Prevention, treatment & follow-up of extravasation with SACT

2.1 West of Scotland Cancer Network SACT Extravasation in Practice Policy, Guidance and Tools June 2015 [Intranet link]
2.2 Vascular Access Device Procedure & Practice Guideline 2019
2.3 Policy and Guidelines for the Safe Prescribing, Dispensing and Administration of Systemic Anti-Cancer Therapy (SACT) For Children, Teenagers and Young Adults Under The Care of the Haematology/Oncology Team RHC, Glasgow (Schiehallion Ward and Schiehallion Daycare Unit) (RHC-HAEM-ONC-014)

3.1 ALL medical, nursing and pharmacy staff involved in the care of the child receiving SACT

3.2 Nursing induction and orientation competency

3.3 Medical Induction

3.4 Extravasation training session

4.1   Extravasation kit and extravasation policy folder (located in treatment areas)

• Report Form
• Audit Form
• Patient information Leaflets
• DMSO Patient Information Leaflet
• Letter For Primary Healthcare Professional
• Classification Of Drugs (see most up to date version on WOSCAN website)

4.2   Hot/cold pack

4.3   Gloves

4.4   Visor

4.5   Armlets

4.6   Apron

NB:   The nursing staff will obtain the extravasation kit and extravasation policy folder when SACT extravasation is suspected, however, it is the responsibility of the medical staff to ensure that all documentation is accurately completed and forwarded/filed as appropriate.

An appropriate system should be in place within each area to ensure these kits are within their expiry date.  Replacement drugs should be ordered from Pharmacy well in advance of expiry dates.  It is the responsibility of the nursing staff to check expiry date on the extravasation kit monthly

The expiry date of all stock drugs required in the event of an extravasation must be checked regularly. Replacement stock should be ordered from pharmacy services one month prior to the drug expiry date.

Prevention

• The patency of any peripheral or central access device must be verified prior to administration of any SACT.
• The site should be observed throughout the administration of bolus SACT and continually monitored during an intravenous infusion and checked and recorded hourly on the fluid balance chart.
• Whenever possible vesicant drugs should be administered before other drugs
• The patient/parent and/or carer should be asked to report any sensation of burning or pain at the site of drug administration
• The risk of extravasation should be explained to the patient/parent and/or carer and what action should be taken if extravasation is suspected.

Action

IF AN EXTRAVASATION IS SUSPECTED THE INFUSION should be stopped AND MEDICAL STAFF contacted IMMEDIATELY. ALL POTENTIAL EXTRAVASATIONS SHOULD BE TREATED AS A MEDICAL EMERGENCY. 

STAFF SHOULD FOLLOW THE EXTRAVASATION FLOWCHART FOR GUIDANCE (POSTER DISPLAYED IN ALL SACT ADMINISTRATION AREAS – see Appendix 1).

• The extravasation kit and extravasation policy folder (located in treatment areas) should be collected from:
  • Schiehallion Ward treatment room / clean utility room
  • Schiehallion DCU clean utility room
  • Ward 1B (Outpatient Dept) treatment room clinic 1

• The flowchart in the WOSCAN extravasation folder should be followed for the specific drug being administered (you must refer to the latest list on the WOSCAN website via the “WOSCAN SACT Extravasation in Practice” interactive pdf document - see section 8 below for weblink).
• The extravasation report form should be completed and filed in patient’s case records
• The extravasation audit form should be completed and filed in the folder
• The patient information leaflet should be completed and given to the patient
• The letter to primary healthcare professional should be completed. A copy of this should be kept in the patient’s case records
• A DATIX form should be completed.
• The DMSO patient information leaflet should be given to the patient if DMSO is administered

Follow-up

Patient follow up should be arranged on discharge ie out-patient clinic or Schiehallion Day Care Unit.  The patient’s progress should be closely monitored to allow further appropriate action to be taken if necessary.  Observation and documentation of the injury should be on a daily basis initially and only extended when clinically indicated to a minimum weekly follow up on a planned basis.

All patients must have a six week review of the extravasation site (even if the site appears to have improved).

This SOP will be reviewed every two years

None.