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BACKGROUND: Extravasation of non-cytotoxic medications can lead to serious complications such as pain, tissue necrosis, limb loss, and even death. This descriptive cross-sectional study aims to assess the knowledge levels of emergency department (ED) nurses regarding extravasation incidents involving non-cytotoxic medications and to highlight the importance of effective management and prevention. METHODS: The study was conducted in the EDs of three hospitals in Istanbul, Türkiye, between November 19, 2020 and December 31, 2020. A total of 100 ED nurses participated in the study. Inclusion criteria required nurses to be working full-time in the EDs during the study period and to provide written and verbal consent. The study utilized a survey to assess sociodemographic characteristics, knowledge of non-cytotoxic medications (e.g., epinephrine), symptoms of extravasation, prevention strategies, and intervention practices. RESULTS: The mean age of the nurses was 29.43 years, with 57% female and 73% holding a bachelor's degree. Among participants, 52% had 0-3 years of ED experience. Ninety-one percent reported not receiving education on extravasation after graduation, and 82% indicated no extravasation protocol was in place at their workplace. Knowledge about non-cytotoxic medications causing extravasation significantly increased with ED experience (p=0.035). Nurses in units with an extravasation protocol had significantly higher knowledge levels (p=0.007). Female nurses demonstrated better knowledge of extravasation symptoms than male nurses (p=0.012). Nurses with a bachelor's or higher degree had significantly better knowledge than others (p=0.015). The knowledge rate for the extravasation care protocol was 64%, with the most recognized protocol item being 'immediately stop the infusion' (97%) and the least recognized being 'aspirate the medication not to exceed 3-5 mL' (33%). Strong correlations were found between non-pharmacological factors and knowledge of non-cytotoxic medications (r=0.601; p<0.001), as well as between knowledge of extravasation care protocols and non-pharmacological factors (p<0.001). CONCLUSION: The study highlights the need for targeted education and the establishment of institutional protocols for managing and preventing extravasation in EDs. Nurses' knowledge significantly impacts their adherence to prevention and care protocols. To ensure patient safety, it is important to provide ongoing education and implement evidence-based intervention protocols for the management of extravasation in ED settings.

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BACKGROUND: Extravasation (paravasation) of chemotherapy and other anticancer drugs represents a significant complication in the patient care. Preventive and therapeutic measures effectively reduce the incidence, severity and extent of extravasation-related complications and its consequences. A working group of authors from expert groups developed recommendations for standard care. AIM: To provide a concise summary of recommended interventions for daily clinical practice. These recommendations are based either on long-term, evidence-based clinical experience or consensus opinions among expert groups representatives. RESULTS: Preventive measures are critical and include early consideration of indications for long-term venous access devices, appropriate selection of the injection and exit sites, thorough venous access device assessment before each anticancer drug administration, and comprehensive patient education. Therapeutic interventions following extravasation primarily involve the administration of specific antidotes (dimethylsulfoxide, hyaluronidase, dexrazoxane) along with the application of dry cold or heat, depending on the specific anticancer agent involved. The use of subcutaneous corticosteroids, moist heat or moist cooling, and compression is not recommended. CONCLUSION: Adherence to these recommendations significantly decreases the risk and mitigates the consequences of extravasation. Clinical sites may adapt and expand these guidelines based on local policies and specific patient care requirements.

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OBJECTIVES: to develop, validate, and evaluate an educational video on the prevention and management of antineoplastic agent extravasation, aimed at nursing professionals. METHODS: this methodological study was developed according to Falkembach's theoretical framework, which outlines five phases in the production of educational video materials: analysis and planning, modeling, implementation, evaluation, and distribution. RESULTS: content validation demonstrated agreement above the minimum threshold stipulated. The overall Content Validity Index was 90.8%, and it was 94.2% among the content and technical evaluation judges, respectively. The target audience evaluated the video positively, highlighting the importance of the content, the clarity of the language used, and the understanding of the information pertinent to the topic. CONCLUSIONS: the video proved to be an appropriate strategy for instructing interventions on the prevention and management of extravasation, with the potential to improve educational practices among nursing professionals.

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BACKGROUND: Recent guidelines recommend direct patient observation, pressure monitoring, and sensor devices to prevent extravasation during contrast media (CM) injection. However, it is impractical in terms of time and cost to install sensors for all patients. PURPOSE: To identify risk factors for CM extravasations during contrast-enhanced computed tomography (CECT) in a large population and to establish criteria for placing the sensor device on patients. MATERIAL AND METHODS: This retrospective study included 143,556 patients who underwent CECT at our hospital between April 2012 and July 2022. We performed multivariable logistic regression analysis between patients with (n = 350) and randomly selected patients without CM extravasation (n = 350). We investigated the percentage of patients with sensor devices and their sensitivity for detecting extravasation using receiver operating characteristic curve analysis. RESULTS: The extravasation rate was 0.27%. Multivariable logistic regression analysis showed that the injection rate (adjusted odds ratio [AOR] = 1.61, 95% confidence interval [CI] = 1.33-1.95: P <0.001), catheter gauge (AOR = 3.86, 95% CI = 1.92-7.76; P <0.001), the use of anticancer drugs (AOR = 1.81, 95% CI = 1.32-2.50; P <0.001), and existing catheters (AOR = 1.52, 95% CI = 1.10-2.11; P = 0.009) were significantly associated with extravasation. To achieve a sensitivity of 90%, 80%, 70%, 60%, and 50%, 80%, 65%, 50%, 40%, and 28% of all patients required the placement of a sensor device, respectively. CONCLUSION: Sensitivity analysis established criteria for effective placing sensor devices.

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RATIONALE AND OBJECTIVES: To identify the risk factors for contrast media (CM) extravasation and provide effective guidance for reducing its incidence. MATERIALS AND METHODS: We observed adult inpatients (n = 38 281) who underwent intravenous contrast-enhanced computed tomography between January 1, 2018, and December 31, 2022. Risk factors for CM extravasation were evaluated using univariate and multivariate logistic regression. RESULTS: Among the 38 281 inpatients who underwent enhanced computed tomography angiography, 3885 received peripherally inserted central venous catheters (PICCs) and 34 396 received peripheral short catheters. In 3885 cases of PICCs, no CM extravasation occurred, but in five cases, ordinary PICCs that are unable to withstand high pressure were mistakenly used; three of those patients experienced catheter rupture, and eventually, all five patients underwent unplanned extubation. Among 34 396 cases of peripheral short catheters, 224 (0.65%) had CM extravasation. Female sex (odds ratio [OR]=1.541, 95% confidence interval [CI]: 1.111-2.137), diabetes (OR=2.265, 95% CI: 1.549-3.314), venous thrombosis (OR=2.157, 95% CI: 1.039-4.478), multi-site angiography (OR=9.757, CI: 6.803-13.994), and injection rate ≥ 3 mL/s (OR=6.073, 95% CI: 4.349-8.481) were independent risk factors for CM extravasation. Due to peripheral vascular protection measures in patients with malignant tumor, there was a low incidence of CM extravasation (OR=0.394, 95% CI: 0.272-0.570). CONCLUSION: Main risk factors for CM extravasation are female, diabetes, venous thrombosis, multi-site angiography, and injection rate ≥ 3 mL/s. However, patients with malignant tumor have a low incidence of CM extravasation. CLINICAL IMPACT: Analysis of these risk factors can help reduce the incidence of CM extravasation.

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Occasionally, the administration of intravenous (IV) therapies can go wrong. Infiltration or extravasation is a complication when a drug or IV therapy leaks into the tissues surrounding the vascular access device. Extravasation can cause serious and often life-changing injuries. Extravasation is often associated with systemic anti-cancer therapy but non-chemotherapy drugs have been reported as having a greater risk of serious complications. This study outlines the first UK Infusion unit evaluation of the ivWatch infusion monitoring device which was undertaken from August 2023 to January 2024. Out of 2254 infusions monitored with ivWatch, the device prevented 122 cases of infiltration and extravasation from causing any harm to the patient, corresponding to a 5.4% 'check IV' notification rate.

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Infiltration and extravasation injuries are a common complication of intravenous therapy and vascular access practice. However, there remains a lack of awareness and understanding surrounding these injuries. The first of two articles (Barton, 2024) reported on data from a study showing that the use of ivWatch infusion site surveillance technology can dramatically reduce the number of infiltration and extravasation injures with peripheral intravenous infusions of vesicant preparations, which can improve patient safety and have a positive financial impact. This second of two articles on infiltration and extravasation examines the financial and academic burdens.

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NEED FOR A REVIEW: Guidelines for management and prevention of contrast media extravasation have not been updated recently. In view of emerging research and changing working practices, this review aims to inform update on the current guidelines. AREAS COVERED: In this paper, we review the literature pertaining to the pathophysiology, diagnosis, risk factors and treatments of contrast media extravasation. A suggested protocol and guidelines are recommended based upon the available literature. KEY POINTS: • Risk of extravasation is dependent on scanning technique and patient risk factors. • Diagnosis is mostly clinical, and outcomes are mostly favourable. • Referral to surgery should be based on clinical severity rather than extravasated volume.

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INTRODUCTION: Extravasation injuries are one of the most feared complications of intravenous drug administration. The most common drugs associated with extravasation injury include chemotherapy agents and contrast media. Natural course of vesicant extravasation is discomfort, pain, swelling, inflammation, and ultimately skin ulceration. While diligence is the principle approach in prevention, immediate bed-side measures are as important in controlling the extent of tissue damage. Various options, either medical or interventional are next steps in treatment of the condition including antidotes, volume dilution, flushing, suction, hyperbaric oxygen therapy, and surgery. MATERIALS AND METHODS: 12 male Wistar albino rats were divided into two groups; one group received fat injections following subdermal doxorubicin infiltration in their right thighs, while other group received saline injection following subdermal doxorubicin infiltration in their right thighs for dilution. Left thighs of both groups were left untreated following subdermal doxorubicin infiltration. Total area of necrosis, as well as resultant epidermal thicknesses were assessed. Histological analyses were conducted using modified Verhofstad scoring system for comparison. RESULTS: Mean necrotic area was significantly smaller in the fat injection group compared to other groups. Median Verhofstad score was lesser in the fat injection group as well. Median epidermal thickness, on the other hand, was greater in the fat injection group. CONCLUSION: Injection of fat grafts following vesicant extravasation might be beneficial in preventing the progression of tissue damage, if employed early.

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BACKGROUNDS: Extravasation (paravasation) of chemotherapy drugs is a very significant complication. Preventive and therapeutic interventions reduce the risk of the complication or the extent of its consequences. A working group of authors from expert groups prepared recommendations for standard care. PURPOSE: A basic summary of recommended interventions for daily practice, defined on the basis of knowledge from long-term, proven, evidence-based practice or on the consensus opinions of the expert groups representatives. RESULTS: Preventive measures are essential and include early consideration of long-term venous access devices indications, choice of injection site, venous line control before each chemotherapy drug application, and patient education. The intervention in case of extravasation mainly involves the application of antidotes (DMSO, hyaluronidase, dexrazoxane) and the application of dry cold or heat according to the type of cytostatic drug. Subcutaneous corticosteroids, moist heat or cooling and compression are not recommended. CONCLUSION: The recommended procedures contribute to reducing the risk and consequences of extravasation. The range of recommended interventions can be expanded individually depending on individual clinical site policy and needs.

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INTRODUCTION: Adverse events (AE) in care are recognized as a leading cause of mortality and injury in patients. Improving patients' safety is difficult to achieve. Therefore, innovative research strategies are needed to identify errors in subgroups of patients and related severity of outcomes as well as reliably measured efficiency of reproducible strategies to improve safety. This trial aims to evaluate the impact of a combined multiprofessional education program on the rate of AE in neonatal intensive care units (NICUs). METHODS AND ANALYSIS: This is a stepped-wedge cluster randomised controlled trial with 3 clusters each containing 4 units. The study time period will be 20 months. The education program will be implemented within each cluster following a random sequence with a control period, a 4-month transition period and a post-educational intervention period. Eligibility criteria: for clusters: 6 NICUs from Ile-de-France and 6 NICUs from different regions in France; for patients: in-hospital during the study period (November 23, 2015 and November 2, 2017 [inclusion start dates varying by unit]) in one of the 12 NICUs; corrected gestational age ≤42 weeks upon admission; hospitalization period >2 days; and parents informed and not opposed to the use of their newborn's data. A routine occurrence reporting of medical errors and their consequence will take place during the entire study period. The intervention will combine an education to implement a standardized root cause analysis method, creation of bundles (insertion, daily goals, maintenance bundles) to prevent catheter-associated blood-stream infection and a poster to prevent extravasation injuries. OUTCOME: We hypothesize a reduction from 60 (control) to 50 (intervention) AE/1000 patient-days. The primary outcome will be the rate of AE/1000 patient-days in the NICU. TRIAL REGISTRATION NUMBER: NCT02598609, trial registered November 6, 2015. https://clinicaltrials.gov/ct2/show/NCT02598609. ETHICS AND DISSEMINATION: Study approved by the regional ethic committee CPP Ile-de-France III (no 2014-A01751-46). The results will be published in peer-reviewed journals.

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PURPOSE: To implement a safe and effective intravenous iron infusion protocol to prevent skin staining. DESIGN/METHODOLOGY/APPROACH: Mixed methods approach was utilised including education, auditing, self-reported survey, patient information leaflet and patient feedback. In total 25 healthcare professionals completed the survey and 15 patients provided feedback. FINDINGS: No skin staining or severe adverse reactions were observed over eight weeks. Audit results found 53 per cent of staff were compliant with the recommended IV iron infusion protocol and 46 per cent informed patients of skin staining risk. Self-report surveys indicated 92 per cent flushed the cannula with sodium chloride before starting the infusion, 88 per cent flushed the cannula after the infusion and 76 per cent informed patients of skin staining risk. Patient feedback was largely positive and constructive. RESEARCH LIMITATIONS: Limitations include self-reported bias, short audit time interval, missing data and discrepancy between audit and survey results. ORIGINALITY/VALUE: This quality improvement project was developed following two skin staining incidences at our maternity hospital. Although rare, skin staining after intravenous iron infusion is potentially permanent and may be distressing for some patients. Intravenous iron is considered safe and effective to treat anaemia during pregnancy and is often prescribed for this patient cohort. To avoid medicolegal action and patient dissatisfaction, it is essential that patients are informed of potential skin staining and an evidence-based administration protocol is utilised.

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RESUMEN Introducción: La extravasación endovenosa de citostáticos es una grave complicación del tratamiento en el paciente con cáncer, que puede provocar graves daños tisulares. Objetivo: Sistematizar las medidas de prevención y tratamiento a tomar por los profesionales de enfermería en la extravasación de quimioterapia intravenosa. Métodos: Revisión bibliográfica sistemática con análisis de contenido de documentos originales y de revisión publicados en español e inglés desde 2009 a 2016, con las siguientes palabras clave: "extravasación", "quimioterapia", "medidas de prevención", "tratamiento de extravasación" en SciELO. Se identificaron y revisaron artículos que fueron útiles para el desarrollo de la revisión, así como monografías de varias revistas y tesis doctorales actualizadas que permitieron el análisis histórico lógico de los criterios que sustentan medidas de prevención y tratamiento en la extravasación de quimioterapia intravenosa. Conclusiones: La prevención de esta complicación ha demostrado ser la mejor medida para evitar el daño a los tejidos, sin embrago existen tratamientos alternativos que el personal de enfermería debe conocer y aplicar con rapidez y eficiencia(AU)

ABSTRACT Introduction: Intravenous cytostatic extravasation is a serious complication of treatment in cancer patients, which can cause serious tissue damage. Objective: To systematize the prevention and treatment measures to be taken by nursing professionals in case of extravasation of intravenous chemotherapy. Methods: Systematic bibliographic review with content analysis of original and review documents published in Spanish and English in SciELO from 2009 to 2016, with the following keywords: extravasación [extravasation], quimioterapia [chemotherapy], medidas de prevención[prevention measures], tratamiento de extravasación[treatment of extravasation]. Articles that were useful for the development of the review were identified and consulted, as well as monographs of several updated journals and doctoral theses, which allowed the logical-historical analysis of the criteria that support prevention and treatment measures in the extravasation of intravenous chemotherapy. Conclusions: The prevention of this complication has proven to be the best measure to avoid tissue damage; however, there are alternative treatments that nurses should know and apply quickly and efficiently(AU)

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Although the risk of extravasation of a chemotherapy (anticancer) medication is low, the complications associated with these events can have a significant impact on morbidity and health care costs. Institutions that administer anticancer agents should ideally have a current guideline on the proper management of the inadvertent administration of these toxic medications into tissues surrounding blood vessels. It is imperative that the health care team involved in administering drugs used to treat cancer be educated on the risk factors, preventative strategies and treatment of anticancer extravasations, as well as practice safe and proper administration techniques. Anticancer agents are generally divided into classes based on their ability to cause tissue damage. The review of current published guidelines and available literature reveals a lack of consensus on how these medications should be classified. In addition, many recently approved drugs for the treatment of cancer may lack data to support their classification and management of extravasation events. The treatment of the majority of extravasations of anticancer agents involves nonpharmacological measures, potentially in the ambulatory care setting. Antidotes are available for the extravasation of a minority of vesicant agents in order to mitigate tissue damage. Due to the limited data and lack of consensus in published guidelines, a working group was established to put forth an institutional guideline on the management of anticancer extravasations.

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Objetivo: Investigar a atuação dos enfermeiros no extravasamento de quimioterápicos antineoplásicos. Métodos: Estudo transversal, com abordagem quantitativa, realizado em um hospital de referência em oncologia, com uma amostra de 21 enfermeiros. Os dados foram coletados por meio da aplicação de questionário semiestruturado, nos meses de outubro e novembro de 2015, analisados por meio da frequência simples e percentual. Resultados: Os enfermeiros evidenciaram conhecimento suficiente quanto aos fatores de risco, prevenção e reconhecimento de sinais e sintomas da ocorrência de extravasamento por quimioterápicos. No entanto, o mesmo não foi verificado quanto às questões relacionadas a: classificação das drogas antineoplásicas e intervenções voltadas à ocorrência do agravo. Conclusão: Os resultados encontrados são importantes, vez que apontam para questões que devem ser refletidas por gestores hospitalares e de instituições formadoras, assim como profissionais preocupados com a melhoria da assistência à população acometida por essa patologia.

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Extravasation is the leakage of a drug (intended primarily for intravenous administration) into tissues surrounding the vascular system. The damage to surrounding varies depending on the nature and volume of extravasation. Cytostatic extravasation is associated with poor outcomes for patients. This paper summarizes the types of risk associated with cytostatic extravasation, and the preventative measures that can be used when such an event occurs. We also provide information on potential treatments. However, justification for their use has only been substantiated in papers with different levels of significance and these papers are not available in all countries. We summarize current international recommendations for actions to be taken in the event of extravasation.

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Medial penetration of the helical blade into the hip joint after fixation of trochanteric fractures using the proximal femur nail antirotation (PFN-A) is a potential failure mode. In low demand patients a blade exchange with cement augmentation may be an option if conversion to total hip arthroplasty is unfeasible to salvage the cut-through. This article describes a technique to avoid intraarticular cement leakage using a cement plug to close the defect in the femoral head caused by the cut-through.

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This article provides a comprehensive overview of the risks associated with the administration of chemotherapy, monoclonal antibodies and targeted or biological therapies in the management of solid tumours. The main physiological actions of these agents are discussed, with reference to the immediate infusion-related side effects and complications that may arise from an extravasation injury. The article focuses on the identification and early recognition of these risk factors to implement preventive measures and appropriate management strategies.