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[放射性药物外渗:法国放射性药物协会(SoFRa)推荐的预防措施与管理方法]

[Extravasation of radiopharmaceuticals: preventive measures and management recommended by SoFRa (Société Française de Radiopharmacie)].

作者信息

Barré E, Nguyen M-L, Bruel D, Fournel C, Hosten B, Lao S, Vercellino L, Rizzo-Padoin N

机构信息

Unité radiopharmacie, service de pharmacie, CHU Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.

出版信息

Ann Pharm Fr. 2013 Jul;71(4):216-24. doi: 10.1016/j.pharma.2013.05.001. Epub 2013 Jun 14.

Abstract

Radiopharmaceuticals extravasation is rare but may have serious clinical issues. Because no specific recommendations are being proposed to date, the goals of our working group created within the French Society of Radiopharmacy are to determine preventive measures and to establish a pragmatic management of extravasation of these drugs. Our preventive measures are to recognize the symptoms (erythema, venous discoloration, swelling), to know the risk factors (which are related to radiopharmaceutical, patient, site of injection, injection technique) and severity (from erythema to skin necrosis, depending on the radionuclide) and how to avoid them (training and awareness of staff, choice of injection site, route of drug administration test, use of a catheter for administration of therapeutic radiopharmaceuticals). Management should be immediate. It can be facilitated by a specific emergency kit. General measures recommended are the immediate cessation of injection, aspiration of fluid extravasation, delimitation of the extravasated area with an indelible pen, informing the doctor. Specific measures taking into account the radiotoxicity of the radionuclide and the type of radiopharmaceutical were also established. The patient should be informed by the doctor about the risks and how to take care of. Traceability of the incident must be ensured. A multidisciplinary reflexion is essential to manage the extravasation as early and effectively as possible.

摘要

放射性药物外渗很少见,但可能会引发严重的临床问题。由于目前尚未提出具体建议,我们在法国放射性药物学会内部成立的工作组的目标是确定预防措施,并建立对这些药物外渗的务实管理方法。我们的预防措施包括识别症状(红斑、静脉变色、肿胀),了解风险因素(与放射性药物、患者、注射部位、注射技术有关)和严重程度(从红斑到皮肤坏死,取决于放射性核素)以及如何避免这些情况(对工作人员进行培训和提高认识、选择注射部位、进行给药途径测试、使用导管给药治疗性放射性药物)。管理应立即进行。使用特定的急救箱有助于管理。建议的一般措施包括立即停止注射、抽吸外渗液体、用不可擦除的笔划定外渗区域、通知医生。还制定了考虑到放射性核素的放射毒性和放射性药物类型的具体措施。医生应告知患者相关风险及如何护理。必须确保事件的可追溯性。多学科思考对于尽早且有效地处理外渗至关重要。

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