Managing chemotherapy extravasation in totally implantable central venous access: Use of subcutaneous wash-out technique

Background: Totally implanted venous access is widely used in chemotherapy administration. With over 1 million intravenous chemotherapy infusions given worldwide each day, complications are frequent. Accidental cases of extravasation in the presence of a catheter are rare yet very serious and may require discontinuation of chemotherapy. The aim of this study was to evaluate the feasibility and efficacy of the subcutaneous wash-out technique for chemotherapy extravasation treatment. Methods: We retrospectively reviewed the medical charts of patients who had received chemotherapy and sustained extravasation in our hospital between October 2013 and October 2016. Subcutaneous wash-out treatments were carried out exclusively, without the application of antidotes or the use of specific antidotes. Results: We documented seven cases of chemotherapy extravasation. Two cases were treated with antidotes and suffered necrosis in the following weeks. The five patients treated using subcutaneous wash-out had no necrosis and had a steady decrease in the inflammatory reaction of the cutaneous and subcutaneous soft tissues. For these five patients, chemotherapy was restarted within 1 month following extravasation. Conclusion: This study would argue for the feasibility and effectiveness of subcutaneous wash-out in the treatment of chemotherapy extravasations.

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OHP-018 Cost-Minimization Study Associated with Two Strategies of Intravenous Chemotherapy: Peripherally Inserted Central Catheters Versus Subcutaneous Central Venous Access Ports: Abstract OHP-018 Table 1

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2013-000276.392 ◽

2013 ◽

Vol 20 (Suppl 1) ◽

pp. A142.1-A142

Author(s):

A Nianzou ◽

J Mayer ◽

L Bauduin ◽

C Chapirot ◽

I Borget ◽

...

Keyword(s):

Cost Minimization ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Intravenous Chemotherapy ◽

Peripherally Inserted Central Catheters ◽

Central Catheters

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The role of implantable central venous access devices (CVAD) in the administration of intravenous chemotherapy to patients with gynecologic malignancies

Gynecologic Oncology ◽

10.1016/0090-8258(89)90873-1 ◽

1989 ◽

Vol 32 (1) ◽

pp. 98

Author(s):

E.S. Donaldson ◽

R.V. Higgins ◽

H.H. Gallion ◽

J.R. van Nagell

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Gynecologic Malignancies ◽

Central Venous ◽

Intravenous Chemotherapy ◽

Venous Access Devices

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The increased risk for thromboembolism pre-cystectomy in patients undergoing neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer is mainly due to central venous access: a multicenter evaluation

International Urology and Nephrology ◽

10.1007/s11255-019-02338-4 ◽

2019 ◽

Vol 52 (4) ◽

pp. 661-669 ◽

Cited By ~ 1

Author(s):

Kristoffer Ottosson ◽

Sofia Pelander ◽

Markus Johansson ◽

Ylva Huge ◽

Firas Aljabery ◽

...

Keyword(s):

Bladder Cancer ◽

Neoadjuvant Chemotherapy ◽

Central Venous Access ◽

Urinary Bladder Cancer ◽

Venous Access ◽

Central Venous ◽

Chemotherapy Administration ◽

Increased Risk ◽

Chi Squared ◽

Muscle Invasive

Abstract Purpose To investigate if patients receiving neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) had an increased risk of thromboembolic events (TEE) and to evaluate when these events occur on a timeline starting from 6 months pre-cystectomy, during NAC-administration and 60 months post-cystectomy. Methods Two hundred and fifty five patients undergoing radical cystectomy during 2009–2014 at three Swedish cystectomy centers (Umeå, Linköping and Sundsvall) were in-detail reviewed retrospectively, using individual medical records. One hundred and twenty nine patients were ineligible for analysis. NAC patients (n = 67) were compared to NAC-naïve NAC-eligible patients (n = 59). The occurrence of TEE was divided into different periods pre-cystectomy and post-cystectomy. Statistical analyses included Chi-squared and logistical regression tests. Results Significant associations were found between receiving NAC and acquiring a TEE during NAC therapy pre-cystectomy. All but one pre-cystectomy event was venous and all but one of the patients received NAC. 31% (14/45) of TEEs occurred pre-cystectomy. The incidence of TEEs pre-cystectomy in NAC-naive NAC-eligible patients was only 10% (2/20), whereas the incidence of TEEs in NAC patients occurred pre-cystectomy in 48% (12/25) and 11/12 incidents were detected during NAC therapy—this including 7/11 (64%) incidents affecting veins in anatomical conjunction with the placement of central venous access for chemotherapy administration. Conclusions There is a significantly increased risk for TEE pre-cystectomy during chemotherapy administration in MIBC patients receiving NAC, compared to the risk in NAC-naïve NAC-eligible MIBC patients. In 64% of the pre-RC TEEs in NAC patients, there was a clinical connection to placement of central venous access.

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Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study

PLoS ONE ◽

10.1371/journal.pone.0242727 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242727

Author(s):

Amine Souadka ◽

Hajar Essangri ◽

Imad Boualaoui ◽

Abdelilah Ghannam ◽

Amine Benkabbou ◽

...

Keyword(s):

Retrospective Study ◽

Intraoperative Complications ◽

Central Venous Access ◽

Venous Access ◽

Demographic Characteristics ◽

Success Rates ◽

Central Venous ◽

Chemotherapy Administration ◽

Significant Difference ◽

Ultrasonographic Guidance

Introduction The insertion of an implantable central venous access is performed according to a variety of approaches which allow the access to the subclavian vein, yet the supraclavicular technique has been underused and never compared to the other methods. The aim of this study was to testify on the efficacy and safety of the subclavian puncture without ultrasound guidance « Yoffa » in comparison with the classical infraclavicular approach (ICA). Material and methods This is a retrospective study with prospective data collection on patients followed at the national oncology institute for cancer, in the period extending from May 1st 2017 to August 31st 2017. All patients had a totally implantable central venous access device inserted by the same surgeon AS for chemotherapy administration and demographic characteristics, as well as procedure details were examined. The primary outcomes were the intraoperative complications, while the secondary outcomes represented immediate postoperative and mid-term complications (at 15 months of follow up). Outcomes were compared between techniques by means of non parametric tests and the Fischer test. Results Our study included 135 patients with 70 patients undergoing the subclavian technique, while 65 were subject to the infraclavicular approach. Both groups had no statistically significant demographic characteristics. The number of vein puncture attempts exceeding once, the accidental artery puncture and operative time were more significant in the ICA group; (39,6 vs 17,6 p = 0,01) (9.2% vs 0; p = 0,01) and (27± 13 vs 23± 8min, p = 0.045) respectively. There was no statistically significant difference in the immediate and midterm complication rate between the two methods 1(1,4) vs 2 (3) p = 0.5. Conclusion In case of unavailability of ultrasonographic guidance, the use of the supra-clavicular landmarks approach is linked to higher success rates and less arterial punctures, thereby proving to be a safe and reliable approach.

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