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Cyndi Cramer
5FU infiltration/extravasation

The below was asked at the Chemotherapy Forum at ONS Online: any feedback?

We have a lady who was rec'g a continuous infusion of 5FU via peripheral IV
as part of a FOLFOX4 regimen. (Why no central line?? surgeon is out of
town!) The concentration was 3.8 mg/ml running at 22 ml/hr. Hard to tell
from the chart when the problems started. Although 5FU has been identified
as a weak vesicant, I see nothing in the ONS guidelines on pg 79-81 about
it. The med onc wants warm compresses. As of this point, pt has maybe
slight induration from wrist (point of infiltration) up to 2 inches above
elbow, with skin sensitivity to touch and discomfort circumferentially
around arm. No discolorations that I can see. What would you use for
treatment?

 

Nadine Nakazawa
We used to give continuous
We used to give continuous 5FU peripherally in the 1980's ---50 mls over 24 hours.   We saw horrible vein phlebitis and took it for granted.    For the past 15-16 years, all continuous 5FU infusions are given via a central line, usually a PICC.   I would treat it with comfort measures, and make sure a PICC gets placed in the other arm.  There aren't any antidotes for 5FU.   Do you have a PICC nurse on staff?   If not, what about a mobile PICC service?   or do you have an interventional radiologist on staff?

Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC

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