de Wit Maike, Ortner Petra, Lipp Hans-Peter, Sehouli Jalid, Untch Michael, Ruhnke Markus, Mayer-Steinacker Regine, Bokemeyer Carsten, Jordan Karin
Klinik für Innere Medizin - Hämatologie und Onkologie, Vivantes Klinikum Neukölln, Berlin, Germany.
Onkologie. 2013;36(3):127-35. doi: 10.1159/000348524. Epub 2013 Feb 25.
Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel.
A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined.
Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended.
We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.
细胞毒性药物外渗是肿瘤学中静脉给药罕见但可能严重且疼痛的并发症。相关文献多为个案报道，系统的临床试验较少。德国癌症支持治疗工作组（ASORS）基于跨学科专家小组制定了关于细胞毒性药物外渗诊断、预防和管理的专家意见。
由各自负责的专家对PubMed进行检索，查找外渗的诊断、危险因素、症状、预防和治疗方法。一个撰写委员会编写了手稿并提出推荐级别。在一次共识会议上，13位专家对细胞毒性药物外渗诊断和管理的当前实践进行了审查和讨论。在专家之间的电话投票中，确定了ASORS的推荐级别。
应尽一切努力降低外渗风险。已确定员工培训、患者教育、正确材料的使用和输液技术对于将外渗风险降至最低至关重要。外渗必须尽快诊断，并应立即开始包括根据外渗药物使用解毒剂在内的特定治疗。无论何处应用静脉细胞毒性药物，都应配备外渗急救箱。建议进行记录和治疗后随访。
我们制定了一项基于文献和专家的共识性建议，以避免细胞毒性药物外渗。它还提供了实用的管理指导，有助于避免手术和严重的晚期效应。
