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Mats Stromberg
Phlebitis from epirubicin?


breast cancer patient receiving first FEC. Administered through PIV. Feels the injection of saline first, but then nothing. Also feels bitter taste on injection of palonoterone. Excellent flow and blood return and no signs of extravasation. About 80% in into the epirubicin infusion she complained of pain in the entire arm, from a decimeter above the PIV and up including the shoulder. Still perfect flow and return and pain goes away completely with stopping of infusion and flushing with some saline. We waited infusing more saline and administered the rest of the dose in the other arm eventless. Back today after 2 weeks for blood transfusion, she reports having had some pain in the arm on and off and is being treated with topical Hirudoid creme.

The doctor I contacted at the event agreed with me that it most likely was a phlebitis and not an extravasation. What do you say - did we do right?

Mats in Stockholm

pH can be low, so this could

pH can be low, so this could be phlebitis. But Gahart's Intravenous Medication book states "Extravasation may occur with or without stinging or burning along the injectionsite even if blood returns well on aspiration of the infusion needle." If no signs of necrosis at 2 weeks, I would say phlebitis or maybe venospasm from either infusion pressure or fluid temparature. Just another guess. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Mats Stromberg
No necrosis

after two weeks, so hopefully we were right, but I will continue to watch out for this lady when she comes back to us. I get the sense that she is sensitive to changes in her body as a whole, so maybe she just feels how a drug like epi irritates our veins better than the average person feels it.



more detail


Would you give more detail on dose, IVP vs. IVPB, dilution, etc?  Did she have any itching or hives along the vein pathway?

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