Prevention, treatment & follow-up of extravasation with SACT

Extravasation is the inappropriate or accidental filtration of SACT into the subcutaneous tissue or subdermal tissues surrounding the administration site. It can occur with other drugs but this policy only covers cytotoxic drugs.

The aim of this SOP is to provide guidance on how to access the policy, the procedure and the documentation in the event of suspected cytotoxic extravasation.

All personnel responsible for the administration of SACT must be appropriately trained.

SUSPECTED EXTRAVASATION SHOULD BE TREATED AS A MEDICAL EMERGENCY

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 2017
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 (Ward 2A/2B) (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 the WOSCAN website)

4.2 Hot/cold pack

4.3 Gloves

4.4 Visor

4.5 Armlets

4.6 Apron

NB: An appropriate system should be in place within each area to ensure these kits are within the 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 the drug expiry date.

5.1 The patency of any peripheral or central access device must be verified prior to administration of any SACT.

5.2 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.

5.3 Whenever possible vesicant drugs should be administered before other drugs

5.4 The patient/parent and/or carer should be asked to report any sensation of burning or pain at the site of drug administration

5.5 The risk of extravasation should be explained to the patient/parent and/or carer and what action should be taken if extravasastion is suspected. 

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

6.1 The extravasation kit and extravasation policy folder (located in treatment areas) should be collected from:

• Ward 4B clean utility room
• Ward 6A clean utility room
• Ward 1B (Outpatient Dept) treatment room clinic 1

6.2 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).  Appendix 1 shows a list of the most commonly used drugs, but this list is not exhaustive.

6.3 The extravasation report form should be completed and filed in patient’s case records

6.4 The extravasation audit form should be completed and filed in the folder

6.5 The patient information leaflet should be completed and given to the patient 

6.6 The letter to primary healthcare professional should be completed. A copy of this should be kept in the patient’s case records

6.7 A DATIX form should be completed.

6.8 The DMSO patient information leaflet should be given to the patient if DMSO is administered

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).