Management of Extravasation of Cytotoxic Drugs in Children

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Appendix 4 : Guidelines for Best Practice When Administering Intravenous Infusions Preventing Extravasation in Infants and Children . Guidelines for best practice. Assess the Risk Check the Site •Extravasation injures are more common and severe in Children and Neonates. •Infants may not be able to localise or report pain. •Confused and sedated patients are more at risk. •Does the patient have reduced sensation I.e. peripheral neuropathy. •Repeated intravenous infusions and injections increases the risk. I.e. Ex premature babies who have had repeat cannulations. •Cover cannula site with designated transparent IV dressing. •Select age appropriate dressing. Splint / Tubigrip / Bandage. Do not apply too tightly. •Ensure insertion site can be easily observed. •Check site hourly whilst infusion is running for: •Redness, Swelling, Leaking, Tracking, Loss of colour to limb, Pain at site, Stinging, Absent or sluggish blood return. •Verify patency of the site prior to the infusion and hourly throughout. If there are any doubts STOP and INVESTIGATE. Resite the cannula if the patency of the cannulation is still not entirely satisfactory. NOTE: If extravasation suspected cannula should remain in situe follow extravasation policy •Record location, condition of the site, verification of patency and patient responses. Report if necessary. •Parents should be asked if there are any new signs of irritability in their child during infusion. Check the Device •Check the device hourly and record: Prescribed rate, actual hourly rate, total volume infused, pressure and alarm limits. •Check clamps, giving set and attachment to cannula are secure and correctly loaded into the device. •Always check the site as well as the pump pressures. This should be done hourly. High pump pressures alone are not a reliable indication of extravasation. Management of Extravasation of Cytotoxic Drugs in Children Ratified: Review: •Pump pressures should be set at minimum. Any changes should be documented and rational given. •Sign/Initial fluid chart to demonstrate checks carried out. 18
Appendix 5: Patient Information Sheet UWhat is Extravasation Extravasation is the leakage (or accidental infiltration) of drugs outside of the vein and into the surrounding tissues. With some drugs, this may lead to an immediate painful reaction, and result in local tissue damage. You may have noticed pain; stinging, swelling or other changes to the skin at the site of drug administration, or the nurse may have noticed that the drug was not flowing in easily. UWhy did this happen Extrava sation is a rare but known complication of intravenous chemotherapy. It is impossible to prevent this even though we take all possible precautions. The important thing is that it has been detected and treated. UWhy is extravasation a problem It can potentially lead to pain, stiffness and tissue damage. UWhat treatment have I received to prevent tissue damage The nurse has given you the recommended treatment for the extravasation that you have experienced. You will have been instructed to apply either a cold or warm pack to the area for 20 minutes, four times a day for two days. It is also advised to keep your arm elevated as much as possible. Although this will help to minimise the chance of developing further problems, you will need to keep checking the area every day. UChecking the area Once a day, check the area for the following: • Has the area changed colour or increased in redness • Is the area blistering, peeling or flaking • Is the area more uncomfortable • Is the pain making it difficult for you to exercise the arm or hand What else do I need to do • Gently exercise the affected arm or hand. • Take mild painkillers if required. • Do not apply any other lotions, creams or ointments unless you have been instructed to do so by a doctor or nurse. • Do not expose the area to strong sunlight. • Avoid wearing tight clothing around the affected area. • Protect the affected area when bathing (or having a shower) so that it does not get wet. When should I contact you If you answered YES to any of the questions in the checklist above, or if you have any other concerns, then you should contact Sennen ward (01872 252069) Management of Extravasation of Cytotoxic Drugs in Children Ratified: Review: 19
Page 1 and 2: Document Title Management of Extrav
Page 3 and 4: Management of Extravasation of Cyto
Page 5 and 6: Table of Contents 1. Purpose and Sc
Page 7 and 8: 3. Ownership and Responsibilities 3
Page 9 and 10: 7. Treatment of Peripheral Line Ext
Page 11 and 12: DMSO (Dimethyl Sulphoxide): DMSO is
Page 13 and 14: 9. Mixed Extravasations In the even
Page 15 and 16: Appendix 1: Drugs commonly used in
Page 17: Appendix 3 : Extravasation Kit Cont
Page 21 and 22: Appendix 7.Initial Equality Impact

Management of Extravasation of Cytotoxic Drugs in Children

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