Chemotherapy extravasation: a consequence of fibrin sheath formation around venous access devices

Abstract

Purpose/objectives: To describe, using two case studies, chemotherapy drug extravasation as a consequence of fibrin sheath formation.

Data sources: Journal articles, textbooks, medical records, and personal experiences.

Data synthesis: Fibrin sheath formation around venous access devices (VADs) frequently leads to persistent withdrawal occlusion (PWO). While PWO often is easily managed with small doses of thrombolytic therapy (e.g., urokinase), it may result in a more serious complication, such as chemotherapy extravasation.

Conclusions: Chemotherapy should not be administered through a VAD unless a free-flowing blood return can be demonstrated.

Implications for nursing practice: Careful nursing assessment of all VADs is important to identify complications such as fibrin sheath formation. To rule out fibrin sheath formation, nurses must obtain catheter dye studies when fibrinolytic therapy fails to restore catheter function.