抗癌化療藥品外滲照護指引

Clinical Practice Guideline: Prevention and Management of Chemotherapy Extravasation

張黎露(Li-Lu Chang) ； 許麗珠(Li-Chu Sheu) ； 周文珊(Wen-Shan Chou) ； 張瀞文(Ching-Wen Chang) ； 張淑惠(Shu-Hui Chang) ； 李佩怡(Pei-Yi Lee) ； 林盈秀(Ying-Siou Lin)

《腫瘤護理雜誌》 13卷增訂刊 (2013/12) Pp. 55-73

https://doi.org/10.6880/TJON.201312/SP_13.02

摘要

外滲是病人接受針劑型化學治療可能發生的重要意外事件，根據研究統計使用中央靜脈導管之發生率為0.26%-2%，周邊靜脈則有0.1%-6%。一旦外滲發生，其對病人造成的傷害程度從表皮發紅、水泡、組織壞死到影響肌肉關節活動度與日常生活等，嚴重者甚至需要截肢，最終可能影響治療計畫的進行與治療結果。此外，此意外之發生會造成病人滿意度降低，護理人員之工作壓力增加，甚至引起醫療糾紛等，導致醫療成本增加。因此，如何預防外滲之發生，以及外滲發生之立即處理與後續追蹤，是化學治療照護中之重要課題。本指引的發展乃依據實證的流程，系統性地搜尋和評讀國內外文獻，再經過跨領域專家的審核和指引使用者意見之彙整，最後完成的指引內容包括：外滲引發組織傷害之病生理機轉、外滲的評估與預防、外滲的症狀與處置、外滲的記錄、追蹤與病人教育等五大章節。此指引可以作為病人接受化學治療期間之外滲的預防、外滲發生時之處置以及後續追蹤之適當決策的參考，亦可作為各醫療機構修定化學治療外滲照護標準之依據，確保病人接受針劑型化學治療之照護安全，以減少抗癌化療藥品外滲發生的風險及嚴重度，提升照護品質與病人安全。

關鍵字

化學治療 ； 外滲 ； 外滲預防 ； 照護指引

並列摘要

Extravasation is a dreadful incidence that may occurs during the administration of intravenous chemotherapy. The rate of chemotherapy extravasation injury ranges from 0.26% to 2% with central lines and from 0.1% to 6% with peripheral lines. Initial signs and symptoms of extravasation are redness, swelling, feelings of pain, discomfort, burning and stinging at the injection site; delayed symptoms may include blistering, necrosis and ulceration. Surgical procedures may be required for the management of those severe extravasations, and even amputation may be the consequence. When extravasations occur, it often increases the burden of nursing work, lowers patient's satisfaction, potentially causes legal problems and increases medical costs. The risk of extravasation can be reduced by taking preventive measures, and the severity of extravasation injury can also be reduced by taking appropriate management and follow-up care. This clinical practice guideline was therefore developed based on the best evidences, consensus opinions of clinical experts and feedbacks from stakeholders. This guideline includes five chapters: 1) pathophysiology of tissue injuries caused by vesicants, 2) assessment of patient, 3) prevention and management of extravasation, 4) documentation and follow-up, and 5) patient education. This guideline can provide useful information to assist healthcare professionals in clinical decision making and serve as a reference for prevention and management of chemotherapy extravasation. After all, hospitals can ensure patient safety and quality of nursing care in patients undergoing chemotherapy if they adopt this guideline into institutional policy and procedures.

並列關鍵字

cancer ； chemotherapy ； extravasation ； guideline