Content area
Full Text
AS SEEN IN ONCOLOGY NURSING FORUM
Certain chemotherapy drugs have tissue-damaging properties and can cause progressive, persistent, and painful ulceration if administered incorrectly. The severity of the injury is related to whether the drug is a vesicant or irritant and whether the drug binds to DNA. Because the initial manifestations can be subtle, extravasation must be differentiated from other paravenous reactions, such as flare or recall reactions. Little evidence exists from human studies to guide the management of vesicant extravasation, and most recommendations remain empirical and controversial.
Risk factors for extravasation can be device, location, agent, patient, and clinician related (see Table 1).
Education can help minimize the risk of extravasation. All nurses who administer chemotherapy or monitor patients receiving continuous IV chemotherapy should complete a certified chemotherapy course and demonstrate essential knowledge and clinical skills. Competency includes risk identification, prevention and management of extravasation, peripheral IV and implanted venous access port (IVAP) skills, appropriate use of venous devices (e.g., peripheral IV peripherally inserted central catheters, tunneled central venous catheters, IVAPs), and components of adequate documentation. In addition, strict institutional policies and procedures can reduce extravasation risk. Nurses should review the ONS Chemotherapy Guidelines and Recommendations for Practice (Polovich, White, & Kelleher, 2005)...