Discussion and conclusion
We observed the target site from pre-catheterization time until the development of induration caused by chemotherapy drug administration through a peripheral intravenous catheter. This is the first study that reported time-course observation of the catheterization site from pre-catheterization to induration development through ultrasonography.
During pre-catheterization, no abnormal findings were observed in the subcutaneous tissue and vein, and its diameter was enough to insert a 24G catheter [7]. There was no complication during drug administration, but subcutaneous edema and thrombus were confirmed upon finishing administration. A week later, induration was not observed at the site, even with the presence of subcutaneous edema and thrombus. However, induration with edema or thrombus was observed 3 weeks later. Above these reasons, induration caused by anticancer drug administration was due to the fibrotic subcutaneous tissue formation, which was a result of mild inflammation that did not induce pain, swelling, and erythema.
Fibrosis which is the last part of inflammation reaction is formed gradually and lasts about a few weeks [8]. Thus, we consider that fibrosis had still not become advanced at one-week post chemotherapy. It means that in short treatment interval chemotherapy, there is possibility of anticancer drug administration using the site that has subcutaneous edema or thrombus as catheter placement site because nurses cannot detect abnormal tissue condition by palpation only.
“Unhealthy subcutaneous tissue” is one of the extravasation risk factors [3]. This case showed that anticancer drug administration through a peripheral intravenous catheter induces the development of unhealthy subcutaneous tissue (thrombus or edema) without subjective symptoms, abnormal sign by palpation or inspection. Also, this case showed how subsequent anticancer drugs, including vesicants, may be infused at vulnerable sites. Continuous administration of irritants or vesicants via a central vein is recommended. However, for patients who unavoidably require peripheral intravenous catheters, the catheterization site must be carefully selected. Short-term interval therapy such as a weekly chemotherapy have especially high risk for anticancer drug infusion at risky sites. Future researchers should consider the possibility of these risky sites when selecting appropriate catheterization site.
Author Contributions :
MA: designed the research; MA and CK: contributed data collection; MA: drafted the manuscript; RM and HS: critically reviewed the manuscript and supervised the whole study process. All authors read and approved the final manuscript.