Chemotherapy Drug Extravasation in Totally Implantable Venous Access Port Systems: How Effective is Early Surgical Lavage?
Purpose Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of...
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| Veröffentlicht in: | The journal of vascular access 2015-01, Vol.16 (1), p.31-37 |
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| creator | Azaïs, Henri Bresson, Lucie Bassil, Alfred Katdare, Ninad Merlot, Benjamin Houpeau, Jean-Louis Bedoui, Sophie El Meurant, Jean-Pierre Tresch, Emmanuelle Narducci, Fabrice |
| description | Purpose
Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of CDE and show the effectiveness of early surgical lavage (ESL).
Methods
Patients who had presented to the Cancer Center of Lille (France) with TIVAPS inserted between January 2004 and April 2013 and CDE had their medical records reviewed retrospectively.
Results
Thirty patients and 33 events were analyzed. Implicated agents were vesicants (51.5%), irritants (45.5%) and non-vesicants (3%). Huber needle malpositionning was involved in 27 cases. Surgery was performed in 97% of cases, 87.5% of which were for ESL with 53.1% of the latter requiring TIVAPS extraction. Six patients required a second intervention due to adverse outcomes (severe cases). Vesicants were found to be implicated in four out of six severe cases and oxaliplatin in two others. Extravasated volume was above 50 ml in 80% of cases. Only one patient required a skin graft.
Conclusions
CDEs should be managed in specialized centers. ESL allows for limited tissue contact of the chemotherapy drug whilst using a simple, widely accessible technique. The two main factors that correlate with adverse outcome seem to be the nature of the implicated agent (vesicants) and the extravasated volume (above 50 ml) leading to worse outcomes. Oxaliplatin should be considered as a vesicant. |
| doi_str_mv | 10.5301/jva.5000316 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1657327419</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.5301_jva.5000316</sage_id><sourcerecordid>1657327419</sourcerecordid><originalsourceid>FETCH-LOGICAL-c322t-6b7119bd92571261e80f57d9ea489176d7dd91c3f039dd45779d6209752daa8f3</originalsourceid><addsrcrecordid>eNptkEtLAzEURoMovlfuJUtBRvOYJI0bkVofUFDwsR3SyZ06ZWZSk0y1_nojVt24yiV897ucg9ABJSeCE3o6W5gTQQjhVK6hbapYnknC2XqaKdOZYnqwhXZCmBHCtKD5Jtpigsv0LbfRx_AFWhdfwJv5El_6fopH79GbhQkm1q7DdYcfXTRNs8S37bwxXTSTBvAzdK4P-KIsIQR873zED8sQoQ1n-Ma94VFVQRnrBeA64JHxaf2h99O6NA0ep_YpnO-hjco0AfZX7y56uho9Dm-y8d317fBinJWcsZjJiaJUT6xmQlEmKQxIJZTVYPKBpkpaZa2mJa8I19bmQiltJSNaCWaNGVR8Fx199869e-0hxKKtQwlNYoHEUFApFGcqpzpFj7-jpXcheKiKua9b45cFJcWX7CLJLlayU_pwVdxPWrC_2R-7f5dD4i1mrvddAv236xOu3od-</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1657327419</pqid></control><display><type>article</type><title>Chemotherapy Drug Extravasation in Totally Implantable Venous Access Port Systems: How Effective is Early Surgical Lavage?</title><source>SAGE Complete A-Z List</source><source>MEDLINE</source><creator>Azaïs, Henri ; Bresson, Lucie ; Bassil, Alfred ; Katdare, Ninad ; Merlot, Benjamin ; Houpeau, Jean-Louis ; Bedoui, Sophie El ; Meurant, Jean-Pierre ; Tresch, Emmanuelle ; Narducci, Fabrice</creator><creatorcontrib>Azaïs, Henri ; Bresson, Lucie ; Bassil, Alfred ; Katdare, Ninad ; Merlot, Benjamin ; Houpeau, Jean-Louis ; Bedoui, Sophie El ; Meurant, Jean-Pierre ; Tresch, Emmanuelle ; Narducci, Fabrice</creatorcontrib><description>Purpose
Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of CDE and show the effectiveness of early surgical lavage (ESL).
Methods
Patients who had presented to the Cancer Center of Lille (France) with TIVAPS inserted between January 2004 and April 2013 and CDE had their medical records reviewed retrospectively.
Results
Thirty patients and 33 events were analyzed. Implicated agents were vesicants (51.5%), irritants (45.5%) and non-vesicants (3%). Huber needle malpositionning was involved in 27 cases. Surgery was performed in 97% of cases, 87.5% of which were for ESL with 53.1% of the latter requiring TIVAPS extraction. Six patients required a second intervention due to adverse outcomes (severe cases). Vesicants were found to be implicated in four out of six severe cases and oxaliplatin in two others. Extravasated volume was above 50 ml in 80% of cases. Only one patient required a skin graft.
Conclusions
CDEs should be managed in specialized centers. ESL allows for limited tissue contact of the chemotherapy drug whilst using a simple, widely accessible technique. The two main factors that correlate with adverse outcome seem to be the nature of the implicated agent (vesicants) and the extravasated volume (above 50 ml) leading to worse outcomes. Oxaliplatin should be considered as a vesicant.</description><identifier>ISSN: 1129-7298</identifier><identifier>EISSN: 1724-6032</identifier><identifier>DOI: 10.5301/jva.5000316</identifier><identifier>PMID: 25362986</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Aged ; Antineoplastic Agents - administration & dosage ; Antineoplastic Agents - adverse effects ; Catheterization, Central Venous - adverse effects ; Catheterization, Central Venous - instrumentation ; Catheters, Indwelling ; Central Venous Catheters ; Child, Preschool ; Equipment Design ; Equipment Failure ; Extravasation of Diagnostic and Therapeutic Materials - diagnosis ; Extravasation of Diagnostic and Therapeutic Materials - etiology ; Extravasation of Diagnostic and Therapeutic Materials - therapy ; Female ; France ; Humans ; Infant ; Infusions, Intravenous ; Male ; Medical Errors ; Middle Aged ; Needles ; Pleural Effusion - etiology ; Pleural Effusion - therapy ; Retrospective Studies ; Therapeutic Irrigation - methods ; Time Factors ; Treatment Outcome</subject><ispartof>The journal of vascular access, 2015-01, Vol.16 (1), p.31-37</ispartof><rights>2015 SAGE Publications</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c322t-6b7119bd92571261e80f57d9ea489176d7dd91c3f039dd45779d6209752daa8f3</citedby><cites>FETCH-LOGICAL-c322t-6b7119bd92571261e80f57d9ea489176d7dd91c3f039dd45779d6209752daa8f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.5301/jva.5000316$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.5301/jva.5000316$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21800,27903,27904,43600,43601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25362986$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Azaïs, Henri</creatorcontrib><creatorcontrib>Bresson, Lucie</creatorcontrib><creatorcontrib>Bassil, Alfred</creatorcontrib><creatorcontrib>Katdare, Ninad</creatorcontrib><creatorcontrib>Merlot, Benjamin</creatorcontrib><creatorcontrib>Houpeau, Jean-Louis</creatorcontrib><creatorcontrib>Bedoui, Sophie El</creatorcontrib><creatorcontrib>Meurant, Jean-Pierre</creatorcontrib><creatorcontrib>Tresch, Emmanuelle</creatorcontrib><creatorcontrib>Narducci, Fabrice</creatorcontrib><title>Chemotherapy Drug Extravasation in Totally Implantable Venous Access Port Systems: How Effective is Early Surgical Lavage?</title><title>The journal of vascular access</title><addtitle>J Vasc Access</addtitle><description>Purpose
Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of CDE and show the effectiveness of early surgical lavage (ESL).
Methods
Patients who had presented to the Cancer Center of Lille (France) with TIVAPS inserted between January 2004 and April 2013 and CDE had their medical records reviewed retrospectively.
Results
Thirty patients and 33 events were analyzed. Implicated agents were vesicants (51.5%), irritants (45.5%) and non-vesicants (3%). Huber needle malpositionning was involved in 27 cases. Surgery was performed in 97% of cases, 87.5% of which were for ESL with 53.1% of the latter requiring TIVAPS extraction. Six patients required a second intervention due to adverse outcomes (severe cases). Vesicants were found to be implicated in four out of six severe cases and oxaliplatin in two others. Extravasated volume was above 50 ml in 80% of cases. Only one patient required a skin graft.
Conclusions
CDEs should be managed in specialized centers. ESL allows for limited tissue contact of the chemotherapy drug whilst using a simple, widely accessible technique. The two main factors that correlate with adverse outcome seem to be the nature of the implicated agent (vesicants) and the extravasated volume (above 50 ml) leading to worse outcomes. Oxaliplatin should be considered as a vesicant.</description><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Catheterization, Central Venous - adverse effects</subject><subject>Catheterization, Central Venous - instrumentation</subject><subject>Catheters, Indwelling</subject><subject>Central Venous Catheters</subject><subject>Child, Preschool</subject><subject>Equipment Design</subject><subject>Equipment Failure</subject><subject>Extravasation of Diagnostic and Therapeutic Materials - diagnosis</subject><subject>Extravasation of Diagnostic and Therapeutic Materials - etiology</subject><subject>Extravasation of Diagnostic and Therapeutic Materials - therapy</subject><subject>Female</subject><subject>France</subject><subject>Humans</subject><subject>Infant</subject><subject>Infusions, Intravenous</subject><subject>Male</subject><subject>Medical Errors</subject><subject>Middle Aged</subject><subject>Needles</subject><subject>Pleural Effusion - etiology</subject><subject>Pleural Effusion - therapy</subject><subject>Retrospective Studies</subject><subject>Therapeutic Irrigation - methods</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1129-7298</issn><issn>1724-6032</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkEtLAzEURoMovlfuJUtBRvOYJI0bkVofUFDwsR3SyZ06ZWZSk0y1_nojVt24yiV897ucg9ABJSeCE3o6W5gTQQjhVK6hbapYnknC2XqaKdOZYnqwhXZCmBHCtKD5Jtpigsv0LbfRx_AFWhdfwJv5El_6fopH79GbhQkm1q7DdYcfXTRNs8S37bwxXTSTBvAzdK4P-KIsIQR873zED8sQoQ1n-Ma94VFVQRnrBeA64JHxaf2h99O6NA0ep_YpnO-hjco0AfZX7y56uho9Dm-y8d317fBinJWcsZjJiaJUT6xmQlEmKQxIJZTVYPKBpkpaZa2mJa8I19bmQiltJSNaCWaNGVR8Fx199869e-0hxKKtQwlNYoHEUFApFGcqpzpFj7-jpXcheKiKua9b45cFJcWX7CLJLlayU_pwVdxPWrC_2R-7f5dD4i1mrvddAv236xOu3od-</recordid><startdate>201501</startdate><enddate>201501</enddate><creator>Azaïs, Henri</creator><creator>Bresson, Lucie</creator><creator>Bassil, Alfred</creator><creator>Katdare, Ninad</creator><creator>Merlot, Benjamin</creator><creator>Houpeau, Jean-Louis</creator><creator>Bedoui, Sophie El</creator><creator>Meurant, Jean-Pierre</creator><creator>Tresch, Emmanuelle</creator><creator>Narducci, Fabrice</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201501</creationdate><title>Chemotherapy Drug Extravasation in Totally Implantable Venous Access Port Systems: How Effective is Early Surgical Lavage?</title><author>Azaïs, Henri ; Bresson, Lucie ; Bassil, Alfred ; Katdare, Ninad ; Merlot, Benjamin ; Houpeau, Jean-Louis ; Bedoui, Sophie El ; Meurant, Jean-Pierre ; Tresch, Emmanuelle ; Narducci, Fabrice</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c322t-6b7119bd92571261e80f57d9ea489176d7dd91c3f039dd45779d6209752daa8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Antineoplastic Agents - adverse effects</topic><topic>Catheterization, Central Venous - adverse effects</topic><topic>Catheterization, Central Venous - instrumentation</topic><topic>Catheters, Indwelling</topic><topic>Central Venous Catheters</topic><topic>Child, Preschool</topic><topic>Equipment Design</topic><topic>Equipment Failure</topic><topic>Extravasation of Diagnostic and Therapeutic Materials - diagnosis</topic><topic>Extravasation of Diagnostic and Therapeutic Materials - etiology</topic><topic>Extravasation of Diagnostic and Therapeutic Materials - therapy</topic><topic>Female</topic><topic>France</topic><topic>Humans</topic><topic>Infant</topic><topic>Infusions, Intravenous</topic><topic>Male</topic><topic>Medical Errors</topic><topic>Middle Aged</topic><topic>Needles</topic><topic>Pleural Effusion - etiology</topic><topic>Pleural Effusion - therapy</topic><topic>Retrospective Studies</topic><topic>Therapeutic Irrigation - methods</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Azaïs, Henri</creatorcontrib><creatorcontrib>Bresson, Lucie</creatorcontrib><creatorcontrib>Bassil, Alfred</creatorcontrib><creatorcontrib>Katdare, Ninad</creatorcontrib><creatorcontrib>Merlot, Benjamin</creatorcontrib><creatorcontrib>Houpeau, Jean-Louis</creatorcontrib><creatorcontrib>Bedoui, Sophie El</creatorcontrib><creatorcontrib>Meurant, Jean-Pierre</creatorcontrib><creatorcontrib>Tresch, Emmanuelle</creatorcontrib><creatorcontrib>Narducci, Fabrice</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of vascular access</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Azaïs, Henri</au><au>Bresson, Lucie</au><au>Bassil, Alfred</au><au>Katdare, Ninad</au><au>Merlot, Benjamin</au><au>Houpeau, Jean-Louis</au><au>Bedoui, Sophie El</au><au>Meurant, Jean-Pierre</au><au>Tresch, Emmanuelle</au><au>Narducci, Fabrice</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chemotherapy Drug Extravasation in Totally Implantable Venous Access Port Systems: How Effective is Early Surgical Lavage?</atitle><jtitle>The journal of vascular access</jtitle><addtitle>J Vasc Access</addtitle><date>2015-01</date><risdate>2015</risdate><volume>16</volume><issue>1</issue><spage>31</spage><epage>37</epage><pages>31-37</pages><issn>1129-7298</issn><eissn>1724-6032</eissn><abstract>Purpose
Totally implantable venous access port systems (TIVAPS) are a widely used and an essential tool in the efficient delivery of chemotherapy. Chemotherapy drug extravasation (CDE) can have dire consequences and will delay treatment. The purpose of this study is to both clarify the management of CDE and show the effectiveness of early surgical lavage (ESL).
Methods
Patients who had presented to the Cancer Center of Lille (France) with TIVAPS inserted between January 2004 and April 2013 and CDE had their medical records reviewed retrospectively.
Results
Thirty patients and 33 events were analyzed. Implicated agents were vesicants (51.5%), irritants (45.5%) and non-vesicants (3%). Huber needle malpositionning was involved in 27 cases. Surgery was performed in 97% of cases, 87.5% of which were for ESL with 53.1% of the latter requiring TIVAPS extraction. Six patients required a second intervention due to adverse outcomes (severe cases). Vesicants were found to be implicated in four out of six severe cases and oxaliplatin in two others. Extravasated volume was above 50 ml in 80% of cases. Only one patient required a skin graft.
Conclusions
CDEs should be managed in specialized centers. ESL allows for limited tissue contact of the chemotherapy drug whilst using a simple, widely accessible technique. The two main factors that correlate with adverse outcome seem to be the nature of the implicated agent (vesicants) and the extravasated volume (above 50 ml) leading to worse outcomes. Oxaliplatin should be considered as a vesicant.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>25362986</pmid><doi>10.5301/jva.5000316</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1129-7298 |
| ispartof | The journal of vascular access, 2015-01, Vol.16 (1), p.31-37 |
| issn | 1129-7298 1724-6032 |
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| source | SAGE Complete A-Z List; MEDLINE |
| subjects | Adult Aged Antineoplastic Agents - administration & dosage Antineoplastic Agents - adverse effects Catheterization, Central Venous - adverse effects Catheterization, Central Venous - instrumentation Catheters, Indwelling Central Venous Catheters Child, Preschool Equipment Design Equipment Failure Extravasation of Diagnostic and Therapeutic Materials - diagnosis Extravasation of Diagnostic and Therapeutic Materials - etiology Extravasation of Diagnostic and Therapeutic Materials - therapy Female France Humans Infant Infusions, Intravenous Male Medical Errors Middle Aged Needles Pleural Effusion - etiology Pleural Effusion - therapy Retrospective Studies Therapeutic Irrigation - methods Time Factors Treatment Outcome |
| title | Chemotherapy Drug Extravasation in Totally Implantable Venous Access Port Systems: How Effective is Early Surgical Lavage? |
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