By Ines Mader, Patrizia R. Fürst-Weger, Robert M. Mader, Elisabeth Nogler-Semenitz, Sabine Wassertheurer, Birte Twisselmann
Extravasation of cytotoxic medications may end up in severe issues in the course of tumour remedy. This quantity is meant as an reduction to evaluate the location quick and conclusively should still this emergency ensue. The substance particular element of the ebook offers unique directions for the way to accommodate forty nine cytotoxic brokers in order that precise measures should be began right away. the final part presents finished details on prevention, common measures to be taken in case of extravasation, particular antidotes, and documentation. For help in the course of daily scientific perform, the e-book is observed via a template for an extravasation package, tables, documentation sheets, and sufferer info. The publication is the end result of a consensus of an interdisciplinary operating team that has amassed and systematically reviewed all released literature at the subject. the sensible directions are followed through a overview of the literature to allow readers to review resource fabrics through the unique released stories.
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Additional resources for Extravasation of Cytotoxic Agents: Compendium for Prevention and Management
Measures Robert Mader General unspecific measures in peripheral venous access These general measures should be taken in cases of extravasation with non-vesicant cytotoxic drugs: 1. 2. 3. 4. 5. 6. 7. 8. 9. Stop injection/infusion immediately Get extravasation kit Put on (sterile) gloves Replace infusion lead or syringe with 5 ml disposable syringe and aspirate slowly as much as possible of the extravasated drug; Cave! v. access while aspirating Elevate limb and immobilise Complete extravasation documentation sheet (mention extent of extravasation) Inform and instruct the patient and relatives Regular control (aftercare) The following general measures should be taken in cases of extravasation with irritant cytotoxic drugs: 1.
Around the affected area depending on size of extravasation. Cave! local analgesia is recommended Application after extravasation of the following substances: Hyaluronidase alone: Paclitaxel Hyaluronidase in combination with heat: Vinblastine Vincristine Vindesine Vinorelbine 50 Measures Dexrazoxane Mechanism of action under discussion: • Anthracycline antagonist as a catalytic inhibitor of topoisomerase II without causing DNA strand breaks [164, 187] • Reduction of free radical formation from iron-anthracycline complexes as chelators of iron ions Particular remarks: • Based on the results of two relatively small randomized multicenter trials, dexrazoxane has been approved as antidote after extravasation of anthracyclines as proven by biopsy .
Ad 7: Elevate limb and immobilise : In outpatients the arm may be put in a sling for two days . v. 9% into the inﬁltrated area . 9% may be mixed with hyaluronidase (150 IU in 1000 ml) . v. access [25, 139]. This should guarantee for the antidote to reach the affected area. This technique is said to be much less traumatic for the patient than the multiple subcutaneous punctures. Immediate administration of the antidote is best . It has been cited as a disadvantage that the original catheter through which the antidote is infused may still contain the cytotoxic agent .