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.