Chemotherapy extravasation: a consequence of fibrin sheath formation around venous access devices.
OBJECTIVE
To describe, using two case studies, chemotherapy drug extravasation as a consequence of fibrin sheath formation.


METHODS
Journal articles, textbooks, medical records, and personal experiences.


RESULTS
Fibrin sheath formation around venous access devices (VADs) frequently leads to persistent withdrawal occlusion (PWO). While PWO often is easily managed with small doses of thrombolytic therapy (e.g., urokinase), it may result in a more serious complication, such as chemotherapy extravasation.


CONCLUSIONS
Chemotherapy should not be administered through a VAD unless a free-flowing blood return can be demonstrated.


CONCLUSIONS
Careful nursing assessment of all VADs is important to identify complications such as fibrin sheath formation. To rule out fibrin sheath formation, nurses must obtain catheter dye studies when fibrinolytic therapy fails to restore catheter function.
Mayo
D J
DJ
Critical Care/Heart, Lung and Blood and Cancer Nursing Service, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Pearson
D C
DC
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000451:nursing; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology* / Q000451:nursing / Q000628:therapy; D005260:Female; D005337:Fibrin / Q000096:biosynthesis*; D006801:Humans; D007262:Infusions, Intravenous; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D000970:Antineoplastic Agents; D005337:Fibrin; D014568:Urokinase-Type Plasminogen Activator