Table 1.
Clinical questions and recommendations
| Clinical questions | Recommendation | Desirable outcomes (benefit) | Undesirable outcomes (harm) | Balance between desirable and undesirable outcomes | Recommendation (strength)a | Certainty of evidenceb | Consensus rate | |
|---|---|---|---|---|---|---|---|---|
| CQ1 | Is multiple patient education regarding extravascular invasion recommended for patients receiving anticancer drugs via peripheral or central veins? | No recommendation | Unidentified (probably decreased ulceration and necrosis, decreased EV, and increased telephone consultation) | Unidentified (probably increased medical staff workload) | Not evaluable | None | D | No voting |
| CQ2 | Is placement of a central venous device (CV catheter, PICC, CV port, etc.) recommended in patients scheduled to start anticancer drugs? | CV devices are weakly recommended | Completion of scheduled administration, less pain and anxiety from cannulation | Device complications (8%) | Central venous device is beneficial | Recommend (weak) | B | 9/9 (100%) |
| CQ3a | Which central venous catheter (CV catheter or PICC) is recommended for cancer patients? | PICC is weakly recommended | Decreased complications such as catheter removal, infection, and thrombus | Unidentified | PICC is beneficial (limited to leukemia patients) | Recommend (weak) | B | 9/9 (100%) |
| CQ3b | Which central venous devices, CV catheter or CV port, is recommended for patients with cancer? | CV port is weakly recommended | Decreased device failures, infections, and complications | Thrombus | CV port is beneficial | Recommend (weak) | B | 9/9 (100%) |
| CQ3c | Which central venous device, PICC or CV port, is recommended for patients with solid tumors? | CV port is strongly recommended | Decreased device failures, infections, and complications | Unidentified (probably medical costs) | CV port is beneficial | Recommend (strong) | A | 9/9 (100%) |
| CQ4 | Is it recommended that peripheral intravenous catheters for the administration of anticancer drugs be placed more centrally than at the puncture site? | Central (upstream) placement is weakly recommended | Decreased EV, decrease in skin ulceration at the site of EV | Unidentified (probably decreased puncture vessel options) | Central (upstream) placement is beneficial | Recommend (weak) | C | 8/9 (89%) |
| CQ5 | Is routine replacement of peripheral venous catheters recommended to prevent extravasation in patients receiving continuous (intermittent) administration of anticancer drugs? | Not to do routine replacement is weakly recommended | Decreased EV, decreased phlebitis, decreased skin inflammation due to adhesive plaster | Unidentified (probably increased patient distress, increased medical staff workload) | Routine replacement is harmful | Not recommend (weak) | C | 9/9 (100%) |
| CQ6 | Is free flow recommended over an infusion pump as a method of administration to prevent extravasation? | Balance between strict rate control and EV prevention; free flow is weakly recommended/when strict rate control is required, not to do free flow is weakly recommended. | Decreased EV, decreased skin inflammation, prevention of skin ulceration (necrosis) | Unidentified (probably decreased accuracy of dose rate control, increased medical staff workload) | Unless strict rate control is required, infusion pump is weakly discouraged | Recommend or not recommend (weak) | C | 8/9 (89%) (second vote) |
| CQ7 | Is administration of fosaprepitant recommended considering the risk of extravasation of anticancer drugs? | Fosaprepitant administration is weakly recommended (limited to patients who cannot be administered orally) | Inhibiting nausea and vomiting | Increased EV and injection-site reactions | Fosaprepitant or aprepitant use is beneficial | Recommend (weak) | C | 9/9 (100%) |
| CQ8 | Is it recommended to check blood backflow for early detection of extravasation? | Checks for blood backflow is weakly recommended. | Early detection of EVs, detection of indwelling needle location and breakage, confirmation of intravascular placement, reduction of skin damage (redness and swelling) | Unidentified | Check blood backflow is beneficial | Recommend (weak) | D | 9/9 (100%) |
| CQ9 | Is suction of residual drug solution or blood recommended to prevent exacerbation of skin injury in the event of extravasation? | No recommendation | Decreased areas of skin injury (redness and swelling), pain, ulcers, and shortened recovery days | Unidentified (probably damage to blood vessels due to suction) | Not evaluable | None | D | No voting |
| CQ10a | Is cold compression recommended as local therapy to prevent aggravation/progression of skin injury and inflammation induced by extravasation? | Cold compression is weakly recommended | Decrease in inflammation (dermatitis and vasculitis), pain, and burning sensation at the site of leakage, and shortened recovery days | Skin damage (burns) and exacerbation of inflammation due to low or high temperatures | Cold compresses is beneficial | Recommend (weak) | D | 9/9 (100%) |
| CQ10ｂ | Is warm compression recommended as local therapy to prevent aggravation/progression of skin injury and inflammation induced by extravasation? | Non-use of warm compresses (heat) is weakly recommended | Hot compresses is harmful | Not recommend (weak) | D | 9/9 (100%) (second vote) | ||
| CQ11 | Is the use of dexrazoxane recommended for extravasation induced by anthracycline cancer drug? | Dexrazoxane use is weakly recommended | Decreased surgical procedures (debridements and skin grafts) and shorter recovery days | Dexrazoxane side-effects, hospitalization, and prolongation of hospital days | Dexrazoxane use is beneficial | Recommend (weak) | B | 8/8 (100%) |
| CQ12 | Is local steroid injection recommended for extravasation caused by anticancer drugs? | Not injecting local steroid is weakly recommended. | Decreased surgical procedures (debridements and skin grafts) and shorter recovery days | Local skin damage, local injection pain | Local steroid injection is harmful | Not recommend (weak) | D | 9/9 (100%) |
| CQ13 | Is topical steroid recommended for extravasation caused by anticancer drugs? | Topical steroid application is weakly recommended | Decreased surgical procedures (debridements and skin grafts) and shorter recovery days | Skin damage at the application site (infection, skin atrophy) | Topical steroid application is beneficial | Recommend (weak) | D | 9/9 (100%) |
| CQ14 | Is debridement recommended for skin ulcers without necrosis due to extravasation? | Not to do debridement is weakly recommended | Skin ulcer healing | Skin invasions | Debridement is harmful | Not recommend (weak) | C | 9/9 (100%) |
CV, central venous catheter; CQ, clinical question; EV, extravasation; PICC, peripherally inserted central venous catheter.
a
Recommend (strong): strongly recommended to do, recommend (weak): weakly recommended to do, not recommend (strong): strongly recommended not to do, not recommend (weak): weakly recommended not to do.
b
A: High—evidence is a great certainty close to the true effect; B: Moderate—evidence is moderately confident of true effectiveness; C: Low—evidence is limited in its certainty of true near-effect (true effects may differ greatly from evidence estimates); D: Very low—evidence is far from convincing of a true effect (true effects differ significantly from evidence estimates).