Chemotherapy extravasation

The conventional medicine is Ole (sodium aescinate), which is applied externally.

Earthwork drugs include: potato chips are applied externally 4-5 times a day, and the effect is good.

Treatment of extravasation of chemotherapy drugs

The most effective way to deal with extravasation is to prevent extravasation!

Steps: 1 Stop chemotherapy.

2 Leave the needle and brake the affected limb.

Suck out the residual drugs or drugs suspected of extravasation in the needle and infusion tube.

4 unplug the needle

5. Avoid squeezing the spilled part.

6 When special chemotherapy drugs extravasate, inject corresponding antidote as instructed.

7 If extravasation occurs due to the use of special drugs, give hot compress or cold compress.

8 Raise the upper limbs

Inform the doctor to discuss whether the extravasation site needs further treatment and filming.

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Vinblastine, vincristine, vincristine etc. Hot compress should be applied for at least 15-20 minutes every day within 24-48 hours of extravasation, and the affected limb should be raised.

Adriamycin and daunorubicin should be cooled locally.

Pathogenesis: Chemotherapy drugs enter the perivascular tissues, causing tissue degeneration, necrosis and even ulcer formation.

Clinical manifestations: congestion, pain, swelling and even ulceration at the injection site.

Emergency measures: 1. Stop the injection immediately; 2. Subcutaneous injection of local procaine and normal saline can slow down the absorption and analgesia of chemotherapy drugs; 3. Local cold compress of ice packs limits the damaged area; 4. People with obvious local swelling can use magnesium sulfate wet compress to eliminate swelling; 5. If ulcers or blisters have appeared, surgery should be performed; 6. After the acute stage of inflammation, physical therapy can be used to promote recovery.

Preventive measures: 1. First, select blood vessels from the distal end; 2. Multi-site alternate injection is beneficial to vascular recovery; Chemotherapy drugs were added after the patency of blood vessels was confirmed, and the catheter was washed with normal saline after chemotherapy to reduce the stimulation of blood vessels; If there is no special requirement, the injection speed should be adjusted quickly.

Personal practical experience: prevention of extravasation of chemotherapy drugs is the key, and skilled puncture technique and reasonable blood vessel selection are the key to prevention.

Detoxification methods of intravenous extravasation of common anticancer drugs

4ml of 1 and 4 ml of nitrogen mustard 10% sodium thiosulfate were mixed with 6ml of sterile water for injection, and 5-6ml were injected intravenously locally, and the extravasation site was injected subcutaneously several times; Repeat for hours. Detoxification mechanism: accelerating alkylation.

2. The method of mitomycin is the same as above. Vitamin C 1ml was injected intravenously. Detoxification mechanism: direct inactivation.

3. Adriamycin (1)50-200mg hydrocortisone sodium succinate is injected intravenously, and 1% hydrocortisone cream is used externally; (2) 5 ml of 8.4% sodium bicarbonate +4mg of norepinephrine were injected intravenously, and subcutaneous injection was performed at multiple extravasation sites. Detoxification mechanism: reduce inflammation.

4, daunorubicin 8.4% sodium bicarbonate 5ml+ Demi 4mg local intravenous injection, subcutaneous injection of extravasation site for many times. Detoxification mechanism: reduce the combination of drugs and DNA and reduce inflammation.

5. Actinomycin D method with mitomycin. Detoxification mechanism: reduce the combination of drugs and DNA.

6, carbamazepine 8.4% sodium bicarbonate 5ml local intravenous injection. Detoxification mechanism: chemical inactivation.

7. Inject vinblastine, vinblastine, etoposide 8.4% sodium bicarbonate 5ml or hyaluronidase 1-6ml subcutaneously at the extravasation site every few hours, and apply hot compress. The use of corticosteroids and local cold compress will aggravate toxicity. Detoxification mechanism: chemical precipitation; Accelerate the absorption and diffusion of extravasated drugs.

For the above data, please refer to the Specification of Chemotherapy Schemes for Malignant Tumors edited by Wang Huaqing and the summary of undergraduate clinical practice. Prevention and treatment of phlebitis and drug extravasation during chemotherapy

Chemotherapy for patients with malignant tumor is easy to cause phlebitis and drug extravasation due to repeated use of anticancer drugs and long-term intravenous administration. Once drug extravasation occurs, it will bring great pain to patients, cause unnecessary medical disputes, and even leave patients with lifelong disability. In order to solve the difficulties in clinical nursing, nurses have done a lot of clinical research to effectively control drug extravasation. In order to master the basic knowledge and skills of chemotherapy nurses, the etiology, pathology, extravasation classification, prevention, leakage treatment and prevention of this complication were expounded respectively.

1 Etiology and Pathology

1. 1 Chemotherapy phlebitis is mainly caused by the chemical inflammation of the blood vessel wall caused by the stimulation of chemotherapy drugs.

1.2 extravasated drugs penetrate into subcutaneous tissue, which increases vascular permeability and tissue inflammatory exudation, leading to edema around damaged vein skin.

1.3 drugs that bind to cell DNA are the most likely to cause tissue necrosis, and the reaction can last for several weeks after the irritating drugs are removed.

1.4 strong acid, strong alkali or hypertonic stimulation of chemotherapeutic drugs can induce the maturation and arrest of proliferating cells, and can also lead to local tissue toxicity and endothelial damage.

1.5 In the process of drug preparation, if the operating procedures are not followed and the environment is polluted, fine capillary particles can also enter blood vessels, which will stimulate and damage the inner wall of blood vessels, produce tissue edema and form inflammation.

2 Clinical manifestations

2. 1 Burning pain or local swelling along blood vessels often occurs during infusion.

2.2 local redness, swelling, heat, pain and inflammatory reaction occurred at the extravasation injection site. If the treatment is not timely or untreated, bullae and cluster blisters will appear in severe cases, and then local purple spot ulcer and necrosis will appear.

2.3 purple erythema is hard, burning, subcutaneous tissue involved, and activity is limited.

2.4 subcutaneous tissue is stimulated by drugs, tissue is damaged, nerve endings are stimulated to cause radiation pain, cervical and axillary lymph nodes are swollen, and septicemia is accumulated.

2.5 Ulcer formation, gradually spread from the center to the outside, subcutaneous tissue necrosis, obvious proliferation of epidermis at the edge, irregular.

2.6 "Venous distension" reaction mainly manifested as a series of rashes along the vascular access direction, superficial erythema, edema, induration, itching and tenderness along the vascular direction. Some patients suffered from palpitation and discomfort, and the symptoms disappeared about one day after stopping the drug, and there was no residual tissue damage. This reaction accounts for 3%, mostly in the application of adriamycin.

3 Classification of extravasation of chemotherapeutic drugs

The degree of subcutaneous tissue damage caused by extravasation of chemotherapy drugs can be divided into three categories:

(1) chemotherapy drugs for sores; ② Stimulus chemotherapy drugs; (3) Non-irritating chemotherapy drugs, nurses should be familiar with the local stimulation intensity of various drugs.

3. 1 Foaming chemotherapy drugs are one of the common clinical complications, which are mainly composed of vincristine, vinorelbine, tomahawk, ricin, adriamycin, epirubicin and mitomycin. Once infiltrated into blood vessels, it may cause redness, swelling, heat and pain in a short time, even skin and tissue necrosis, and may also lead to permanent ulcers.

3.2 Stimulating chemotherapy drugs can cause mild tissue inflammation and pain, but not subcutaneous and tissue necrosis, such as azithromycin (DTIC) and etoposide (VP- 16).

3.3 Non-irritating drugs have no obvious irritation to skin and tissues, such as 5- fluorouracil (5-Fu), cisplatin (DDP) and methotrexate (MTX). But also pay attention.

4 Preventive measures

4. 1 Nurses in chemotherapy department should first strengthen their sense of responsibility, understand the classification and toxicity of chemotherapy drugs, especially the foam chemotherapy drugs with strong toxicity, make plans for intravenous use, and choose intravenous infusion drugs with large blood vessel diameter, good elasticity, straight walking and easy fixation.

4.2 For cachexia patients with long-term medication and poor vascular filling, puncture of internal jugular vein or subclavian vein and PICC catheter should be advocated to reduce extravasation and phlebitis of chemotherapy drugs.

4.3 In the process of infusion, closely observe the local reaction, and pay attention to whether the puncture point leaks when patrolling the ward or returning the liquid to ensure the smooth flow of the liquid.

4.4 The concentration of chemotherapy drugs after dilution is relatively high, so close observation should be made when infusion is needed for a short time, and the patients should be educated about the importance of protecting veins and the consequences after extravasation, so that the accompanying personnel can actively cooperate.

4.5 For strongly irritating drugs, patients should do a good job in health education, eliminate fear, and emphasize the irritation of drugs. If there is pain or abnormal feeling at the injection site, they should inform the nurse in time to avoid unbearable tissue necrosis.

Treatment and nursing of extravasation of chemotherapy drugs

5. 1 Once the chemotherapeutic drugs extravasate or show signs of drip, the infusion can be stopped immediately. Keep the needle and connect the syringe to extract exudate. Then give the local skin routine disinfection for 2-3 times in time, according to the size of the extravasation site, apply anti-drug local multi-point sealing, the sealing range should exceed the leakage site by 3cm, raise the affected limb, cold compress for 24 hours, report to the doctor in time and record the leakage. The local reaction was observed by the responsible nurse every day.

5.2 Zhou Lian and Jiang Mingjie reported China Journal of Nursing 2000,35 (2)119. Add 20ml of 50% glucose, 25% magnesium sulfate 10ml and vitamin B 12500ug to soak the gauze, completely cover the gauze on the skin leaked by chemotherapy drugs, and then cold press 2b. Vitamin B 12 participates in various chemical metabolic reactions in vivo, promotes the repair and regeneration of damaged skin epithelial cells and vascular endothelial cells, prevents the wound infection from worsening, accelerates the growth of new tissues, repairs hair follicles, sweat glands and subcutaneous tissues, and plays an analgesic role. Hypertonic sugar (50%) and magnesium sulfate (25%) are hypertonic solutions, which can reduce local skin swelling after wet compress. The former can provide energy for the repair of damaged tissues, which is beneficial to the recovery of injuries. The total effective rate is 96%.

5.3 Table 1 Antidotes for Common Anti-cancer Drugs

┃┃┃┃┃┃┃┃┃┃┃┃

┠———————————————————————————— ┨

┃ 10% 4 ml sodium thiosulfate reduced the binding to DNA ┃.

┃ACTD or vitamin c(50 mg/ml) 1 ml reduces DNA binding┃

┃ adriamycin sodium bicarbonate 8.4%, 5ml reduced DNA binding┃.

┃ADM dexamethasone 4mg/ml 1ml reduces inflammation┃

┃ ┃

┃ Glomerycin sodium thiosulfate 10% 4ml fast alkalization┃

┃ mthedta 1 50mg/ml1ml reduces DNA binding┃

┃ ┃

┃ mitomycin sodium thiosulfate 10% 4ml direct inactivation┃

Direct inactivation of ┃MMC or vitc(50 mg/ml) 1 ml is provided.

┃ ┃

Vinblastine sodium bicarbonate 8.4% 5ml chemical precipitation┃ offers.

┃VLB or hyaluronidase 150U/ml 1ml promotes drug absorption┃

┃ ┃

┃8.4%bicarbonate┃ 5ml chemical precipitation of vincristine sodium.

┃ACR or hyaluronidase 150U/ml heating 1ml promotes drug absorption┃.

┃ ┃

┃8.4%bicarbonate┃ 5ml chemical inactivation of carbamazepine sodium.

┃BCNU ┃

┗━━━━━━━━━━━━━━━━━━━━━ ━━━━━━━┛

5.4 Table 2 5 Clinical Observation of Adriamycin Leakage

┏━━━━━┯━━━━━━━━┯━━━━━━━━━━━━━━━━━━━━┯━━━━┓

┃┃┃┃┃┃┃┃┃┃┃fruit.

┃┃┃┃┃├———————————————————————————————— ┨

┃ ┃ ┃ 3 days ┃ 1 week ┃ 2 weeks ┃ 1 month

┠—————┼————————┼——┼————————┼————————┼————┨

┃ case 1 ┃ 5ml intravenous injection of sodium bicarbonate ┃ mild pain ┃ mild pain ┃ cure ┃.

┃ 3 ml┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃

┠—————┼————————┼——┼————————┼————————┼————┨

┃ Case 2 ┃ Sodium bicarbonate 2miv ┃ Swelling ┃ Swelling disappeared ┃ ┃ ┃.

┃ 4 ml ┃2 ml ┃ ecchymosis ┃ mild ecchymosis ┃ ┃

┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃

┃┃┃┃ 25 mg h ┃┃┃┃┃┃┃┃┃

┠—————┼————————┼——┴————————┼————————┼————┨

┃ Case 3 ┃ Sodium bicarbonate 5ml h ┃ See the patient at the end ┃ Slight erythema and swelling ┃ Heal ┃.

┃ 4 ml ┃ Hydrocortisone 50 mg ┃ ┃ Disorder necrosis ┃ ┃.

┠—————┼————————┼—————┬—————┼————————┼————┨

┃ Case 4 ┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃┃

┃ 4 ml ┃ Hydrocortisone 50 ml ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃.

┃┃┃┃ Swelling or pain ┃┃┃ Necrosis ┃┃

┠—————┼————————┼—————┼—————┴————————┼————┨

┃ Case 5 ┃ Sodium bicarbonate 2miv ┃ Local swelling ┃ ┃.

┃ 5 ~ 6 ml h │ │ │ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃ ┃

┃┃┃ Hydrocortisone 50mgiv ┃┃ Pain, erythema ┃┃┃

┗━━━━━┷━━━━━━━━┷━━━━━┷━━━━━━━━━━━━━━┷━━━━┛

5.5 Table 3 Anti-tumor Drug Leakage Inflammatory Reaction Time

┏━━━━━━━━━━━━━━━━━━━━━━━━━━━┓

┃ Drug reaction time┃

┠———————————————————————————┨

┃ Gentamicin 1 ~ 2 weeks > 2 weeks┃

┃ adriamycin 1 ~ 2 weeks > 2 weeks┃

┃ Glomerycin 1 week > 2 weeks┃

┃ mitomycin 1 week > 2 weeks┃

┃ vincristine 12 ~ 24 h > 2 weeks┃

┗━━━━━━━━━━━━━━━━━━━━━━━━━━━┛

It takes 1 ~ 2 weeks for the inflammatory reaction to occur when the liquid medicine leaks, so it is suspected that there is leakage during injection, that is, it should be treated as leakage, and it should not be easily let go, resulting in serious consequences.

Literature report 1 A week after adriamycin injection, inflammatory reaction, severe pain, ulcer formation, extensive erosion of tendons and ligaments, leading to irreversible damage. Because there are abundant tiny tendons and ligaments on the back of hand and wrist, it is extremely difficult to deal with the injury caused by the leakage of liquid medicine. Even disabled, so for drugs with strong irritation, don't inject them here, use the vein with thick forearm.

6 prevention of phlebitis

6. 1 Lock an yun reported Shanxi Journal of Nursing 96, 10262, Clinical Observation on Treatment of Chemotherapy Phlebitis by External Application of Potato and Irradiation with Spectrometer. Wash and slice fresh potatoes, cut them into thin slices with a thickness of about 0.5cm, apply them to the affected limb phlebitis 12 hours, then take out the externally applied potato slices, and irradiate the affected area with WS-simulated human spectrometer for 40 minutes each time, twice a day. Potato is a kind of potato food, which contains a lot of starch, various salts and solanine. Solanine can relieve spasm and reduce exudation, and local external application can achieve the effect of detumescence and pain relief.

6.2 Gao reported that China Journal of Nursing 0 1, 36( 1)65, nitroglycerin patch was used to prevent phlebitis caused by chemotherapy. At the beginning of chemotherapy, a nitroglycerin patch with a diameter of 3.52-3cm was put on the front end of the puncture point (about 5mg nitroglycerin was released every 24 hours) for 24 hours, and the left and right hands were punctured every other day 1 time, with 7 times of chemotherapy as a course of treatment. Nitroglycerin skin patch can absorb drugs to skin mucosa and directly relax vascular smooth muscle, especially small vascular smooth muscle. Maintain local vasodilation and relieve vasospasm caused by drug toxic stimulation. The effect of preventing phlebitis is better.

6.3 Song Xiaoning and Shao Junhui reported Shanxi Nursing Journal 97, 1 1247. Take 1-2 oral vitamin e capsules (each capsule 100 mg), puncture with a needle, take out the internal fluid, directly apply it to the discolored skin, and then gently apply it evenly with a glass rod or needle handle to expose it. Vitamin E, also known as tocopherol, is an important physiological antioxidant, which has obvious antioxidant effect, can reduce oxygen consumption of tissues, enhance mitochondrial function, and affect nucleic acid metabolism and various enzymes.

Function.

6.4 He Fan reported Qilu Journal of Nursing 200 1, 7 457. Mix 2% 654-2%654-2 10mg and 0.9%NS 1ml evenly, take a 3cm×4cm cotton piece, soak the medicine and apply it 2-3 cm above the puncture site. 654-2 can significantly relax smooth muscle, relieve vasospasm, improve microcirculation, especially relieve sensitive person's pain and reduce the occurrence of phlebitis.

6.5 Zhao and Ding Rongshuang reported that in order to prevent the venous reaction caused by navelbine, they used 1% dicaine wet compress before injection, and then injected dexamethasone (or lidocaine) after injection. Studies have shown that 1% tetracaine can prevent sodium ions from entering cells, prevent potassium ions from flowing out of cells, reduce acetylcholine release from nerve endings vesicles, keep cell membrane potential stable, and prevent nerve conduction, thus effectively preventing venous reaction and pain caused by NUB injection. Dexamethasone can stabilize lysosomal membrane, effectively inhibit the release of inflammatory mediators, histamine and 5- hydroxytryptamine, reduce capillary permeability, enhance cell tolerance to various stimuli, and resist inflammatory reactions caused by physical, chemical, immune and other reasons. Lidocaine can stabilize the transmembrane potential of cell membrane, reduce various stimulation reactions, block the sympathetic nerve excitement caused by inflammatory stimulation, and effectively reduce the reaction of phlebitis.

6.6 Improper injection methods often cause phlebitis, so attention should be paid to protecting veins. Dissolve the drug in 20ml solvent, push it by static pressure, or use intravenous infusion to reduce the stimulation of the drug to the intima of blood vessels. Long-term treatment needs to make a vein use plan, and the left arm and the right arm are used alternately to repair the injured vein. Because the veins of lower limbs are easy to be embolized, it is not suitable to inject drugs into veins of lower limbs except for the compression sign of superior vena cava. If the vein has been red, swollen, hot and painful inflammatory reaction, it is necessary to stop dripping and wet compress with magnesium sulfate.

Treatment and nursing of skin tissue necrosis caused by extravasation of chemotherapy drugs It is difficult to treat skin tissue necrosis caused by extravasation of chemotherapy drugs in clinic. The ulceration spreads outward from the drug center, but the boundary is unclear, which brings a lot of trouble to clinical treatment, and the ulcerated surface is not easy to heal.

7. 1 To treat skin erythema, add 5mg of flumethasone and 100mg of lidocaine to 0.9% NS 5- 10 ml, and insert the needle at a distance of 1-2 cm. Once a day, gradually inject the needle into the central part at multiple points (avoid blood vessels), and observe the skin color and skin color on this day.

7.2 In the treatment of skin ulceration, once ulceration is caused by drug extravasation, great attention should be paid to debridement and dressing change, and 200ml chlorobenzene solution, 1-2 times a day,/60,000 u gentamicin, 10mg dexamethasone should be used for local infiltration, or sterile gauze should be used for wet compress to reduce pollution, and antibiotics should be given to control inflammation. Surgical skin grafting can be considered for those who do not heal.

In recent years, due to the increase of tumor patients and various reasons, the prevention of phlebitis has been further discussed by the majority of nursing workers, although many experiences and measures have been obtained for reference. And pay attention to prevention, strengthen the sense of responsibility and compassion of nurses. Especially before infusion of chemotherapy drugs, further confirm whether the needle is in the blood vessel. For highly irritating drugs, such as vincristine, daunorubicin, topiramate, etc. A small amount of solution is diluted and injected to make chemotherapy drugs enter blood vessels quickly. Inject normal saline after taking medicine to reduce the drug concentration in local blood vessels and shorten the residence time of chemotherapy drugs in local blood vessels, thus avoiding the continuous stimulation of drugs to blood vessels, reducing the leakage of liquid medicine outside blood vessels when taking medicine, and effectively avoiding phlebitis and blisters.