Background Chemotherapy extravasation is an accidental complication of antineoplastic administration. Due to its low incidence but serious consequences, further studies are needed to achieve a better management.
Purpose To analyse the context in which extravasation occurs, the degree of compliance with the extravasation protocol and the impact of electronic records on extravasation notification.
Material and methods This was a retrospective study set in a tertiary-level hospital between 2013 and 2017. Data were obtained from 54 extravasation notifications received either on paper or electronically. Collected variables were: patient demographics, antineoplastic drug extravasated, potential factors for extravasation, description of resulting damage, degree of information given in the form, observance of extravasation protocol and follow-up of patients.
Results Extravasation incidence was 54 of 1 47 837 doses of chemotherapy administered (0.04%): 48.15% were males and 51.85% females, mean age was 63.9±12.2 years. 48.15% (n=26) of the drugs involved were vesicant and 38.89% (n=21) irritant. The most frequent extravasated drugs were carboplatin (10, 18.5%) and paclitaxel (eight, 14.8%). 36.54% (n=19) of extravasated veins were weak, 36.54% (n=19) were small-diameter and 11.54% (n=6) were trough. In 51 cases (94.4%) the medical device access was a peripheral catheter and in 51.9% (n=28) the point of puncture was in the plexus arm or in the hand. Infusion pumps with occlusion sensor were used in 40.74% (n=22) of extravasations. In the majority of the cases, the patient (31, 57.4%) was the one who detected the incident. Most common symptoms described were qedema (35, 64.8%), pain (31, 57.4%) and redness (18, 33.3%). Protocol adherence was 83.3% (n=45). In 21 extravasations (38.9%) a control photograph was not taken. First follow-up occurred during the first 24 hours after the extravasation in 19 patients (35.19%) but in 58% of them, it was telephonically. Notifications received electronically were completed worse than paper notifications, 25.3% of unanswered questions (n=373) and 10.1% (n=102) respectively.
Conclusion Although the incidence of extravasation is low, patient education and nursing staff training are essential for an early detection, a correct actuation, an adequate record of the incident and a proper follow-up. If the patient’s venous assessment indicates a potential issue with access, a peripheral catheter should be avoided, especially if the drug is vesicant and it is infused over more than 30 min (such as paclitaxel).
No conflict of interest