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Oncology Certification Nursing - Oncology 2 Questions and answers .
Oncology Certification Nursing - Oncology 2 Questions and answers .
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Oncology Certification Nursing - Oncology2 Questions and answers
infiltration - ANSWER-passage or escape of IV administered drugs into the tissue
extravasation - ANSWER-leakage of drugs capable of causing tissue damage
into the subcutaneous or subdermal tissue or other unintended sites.
irritation - ANSWER-a localized inflammatory reaction at the infusion or injection
site
flare reaction - ANSWER-a local allergic reaction along a vein caused by irritating
drugs.
infusion reactions - ANSWER-reactions mediated by the immune system
(hypersensitivity, anaphylaxis, cytokine release syndrome)
DNA-binding vesicants - ANSWER-vesicant binds to nucleic acids in the DNA of
healthy cells in the tissue, causing cell death. the dead cells then release
complexes, which are taken up by adjacent healthy cells. this process causes a
continuing cycle of tissue damage as the vesicant is retained in the tissue for a
long period of time.
NON-DNA binding vesicants - ANSWER-the vesicant has an indirects effect on
healthy cells. it does not bind to cellular DNA. it is metabolized in the tissue and
is more easily neutralized.
cabazitaxel (jevtana) - ANSWER-a taxane where infiltration has not caused skin
or tissue impairment
Docetaxel (taxotere) - ANSWER-extravasation may cause hyperpigmentation,
erythema and tenderness.
,paclitaxel (taxol) - ANSWER-injection site reactions, including reactions
secondary to extravasation, usually mild and consist of erythema, tenderness,
skin hyperpigmentation or swelling at injection site. seen more often with 24 hour
infusions than with 3 hour infusions. severe reactions such as phlebitis, cellulitis,
induration, skin exfoliation, necrosis and fibrosis have been reported. onset has
been delayed by a week to 10 days.
recall reactions - ANSWER-recurrence of skin reactions at the site of previous
extravasation following paclitaxel injection at a different site.
docetaxel and paclitaxel - ANSWER-classified as exfoliants or drugs that may
cause inflammation and peeling of skin without causing underlying tissue death.
factors affecting tissue damage severity following a vesicant extravasation -
ANSWER-1. DNA binding vesicants cause greater tissue damage than non-dna
binding vesicants
2. the higher the concentration and greater amount of a vesicant the more
damaged caused.
3. location of the extravasation such as those with little subcutaneous tissue and
overlying veins, arteries and nerves are likely to have more damage.
4. older age, comorbidity and impaired immunocompetence cause more damage.
risk factors for peripheral extravasation - ANSWER-1. small, fragile veins
2. previous multiple venipunctures
3. sensory deficits
4. application of topical skin numbing agents prior to venipuncture
5. limited vein selection d/t lymph node dissection
6. impaired cognition, altered mental status or somnolence
7. probing during IV catheter insertion
8. administration site in areas prone to movement
9. use of rigid IV devices.
10. prior treatment with irritating or sclerosing drugs
11. administration of a vesicant peripherally when the manufacturer stipulates it
should be administered via a central line.
, possible etiologies of peripheral extravasations - ANSWER-1.vein wall puncture,
piercing or trauma.
2. dislodgement of the catheter from a vein
3. administration of a vesicant in a vein below a recent venipuncture site.
4.administration of a vesicant in a vein below or recent or non-healed vesicant
extravasation site.
5. inadvertent intramuscular or subcutaneous vesicant administration.
Risk factors for extravasation from central VADs - ANSWER-1. difficulty
encountered during device insertion
2. inadvertent slicing, piercing or nicking of catheter prior to insertion
3. device misplacement with catheter tip outside of the venous system.
4. insufficient length of non coring needle (implanted port)
5. presence of a fibrin sheath or thrombus at the catheter tip.
6.catheter migration
7. long dwell time of catheters inserted using a subclavian approach, in which the
catheter is placed between the clavicle and first rib
possible etiologies of extravasations from central VADs - ANSWER-1. inadvertent
misplacement of catheter tip outside of the venous system during insertion
procedure.
2. vein perforation during insertion
3. post insertion vein erosion, catheter leakage, rupture or fracture.
4. separation of the catheter from a portal body.
5. incomplete insertion of a non coring needle into an implanted port
6. non coring needle dislodgement from an implanted port.
7. backflow of vesicant along the catheter to the venotomy site secondary to
fibrin sheath or thrombus at the catheter tip.
signs and symptoms of vesicant extravasation - ANSWER-1. vein irritation and
flare reactions may mimic signs of vesicant extravasation.
2. vein irritation and flare reactions only occur in peripheral chemo administration
3. if it happens in CAD it is d/t catheter tip placement outside of the venous
access device or erosion of the vein wall.
4. this may cause SOB and shock to secondary blood loss.
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