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Introduction: To provide long-term vascular access in clinical oncology peripheral forearm veins (up to 95% of patients in Ukraine), central venous access and "complete implanted vascular systems" are used most often. Many oncology patients have contraindications to catheterization of superior vena cava. Besides, exploitation of central veins is associated with potential technical and infectious complications. The aim - to study short-term and long-term results of arteriovenous fistula exploitation as vascular access for continuous anticancer therapy., Materials and Methods: Peripheral venous bed status in 41 oncology patients taking long-term chemotherapy treatment is analyzed in the article. Doppler sonography, morphologic and immune histochemical analyses were used in the study., Results: Doppler sonography found qualitative and quantitative changes in forearm veins at different time periods after initiation of chemotherapy in the majority of patients. The major morphologic manifestations of venous wall damage were chemical phlebitis, local or extended hardening of venous wall, venous thrombosis and extravasations with necrosis and subsequent paravasal tissue sclerosis. Alternative vascular access created in 12 patients completely met the adequacy criteria (safety, multiple use, longevity, realization of the designed therapy program). The conclusion was made about inapplicability of forearm veins for long-term administration of cytostatic agents. If it is impossible to use central veins, arteriovenous fistula can become an alternative vascular access.

The success of an effective drug delivery system using liposomes for solid tumor targeting based on EPR effects is highly dependent on both size ranging from 100-200 nm in diameter and prolonged circulation half-life in the blood. A major development was the synthesis of PEG-liposomes with a prolonged circulation time in the blood. Active targeting of immunoliposomes to the solid tumor tissue can be achieved by the Fab' fragment which is better than whole IgG in terms of designing PEG-immunoliposomes with prolonged circulation. For intracellular targeting delivery to solid tumors based on EPR effects, transferrin-PEG-liposomes can stay in blood circulation for a long time and extravasate into the extravascular of tumor tissue by the EPR effect as PEG-liposomes. The extravasated transferrin-PEG-liposomes can maintain anti cancer drugs in interstitial space for a longer period, and deliver them into the cytoplasm of tumor cells via transferrin receptor-mediated endocytosis. Transferrin-PEG-liposomes improve the safety and efficacy of anti cancer drug by both passive targeting by prolonged circulation and active targeting by transferrin., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Oxaliplatin has been classified as an irritant drug. Less than 10 cases of oxaliplatin extravasation through a central venous access have been described to date. We present a case of extravasation through a central venous access, of the highest dose (165 mg) of oxaliplatin reported to date. We confirmed the irritant effect, and full recovery from toxicity was achieved. We describe the treatment administered and offer a review of literature.

Doxorubicin, vincristine, and vinblastine are chemotherapeutic drugs commonly used in the treatment of cancer in pets. It takes technical skill to administer these drugs, because they are caustic sclerotics. If doxorubicin is extravasated into the perivascular tissues, the results may be devastating. The attending nurse and clinician must act vigorously to immediately remove every drop of the drug spilled into the tissues. Unfortunately, little has been written on how to effectively do that, but this paper describes an aggressive technique that can be used to combat such a spill.

The extravasation of cytostatic agents is a known, serious situation that can easily occur and cause chronic, irreversible damage. The incidence of extravasation ranges from 0.1 %-6.5 %, according to different studies. Many cases of extravasation can be prevented by systematizing the administration techniques for cytostatic agents. We present the clinical and histological characteristics of a series of patients with extravasation lesions. Included in the study were all patients treated with chemotherapy who developed localized lesions in the area of the cytostatic injection after extravasation was detected during administration. The patients were studied and followed up for a three-year period, from January 2000 to December 2003, inclusive. We found nine cases of extravasation among the 2,186 patients who were treated with chemotherapy, which represents an incidence of 0.41 %, and 3.4 % of all chemotherapy-induced skin lesions. The cytostatic agent most often involved was vinorelbine, and the most frequent location was the antecubital fossa. The intensity of the lesions made it necessary to delay the next cycle of treatment in 55 % of the cases. The histological findings varied depending on when the biopsy was done, showing panniculitis with low cellularity together with epidermal lesions attributable to direct cytotoxicity. The best treatment for extravasation is prevention, but when it has already occurred, measures vary depending on the cytostatic drug extravasated and the intensity of the lesions. Conservative measures are advisable before surgery.

Extravasation of a chemotherapeutic agent is one of the most frequent complications in cancer patients. Full-thickness skin necrosis often occurs after extravasation. Alternative approaches to treatment are local wound care, elevation, and hypothermia. It was shown that heparin prevents skin necrosis. In this experimental study, the effects of heparin fractions on the prevention of skin necrosis were compared by applying an extravasation model of Adriamycin in rats. Forty Sprague-Dawley male rats weighing 250 to 300 g were used. A total of 0.3 ml doxorubicin hydrochloride was administered subcutaneously to all rats. Ten minutes later, in the control group (group I), 1 ml normal saline was administered subcutaneously. In the first experimental group (group II), 100 U per day heparin sodium was administered in a volume of 1 ml subcutaneously. In the second experimental group (group III), nadroparin calcium (5 anti-Xa U per kilogram per day) was administered. In the third and last experimental group (group IV), dalteparin sodium (5 anti-Xa U per kilogram per day) was administered. All drugs were administered for 2 weeks. Necrotic areas were measured 4 weeks later. Statistical analysis was performed using the Kruskal-Wallis analysis of variance and the Mann-Whitney test. Heparin fractions caused a decreased ulcer rate and size than controls ( < 0.05). There was no superiority among heparin fractions. The authors think that low-molecular weight heparins are preferred, considering the higher risk of bleeding with unfractionated heparin.

Extravasation injuries in subcutaneous tissues during peripheral intravenous administration can result in extensive soft-tissue defects. Early treatment (surgical removal of the extravasated material within 24 h) and late treatment (debridement and coverage) are two possible approaches for this kind of injury. Eighteen patients who suffered a significant extravasation injury were treated surgically between 1/1996 and 5/2001. All patients were referred late (mean 22 days after the event) to our clinic with soft-tissue defects or skin necrosis and were accordingly only amenable to late treatment. The patients with defects over the dorsum of the hand, forearm or cubital fossa area underwent debridement, temporary wound coverage and skin grafting or coverage with a local flap. Spotted infiltrating lesions and necrosis are typical histologic features of a cytotoxic agent extravasation. A safe margin of resection is only achievable with a wide three dimensional excision. The healing time of defects was a mean of 15 days after either skin grafting or flap coverage with no significant difference between the two differing treatment groups. Early referral of patients with extravasation injuries to a specialized department for plastic and hand surgery may in future enable earlier surgical treatment, reduce time of illness and costs.

Purpose/objectives: To describe the four primary causes of extravasation from implanted ports., Data Sources: Journal articles, textbooks, medical records, depositions, serial photographs, and the authors' personal experiences., Data Synthesis: Extravasation from ports can occur by four major mechanisms: incomplete needle placement and needle dislodgment, thrombus or fibrin sheath formation, perforation of the superior vena cava, and catheter fracture. The degree of tissue injury can vary but may be severe enough to require that a simple mastectomy be performed to manage chest wall necrosis., Conclusions: Extravasation is a known risk of chemotherapy administration via implanted ports. Vesicants should be administered only after a blood return has been obtained and the needle inserted into the port septum has been adequately secured., Implications for Nursing Practice: Extravasation of vesicant drugs from ports can cause tissue necrosis and may prompt litigation. Risk-management strategies include careful assessment and use of ports, comprehensive patient teaching about the risk of extravasation and measures to decrease the likelihood of needle dislodgment, and development of extravasation-management policies that address port extravasations.

Rationale and Objectives: In percutaneous ethanol injection therapy, uncontrolled spread of ethanol sometimes causes complications. This study tested the accuracy of ultrasonography in showing the spread of ethanol during injection in normal postmortem pig livers., Methods: Methylene blue-stained 96% (vol) ethanol (0.5-2 ml) was injected into pig livers under sonographic control. The volumes of the sonographically determined areas infiltrated by the injections and the corresponding pale lesions seen after dissecting the livers were measured and compared. The locations of the stained areas were determined., Results: Uncontrolled spread of ethanol was often seen sonographically as hyperechoic lines spreading centrifugally from the injection site. After dissection, nearly all vessels and ducts were stained blue, indicating a major escape of ethanol from the injection sites. The volumes of the sonographically determined injection areas were significantly larger (P < 0.001) than the lesions found after dissection., Conclusions: Ultrasonography may overestimate the spread of ethanol, making the survival of peripheral tumor cells possible.

One of the local complications of certain chemotherapeutic agents is tissue necrosis resulting from extravasation. The purpose of this study was to evaluate the effectiveness of a conservative approach to treatment in order to minimize necrosis and the need for reconstructive surgery. Fifty-three patients entered this study. Twenty-one had old lesions while 32 had recent extravasations. Drugs responsible for the extravasations were doxorubicin, epirubicin, vinblastine, mitoxantrone, and mitomycin C. The basis of treatment was betamethasone ointment, which was applied to the lesion with a tight elastic bandage and was replaced every 12 hours for the first 2 days and then every 24 hours until complete healing. For old lesions a keratolytic ointment was initially applied, whereas in the new lesions multiple subcutaneous injections with hydrocortisone solution preceded the application of betamethasone ointment. None of our patients developed tissue necrosis and sloughing that necessitated surgery. All lesions healed in patients. Healing time varied with the different drugs used and was proportional to the extension of extravasation and to the time when therapy was begun. We conclude that the application of conservative measures in extravasated areas from chemotherapy may avoid tissue necrosis and reconstructive surgery.

Extravasation of vesicant agents into the soft tissues can lead to painful and indolent ulcerations. Precautions for avoiding extravasation include the use of fresh intravenous lines. The line should be placed in the forearm whenever possible. Hand veins, joint surfaces and extremities with impaired circulation should be avoided as infusion sites. If evidence of extravasation appears, the infusion must be stopped immediately and appropriate measures initiated.