Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment

TY - JOUR

T1 - Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment

AU - de Wit, Maike

AU - Ortner, Petra

AU - Lipp, Hans-Peter

AU - Sehouli, Jalid

AU - Untch, Michael

AU - Ruhnke, Markus

AU - Mayer-Steinacker, Regine

AU - Bokemeyer, Carsten

AU - Jordan, Karin

N1 - Copyright © 2013 S. Karger AG, Basel.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - BACKGROUND: Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel.MATERIAL AND METHODS: A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined.RESULTS: Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended.CONCLUSION: We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.

AB - BACKGROUND: Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel.MATERIAL AND METHODS: A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined.RESULTS: Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended.CONCLUSION: We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.

KW - Administration, Intravenous

KW - Antineoplastic Agents

KW - Extravasation of Diagnostic and Therapeutic Materials

KW - Germany

KW - Humans

KW - Medical Oncology

KW - Neoplasms

KW - Practice Guidelines as Topic

KW - Risk Factors

U2 - 10.1159/000348524

DO - 10.1159/000348524

M3 - SCORING: Journal article

C2 - 23486002

VL - 36

SP - 127

EP - 135

JO - ONKOLOGIE

JF - ONKOLOGIE

SN - 0378-584X

IS - 3

ER -