding tissue.
Patient movement and accidental tugging on IV tubing may cause cannula dislodgement followed by vesicant extravasation into the tissue. Incomplete non-coring needle insertion, needle dislodgement and device damage or breakage may result in extravasation from an implanted port.
Although the majority of vesicant extravasations occur in the subcutaneous tissue of the forearm or anterior chest wall, they may also occur in the mediastinum, lung and other areas when central venous catheters perforate or migrate from the superior vena cava. Tissue necrosis has also been reported when vesicants intended for IV administration are accidentally injected into the muscle or tissue of the thighs and buttocks (Bozkurt et al 2003, Ener et al 2004, Jost et al 2008).
Vesicant chemotherapy agents can be divided into two categories: deoxyribonucleic acid (DNA) binding and non-DNA binding (Table 1).
Vesicants that bind to nucleic acids in DNA , for example, anthracylines, bind to the DNA in the cells of healthy tissue when they extravasate from the vein and cause cell death. If left untreated, DNA binding vesicants remain in the tissue for long periods and...