Prevención y conducta ante la Extravasación de quimioterápicos antineoplásicos: scoping review

Melo, João Marcos Alves; Oliveira, Patrícia Peres de; Souza, Raíssa Silva; Fonseca, Deborah Franscielle da; Gontijo, Thaís Fonseca; Rodrigues, Andrea Bezerra

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

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Brasil

Español English

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0008 copiar

Prevención y conducta ante la Extravasación de quimioterápicos antineoplásicos: scoping review

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

identificar y sintetizar evidencia científica sobre prevención y manejo de fugas de agentes antineoplásicos en pacientes adultos por parte de enfermeras.

Métodos:

revisión del alcance, según el Instituto Joanna Briggs y PRISMA-ScR. La investigación se realizó en cinco bases de datos electrónicas, la Biblioteca Cochrane y ocho catálogos de tesis y disertaciones. La recopilación de datos se produjo de abril a julio de 2018, sin límite de tiempo. Los datos extraídos fueron analizados y sintetizados en forma narrativa.

Resultados:

se recuperaron un total de 3.110 registros y se conservaron 18 estudios para su revisión. La mayoría de las publicaciones (66,6%) tenían un enfoque cualitativo y abordaban ambos aspectos, es decir, la prevención y el tratamiento contra la extravasación de quimioterapia en pacientes adultos.

Conclusiones:

la implementación de protocolos basados en evidencia científica sobre prevención y manejo de la fuga antineoplásica es primordial para proporcionar seguridad al paciente y apoyo al personal de enfermería.

Descriptores:
Quimioterapia Combinada; Antineoplásicos; Atención de Enfermería; Extravasación de Materiales Terapéuticos y Diagnósticos; Oncología Médica

Author(s)	Year	Type / Title	Journal or institution	Objective(s)
Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ⁾	2017	Article / Chemotherapy extravasation: establishing a national benchmark for incidence among cancer centers	Clinical Journal of Oncology Nursing	- To evaluate vesicant extravasation of CT in adult cancer patients (739,812 doses of vesicant and irritant CT infusions were included in the evaluation of 11 cancer services); - To report the incidence of extravasation of vesicants and irritants with potential vesicant.
Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al ⁽¹⁵15 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	2017	Article / Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions	Journal of Infusion Nursing	- To evaluate the predictive validity of thermography to identify extravasation during intravenous antineoplastic therapy.
Custódio CS ⁽¹⁶16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ⁾	2016	Dissertation / Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal	Repository of UnB	- To evaluate changes in peripheral veins used for chemotherapy infusion in breast cancer patients over the course of treatment and to describe care and guidance in choosing venous access for CT infusion.
Freitas KABS ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ⁾	2015	Dissertation / Estratégias para administração segura de antineoplásicos	Institutional Repository of UNESP	- To trace the profile and knowledge in CT of inpatient nurses of a University Hospital and develop strategies for safe administration of antineoplastic drugs.
Harrold K, Gould D, Drey N ⁽¹⁸18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363 https://doi.org/10.1111/ecc.12363... ⁾	2015	Article / The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice	European Journal of Oncology Nursing	- To critically analyze the quality of evidence supporting contemporary practice of extravasation of CT management and to verify whether patient experience is taken into account in relation to extravasation of CT management.
Muthuramalingam S, Gale J, Bradbury J ⁽¹⁹19 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103 https://doi.org/10.1111/ijcp.12103... ⁾	2013	Article / Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice	International Journal of Clinical Practice	- To report UK case review (102) on the efficacy of Dexrazoxane for the treatment of anthracycline extravasation.
Harrold K, Gould D, Drey N ⁽²⁰20 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023 https://doi.org/10.1111/ecc.12023... ⁾	2013	Article / The efﬁcacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report	European Journal of Cancer Care	- To present the results of a historical case series of extravasation of CT administered by saline washout and; evaluate the effectiveness of the procedure based on patient outcome.
Drake D ⁽²¹21 Drake D. BET3: Emergency management of anthracycline extravasation. Emerg Med J [Internet]. 2012 [cited 2018 Sep 28]; 29(9):777-9. Available from:http://dx.doi.org/10.1136/emermed-2012-201686.4 http://dx.doi.org/10.1136/emermed-2012-2... ⁾	2012	Article / Emergency management of anthracycline extravasation	Emergency Medicine Journal	- To establish that intravenous dexrazoxane reduces the risk of tissue necrosis following anthracycline chemotherapy extraction.
Schneider, F; Pedrolo, E. ⁽²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ⁾	2011	Article / Extravasamento de drogas antineoplásicas: avaliação do conhecimento da equipe de enfermagem	Revista Mineira de Enfermagem	- To point out the importance of improvement in service and the elaboration of a clinical guideline, so that professionals can identify patients at higher risk of extravasation of CT, promote prevention and damage minimization actions.
Adami NP, de Gutiérrez MG, da Fonseca SM, de Almeida EP ⁽²³23 Adami NP, de Gutiérrez MG, da Fonseca SM, de Almeida EP. Risk management of extravasation of cytostatic drugs at the adult chemotherapy outpatient clinic of a University Hospital. J Clin Nurs [Internet]. 2005 [cited 2018 Sep 28];14(7):876-82. Available from: https://doi.org/10.1111/j.1365-2702.2005.01124.x https://doi.org/10.1111/j.1365-2702.2005... ⁾	2005	Article / Risk management of extravasation of cytostatic drugs at the adult chemotherapy outpatient clinic of a University Hospital	Journal of Clinical Nursing	- To check the incidence of antineoplastic drug extravasation in outpatients treated at a university hospital for five years and to evaluate the quality of care provided by the nursing staff.
Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al ⁽²⁴24 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf https://link-springer-com.ez18.periodico... ⁾	1992	Article / Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach	Cancer Chemotherapy and Pharmacy	- To comparatively evaluate the effectiveness of a conservative approach to treatment using two therapeutic regimens (with or without sodium thiosulfate).
Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS ⁽²⁵25 Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol[Internet].1988[cited 2018 20 Dec];6(11):1732-5. Available from:https://doi.org/10.1200/JCO.1988.6.11.1732 https://doi.org/10.1200/JCO.1988.6.11.17... ⁾	1988	Article / A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation	Journal of Clinical Oncology	- To introduce anthracycline extravasation treatment with 99% topical dimethyl sulfoxide (DMSO) over a three-month period with regular examinations and photographs.

Author(s)	Year	Type/Title	Journal or institution	Objective(s)
Dougherty L, Oakley C ⁽²⁶26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp http://cancernursingpractice.rcnpublishi... ⁾	2011	Article / Advanced practice in the management of extravasation	Cancer Nursing Practice	- To describe flush-out training for nurses to provide more timely and less inconvenient interventions for patients.

Author(s)	Year	Type/Title	Journal or institution	Objective(s)
Onesti MG, Carella S, Fioramonti P, Scuderi N ⁽²⁷27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... ⁾	2017	Article / Chemotherapy Extravasation Management: 21-Year Experience	Annals of Plastic Surgery	- To explore prevention and treatment of extravasation injuries by proposing a standard therapeutic protocol along with a literature review.
Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al ⁽²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ⁾	2015	Article / Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol	Support Care Cancer	- To observe the extravasation of antineoplastic agents from 169 patients and evaluate the effectiveness of their interdisciplinary management in a single research setting.
de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al ⁽²⁹29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... ⁾	2013	Article / Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment	Onkologie	- To review and discuss the practice in the diagnosis and management of extravasation of CT.
Pérez Fidalgo JA, García Fabregat L, Cervantes A, et al ⁽³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾	2012	Article / Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines	European Journal of Oncology Nursing	- To introduce the European Society for Medical Oncology Guidelines published in cooperation with the European Oncology Nursing Society (EONS).
Wengström Y, Margulies A, European Oncology Nursing Society Task Force ⁽³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾	2008	Article / European Oncology Nursing Society extravasation guidelines.	European Journal of Oncology Nursing	- To introduce European Oncology Nursing Society Guidelines for prevention, detection, and management of extravasation.

Prevention measures of the extravasation of antineoplastic agent in adults
Beware of each individual's risk factors (threadlike and/or fragile veins, obesity, multiple previous venous punctures, presence of disseminated skin diseases (e.g., eczema or psoriasis), patient movement and level of consciousness ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁵15 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article... ^,¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁶26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp http://cancernursingpractice.rcnpublishi... ^,²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Advise the patient to report any level of pain, burning, tingling or itching, which suggests perceptive infiltration, i.e., oriented to recognize extravasation ⁽¹⁶16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. 17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^-¹⁸18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363 https://doi.org/10.1111/ecc.12363... ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁹29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... 30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Avoid puncture in limbs with loss of sensation, surgical manipulation site and previously irradiated limbs ⁽¹⁶16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ^-¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁶26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp http://cancernursingpractice.rcnpublishi... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Avoid puncturing sites such as wrist, back of the hand and joints ⁽¹⁵15 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article... 16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ^-¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... 29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... 30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Avoid using piped peripheral access for more than 24 hours, preferring puncture at the moment ⁽¹⁶16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ^-¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²⁹29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... 30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Avoid using rigid devices for the administration of vesicant CT ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Always use as the ideal material for a peripheral venous catheter for CT administration: chemically inert, non-thrombogenic, flexible, radiopaque and transparent ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Secure venous access with means that make the puncture site visible ⁽¹⁵15 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article... ^,²⁰20 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023 https://doi.org/10.1111/ecc.12023... ⁾
Constantly assess for risk of peripheral venous extravasation ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁵15 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article... 16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. 17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. 18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363 https://doi.org/10.1111/ecc.12363... ^-¹⁹19 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103 https://doi.org/10.1111/ijcp.12103... ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁷27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... 28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... 29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... 30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Check blood flow after puncture and then flush with 10 ml normal saline and check for signs of extravasation ⁽²⁹29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... ^-³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾.
Wash with 10 to 20 ml saline between different anti-neoplastic drug infusions ⁽³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Check blood flow before CT is administered and regularly during bolus infusion ⁽³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Administer physiological solutions concomitantly with vesicant and / or irritant CT infusion ⁽¹⁶16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Monitor the punctured access, both to assess its permeability, as well as for the quick visualization of possible reactions from vascular lesions or extravasation ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁵15 Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J InfusNurs [Internet]. 2017 [cited 2018 Aug 25];40(6):367-74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680995/. https://www.ncbi.nlm.nih.gov/pmc/article... 16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ^-¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Contraindicating the use of bolus CT infusion pumps ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Training nursing staff and implementing CT overflow prevention protocols are crucial ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁶16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ^-¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... 29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... ^-³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Recommend the use of central venous access for administration of vesicants or irritants ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁶16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. ^-¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Advise patients to obtain central venous access, where indicated, and provide informed consent on the risks and benefits of such access ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,²⁹29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... ^-³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Conduct before the extravasation of antineoplastic agents in adults
Use the incidence of extravasation as a quality indicator ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁸18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363 https://doi.org/10.1111/ecc.12363... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Train nursing staff and implement conduct protocols in CT extravasations ⁽²⁰20 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023 https://doi.org/10.1111/ecc.12023... ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁶26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp http://cancernursingpractice.rcnpublishi... 27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... ^-²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Remember that if an extravasation occurs, the degree of damage depends on the type of drug, the concentration of the drug, the site and how long a drug develops its potential for damage ⁽²⁶26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp http://cancernursingpractice.rcnpublishi... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Stopping CT infusion is the first measure when extravasation occurs or is suspected ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁷27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Beware for: In the event of a suspicious spill, treat it as a real event ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Perform drug aspiration, limb elevation and application of thermal compress (cold or heat) ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²⁰20 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023 https://doi.org/10.1111/ecc.12023... ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,²⁷27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Demarcate and photograph CT overflow area ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²⁴24 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf https://link-springer-com.ez18.periodico... ^-²⁵25 Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol[Internet].1988[cited 2018 20 Dec];6(11):1732-5. Available from:https://doi.org/10.1200/JCO.1988.6.11.1732 https://doi.org/10.1200/JCO.1988.6.11.17... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Apply compress for 20 minutes four times a day for one or two days only for CT classified as Vinca Alkaloids ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^,³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Apply cold compresses to anthracycline extravasations, tumor antibiotics and alkylating agents. Only on oxaliplatin is heat applied ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²²22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... ^-²³23 Adami NP, de Gutiérrez MG, da Fonseca SM, de Almeida EP. Risk management of extravasation of cytostatic drugs at the adult chemotherapy outpatient clinic of a University Hospital. J Clin Nurs [Internet]. 2005 [cited 2018 Sep 28];14(7):876-82. Available from: https://doi.org/10.1111/j.1365-2702.2005.01124.x https://doi.org/10.1111/j.1365-2702.2005... ⁾
Follow up CT extravasation (nurse and patient provider), whether actual or suspected extravasation ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²⁴24 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf https://link-springer-com.ez18.periodico... 25 Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol[Internet].1988[cited 2018 20 Dec];6(11):1732-5. Available from:https://doi.org/10.1200/JCO.1988.6.11.1732 https://doi.org/10.1200/JCO.1988.6.11.17... 26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp http://cancernursingpractice.rcnpublishi... 27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... ^-²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Follow up the extravasation by phone or in person. On day 1, after the event and at least weekly (or more often as needed). Follow-up should continue for a period of three weeks to six weeks, or until complete resolution of extravasation is complete ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Start as early as possible (up to 6 hours) dexrazoxane (Savene^®), the only antidote licensed for the treatment of anthracycline extravasation ⁽¹⁹19 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103 https://doi.org/10.1111/ijcp.12103... 20 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023 https://doi.org/10.1111/ecc.12023... ^-²¹21 Drake D. BET3: Emergency management of anthracycline extravasation. Emerg Med J [Internet]. 2012 [cited 2018 Sep 28]; 29(9):777-9. Available from:http://dx.doi.org/10.1136/emermed-2012-201686.4 http://dx.doi.org/10.1136/emermed-2012-2... ^,²⁷27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾; administer intravenously into a vein in an area away from the extravasation site at a dose of 1000 mg/m² day and two to 500 mg/m² on day three ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. 18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363 https://doi.org/10.1111/ecc.12363... ^-¹⁹19 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103 https://doi.org/10.1111/ijcp.12103... ^,²¹21 Drake D. BET3: Emergency management of anthracycline extravasation. Emerg Med J [Internet]. 2012 [cited 2018 Sep 28]; 29(9):777-9. Available from:http://dx.doi.org/10.1136/emermed-2012-201686.4 http://dx.doi.org/10.1136/emermed-2012-2... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Start topical DMSO as early as possible (99%), preferably within 10 minutes if mitomycin C is spilled. It should be applied every 8 hours for 7 days ⁽¹⁸18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363 https://doi.org/10.1111/ecc.12363... ^,²⁷27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... ^-²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Use sodium thiosulfate 0.17 M (solution by mixing 4 mL sodium thiosulfate with 6 mL sterile water for injection) as a subcutaneous injection immediately if mechlorethamine is extravasated. Subcutaneous injection of 2 ml solution made from 4 ml sodium thiosulfate + 6 ml sterile water ⁽²⁴24 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf https://link-springer-com.ez18.periodico... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Administer hyaluronidase by subcutaneous injection (150-900 IU around the extravasation area) in case of Vinca Alkaloid extravasation ⁽²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾ after application of dry heat for a period of seven days (three times daily) ⁽²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Administer subcutaneous injection hyaluronidase 150-900 UI around the taxane extravasation area ⁽³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾, without heat application after paclitaxel extravasation ⁽²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ⁾
Beware not to use subcutaneous ⁽²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾ and topical corticosteroids in CT extravasations ⁽¹⁷17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. ^,²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ⁾
Notify the patient's physician and a plastic surgeon should be consulted within 24 hours of detection of vesicant antineoplastic agent extravasation ⁽²⁸28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... ^,³⁰30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Document photographically (authorized in writing by the patient) and record the date, time, name of the extravasated drug, signs and symptoms, description of venous access, extravasation site, and the evolution of the case of CT extravasation ⁽⁹9 Jackson-Rose J, Del Monte J, Groman A, Dial LS, Atwell L, Graham J, et al. Chemotherapy Extravasation: establishing a national benchmark for incidence among Cancer Centers. Clin J Oncol Nurs [Internet]. 2017 [cited 2018 Aug 05]; 21(4):438-45. Available from: http://dx.doi-org.ez18.periodicos.capes.gov.br/10.1188/17.CJON.438-445 http://dx.doi-org.ez18.periodicos.capes.... ^,¹⁶16 Custódio, CS. Injurias vasculares relacionadas a infusão periférica de quimioterapia em mulheres com câncer de mama: estudo longitudinal [Dissertação]. Brasília (DF): Universidade de Brasília; 2016. 17 Freitas KABS. Estratégias para a administração segura de antineoplásicos [Dissertação]. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu (SP); 2015. 18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363 https://doi.org/10.1111/ecc.12363... 19 Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract [Internet]. 2013 [cited 2018 Sep 28];67(3):244-9. Available from: https://doi.org/10.1111/ijcp.12103 https://doi.org/10.1111/ijcp.12103... 20 Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation: a historical case series report. Eur J Cancer Care [Internet]. 2013 [cited 2018 Sep 28];22(2):169-78. Available from:https://doi.org/10.1111/ecc.12023 https://doi.org/10.1111/ecc.12023... 21 Drake D. BET3: Emergency management of anthracycline extravasation. Emerg Med J [Internet]. 2012 [cited 2018 Sep 28]; 29(9):777-9. Available from:http://dx.doi.org/10.1136/emermed-2012-201686.4 http://dx.doi.org/10.1136/emermed-2012-2... 22 Schneider F, Pedrolo E. Extravasation of antineoplastic drugs: assessment of the nursing team knowledge. Rev Min Enferm [Internet]. 2011 [cited 2018 July 25];15(4):522-9. Available from: http://www.reme.org.br/artigo/detalhes/66. http://www.reme.org.br/artigo/detalhes/6... 23 Adami NP, de Gutiérrez MG, da Fonseca SM, de Almeida EP. Risk management of extravasation of cytostatic drugs at the adult chemotherapy outpatient clinic of a University Hospital. J Clin Nurs [Internet]. 2005 [cited 2018 Sep 28];14(7):876-82. Available from: https://doi.org/10.1111/j.1365-2702.2005.01124.x https://doi.org/10.1111/j.1365-2702.2005... 24 Tsavaris NB, Komitsopoulou P, Karagiaouris P, Loukatou P, Tzannou I, Mylonakis N, et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemoth Pharm [Internet]. 1992 [cited 2018 Sep 28];30(4):330-3. Available from: https://link-springer-com.ez18.periodicos.capes.gov.br/content/pdf/10.1007%2FBF00686305.pdf https://link-springer-com.ez18.periodico... 25 Olver IN, Aisner J, Hament A, Buchanan L, Bishop JF, Kaplan RS. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol[Internet].1988[cited 2018 20 Dec];6(11):1732-5. Available from:https://doi.org/10.1200/JCO.1988.6.11.1732 https://doi.org/10.1200/JCO.1988.6.11.17... 26 Dougherty L, Oakley C. Advanced practice in the management of extravasation: Lisa Dougherty and Catherine Oakley report how chemotherapy nurses in south London have been trained in the flush-out technique. Cancer Nursing Practice [Internet]. 2011 [cited 2018 Sep 28];10(5):16-22. Available from: http://cancernursingpractice.rcnpublishing.co.uk/index.asp http://cancernursingpractice.rcnpublishi... 27 Onesti MG, Carella S, Fioramonti P, Scuderi N. Chemotherapy extravasation management: 21-year experience. Ann Plast Surg [Internet]. 2017 [cited 2018 Sep 28];79(5):450-7. Available from: https://doi.org/10.1097/SAP.0000000000001248 https://doi.org/10.1097/SAP.000000000000... 28 Pluschnig U, Haslik W, Bayer G, Soleiman A, Bartsch R, Lamm W, et al. Outcome of chemotherapy extravasation in a large patient series using a standardised management protocol. Support Care Cancer [Internet]. 2015 [cited 2018 Sep 28];23(6):1741-8. Available from: https://link.springer.com/content/pdf/10.1007%2Fs00520-014-2535-2.pdf https://link.springer.com/content/pdf/10... 29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... 30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾
Maintain an emergency overflow kit (containing at least procedure gloves, low-permeability apron, absorbent pads, respiratory and eye protection, soap, identified waste container) always available where antineoplastic agents are administered ⁽¹⁸18 Harrold K, Gould D, Drey N. The management of cytotoxic chemotherapy extravasation: a systematic review of the literature to evaluate the evidence underpinning contemporary practice. Eur J Cancer Care [Internet]. 2015 [cited 2018 Sep 28];24(6):771-800. Available from: https://doi.org/10.1111/ecc.12363 https://doi.org/10.1111/ecc.12363... ^,²⁹29 de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, et al. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie [Internet]. 2013 [cited 2018 Sep 28];36(3):127-35. Available from: https://doi.org/10.1159/000348524 https://doi.org/10.1159/000348524... 30 Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. ESMO Guidelines Working Group. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol [Internet]. 2012 [cited 2018 Sep 28];23(Suppl 7):vii167-vii173. Available from: https://doi.org/10.1093/annonc/mds294 https://doi.org/10.1093/annonc/mds294... ^-³¹31 Wengström Y, Margulies A, European Oncology Nursing Society Task Force. European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs [Internet]. 2008 [cited 2018 Sep 28];12(4):357-61. Available from: https://doi.org/10.1016/j.ejon.2008.07.003 https://doi.org/10.1016/j.ejon.2008.07.0... ⁾

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[1] Corresponding author: Patrícia Peres de Oliveira. E-mail: pperesoliveira@ufsj.edu.br