Kemoterapi Tedavi Merkezine İlaç Tedavisi İçin Gelen Hastalarda Ekstravazasyon İnsidansı ve Nedenleri

Öz

Giriş: Günümüzde ekstravazasyon hemşirelik bakımında bir yaşam kalitesi indikatörü olarak görülmekte ve sıfırlanması önerilmektedir. Ekstravazasyonun gelişimini önleyecek uygulamaları bilmek, önlemleri almak, geliştiğinde ise uygun hemşirelik yönetimini yapmak hemşirenin en önemli sorumluluklarındandır. Amaç: Gündüz tedavi merkezinde sitotoksik ilaç tedavisi alan hastalarda gelişen extravazasyon nedenlerini tanılamak ve bir yıllık extravazasyon insidansını belirlemektir. Yöntem: Kesitsel ve tanımlayıcı nitelikteki bu çalışma, bir üniversite hastanesinin gündüz tedavi merkezinde yapılmış ve çalışmaya intravenöz girişim sonrası extravazasyon gelişmiş tüm hastalar alınmıştır. Veriler, Hasta Tanıtım Formu ve Hemşirenin Extravazasyon Nedenini Tanılama Formu ile toplanmıştır.Bulgular: Kemoterapi Gündüz Tedavi Merkezi’nde Ağustos 2015- Eylül 2016 tarihleri arasında 17 extravazasyon olayı saptanmış; extravazasyon gelişme insidansı %0.22 olarak bulunmuştur. Hastaya extravaze olan ajanların tamamının vezikant tipte ilaç olduğu , %88.2’sinin hastada geç tipte reaksiyon oluşturduğu; hastalarda extravazasyona bağlı olarak tamamında kızarıklık, %35.8’inde şişlik, %23.5’inde pullanma oluştuğu görülmüştür. Hastada extravazasyon gelişimini etkileyebilecek faktörlerle; IV bölgeyi olaydan korumaya yönelik hemşirelik girişimleri arasında anlamlı ilişki bulunamamıştır(p>0.05). Sonuç: Extravazasyon gelişimini önlemek için hemşirenin risk tanılamasını dikkatli yapması ve hastayı bulgular yönünden tekrarlı olarak bilgilendirmesi önemlidir.

Anahtar Kelimeler

• Kemoterapi, Sitotoksik Ajanlar, Ekstravazasyon, Hemşirelik Girişimleri.

Incidence and Causes of Extravasation in Patients Admitted to Chemotherapy Treatment Centers for Medication Therapy

Öz

Objective: The aim of the study is to identify the causes of extravasation in patients receiving cytotoxic drug therapy in the ambulatory treatment center and to determine the incidence of extravasation in one year. Methods: This cross-sectional and descriptive study was conducted in the ambulatory treatment center of a university hospital and all the patients who experienced extravasation after an intravenous procedure were included in the study. The data were collected with the Sociodemographic Characteristics Questionnaire and the Cause of Extravasation Diagnosis Form for Nurses. Results: Seventeen extravasation cases were detected in the Outpatient Chemotherapy Treatment Center between August 2015 and September 2016. The incidence of extravasation cases was 0.22%. All of the agents which caused extravasation in the patients were vesicant type drugs. Of them, 88.2% led to late type reactions in the patient, 100% cause rashes, 35.8% caused swellings and 23.5% caused scaling at the extravasation site. Of the patients, 52.9% did not give feedback to nurses on the indications of extravasation. Conclusion: To prevent the development of extravasation, it is important for nurses to carefully carry out risk assessment and to frequently inform the patient about the results

Anahtar Kelimeler

• Chemotherapy, Cytotoxic Agants, Extravasation, Nursing İnterventions

Kaynakça

1. Boulanger, J., Ducharme, A., Dufour, A., Fortier S. & Almanric, K. (2015).Comité de l’évolution de la pratique des soins pharmaceutiques (CEPSP); Comité de l’évolution des pratiques en oncologie (CEPO). Management of the extravasation of anti-neoplastic agents. Support Care Cancer, 23(5), 1459-1471
2. Chanes, D.C., da Luz Gonçalves, P.M. & de Gutiérrez, M.G. (2012). Antineoplastic agents extravasation from peripheral intravenous line in children: a simple strategy for a safer nursing care. European Journal of Oncology Nursing, 16(1), 17-25.
3. Clifton, K.R. (2006). Wound care after peripheral intravenous extravasation: what is the evidence? Newborn Infant Nursing Review, 6(4), 202-211.
4. Corbi, D., Engelking, C., Sauerland, C. & Wickham, R. (2006). Vesicant part I: mechanisms, pathogenesis and nursing care to reduce risk. Journal of Oncology Nursing Forum, 33(6), 1134–1141.
5. Coyle, C.E., Griffie, J. & Czaplewski, L.M. (2015). Eliminating extravasation events: A multidisciplinary approach. Journal of Infusion Nursing, 38(Suppl 6,), 43-50.
6. de Wit, M., Ortner, P., Lipp, H.P., Sehouli, J., Untch, M., Ruhnke, M. et al. (2013). Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie, 36(3), 127-135.
7. Doellman, D., Hadaway, L., Bowe-Geddes, L.A., Franklin, M., LeDonne, J., Papke-O'Donnell, L. et al. (2009).
8. Infiltration and extravasation: update on prevention and management. Journal of Infusion Nursing, 332(4), 203-211.

9. Kähler, K.C., Mustroph, D. & Hauschild, A. (2009). Current recommendations for prevention and therapy of extravasation reactions in dermato-oncology. Journal of The German Society of Dermatology, 7(1), 21-8.
10. Kreidieh, F.Y., Moukadem, H.A. & El Saghir, N.S (2016). Overview, prevention and management of chemotherapy extravasation. World Journal of Clinical Oncology, 7(1), 87-97.
11. Lacey, S.R., Smith, J.B. & Dunton, N.E. (2006). Developing measures of pediatric nursing quality. Journal of Nursing Care Quality, 21(3), 210-220
12. Patel, N.P. & Fletcher, M. (2008). The national patient safety agency annual report and accounts 2007/08. Erişim: 17.7.2017. http://www.extravasation.org.uk.
13. Pearson, A., Wiechula, R., Court, A. & Lockwood, C. (2008). A re-consideration of what constitutes “evidence” in the health care professions. Nursing Science Quarterly, 20 (1), 85-88.
14. Reynolds, P.M., MacLaren, R., Mueller, S.W., Fish, D.N. & Kiser T.H. (2014). Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Pharmacotherapy, 34(6), 617-632.
15. Sakaida, E., Sekine, I., Iwasawa, S., Kurimoto, R., Uehara, T., Ooka, Y. et al. (2014). Incidence, risk factors and treatment outcomes of extravasation of cytotoxic agents in an outpatient chemotherapy clinic. Japanase Journal of Clinical Oncology, 44(2), 168-171.
16. Sauerland, C., Engelking, C., Wickham, R. & Corbi, D. (2006). Vesicant extravasation part I:mechanisms, pathogenesis and nursing care to reduce risk. Oncology Nursing Forum, 33(6), 1134-1141.
17. Schulmeister, L. (2011). Extravasation management clinical update. Seminars in Oncolog Nursing, 27(1), 82-90.
18. Steve, W. (13.02.2015). Guidelines for the management of extravasation. Erişim tarihi: 17.5.2017. www.necn.nhs.uk/.../NECN
19. Ünsal, A.E. & Aydınoğlu, N. (2012). Extravasations of vesicant / non- vesicant drugs and evidence based management. International Journal of Caring Sciences, 5(2), 191-202.
20. Wengström, Y. & Margulies, A. (2008). European oncology nursing society extravasation guidelines. European Journal of Oncology Nursing, 12(4), 357–361
21. Wickham, R., Engelking, C., Sauerland, C. & Corbi, D. (2006). Vesicant extravasation part II: evidence-based management and continuing controversies. Journal of Oncology Nursing Forum, 33(6), l143-1150.