When the physiology of healthy tissue and organs is interrupted by the invasion and spread of abnormal cells throughout the body cytotoxic agents are principal options for treatment (1). Compounds that induce toxicity to the cells and inhibit cellular proliferation are termed cytotoxic. Exposure of both normal and abnormal cells to cytotoxic agents has different outcomes that range from minor adverse effects to cell death (2).
Cytotoxics are essential drugs used in health institutions for the management of a variety of cancer and noncancerous disorders. The word cytotoxic is used interchangeably with chemotherapy, antineoplastic and oncology drugs (3). Cytotoxic is a major type of systemic cancer treatment that refers to one or more anti-cancer drugs/ chemotherapeutic agents (4). Throughout the world more than one million intravenous infusions of cytotoxic is administered by nurses each day for the treatment of cancer disorders and administration of cytotoxic can result in various safety issues for nurses as well as for cancer patients (5). As a result of the direct effect on cellular division cytotoxics cause many adverse effects on the tissue besides controlling cancer cells (4).
One of the adverse effects of cytotoxic administration is extravasation, defined as accidental or unintentional outflow of cytotoxic medication from blood vessels to the nearby tissues during intravenous administration. The extravasated cytotoxic medication had a toxic effect on nerves, tendons, and joints. If immediate management doesn’t take place it has diverse consequences like local pain, skin grafting, surgical debridement, patients’ distrust, increased the length of hospital stay & medical costs and surgical removal of extremities (6).
There are several factors for the occurrence of extravasation in addition to health care provider’s issues such as lack of knowledge and training. The veins of patients who are treated with chemotherapy are fragile, mobile, and difficult to cannulate. Certain other factors like surgical removal of breast and lymph node dissection impair the flow of venous system that result for leakage and development of extravasation (6).
The symptoms of extravasation due to some cytotoxic drugs can take place immediately or lasts weeks to even months. Healing of impaired skin integrity secondary to cytotoxic extravasation is delayed in cancer patients as a result of long time reaction and extensive deep ulcers formation. Extravasations of cytotoxic drugs through the central line is rare (0.24% of 815 patients). Preparation, administration, and post-treatment follow up of cytotoxic drugs is not only the duty of nurses because clinical symptoms are different, other professional disciplines should be participated in the prevention and management of extravasation (8).
Each day extravasation happens even with the availability of effective treatment options and different preventive mechanisms are in place. Physical intervention, pharmacological intervention and surgical intervention are among treatment modalities for extravasation depending on the amount of extravasated drug, health status of patient and time of treatment is started (9).
Inspecting blood backflow, aspirating remaining drug, marking the affected area, applying cold or hot compress, administering antidote and reporting incidence are major steps in the prevention and management of cytotoxic extravasation, However nurses knowledge about prevention and management of cytotoxic extravasation is little (10).
The primary objective of cytotoxic extravasation is prevention. Study findings in the city of Recife cancer hospital on 21 nurse’s shows 85.7% of them had knowledge on how to prevent extravasation and 76.2% have correct information on signs and symptoms of extravasation. Depending on specific types of cytotoxic drugs 33.3% of them use hot and cold compress when extravasation is occurred while 66.7% does not know when to apply cold or hot compresses after extravasation according to different class of cytotoxic drug and 90.5% had knowledge on topmost factors that predispose cancer patients to extravasation while 9.5% are not knowledgeable. The finding indicates having knowledge on factors that contribute to extravasation is basic for quality improvement (21).
Cytotoxic Extravasation is a medical emergency that exposes cancer patients for serious disability, reduces quality of life (QOL) and puts nurses to the risk of unprofessional conduct claims. Nurses play a major role in providing care for cancer patients in addition to prevention and management of cytotoxic extravasation. Therefore it’s essential to assess the care providers knowledge on how to prevent and manage the adverse effects associated with cytotoxic administration (4).