Extravasation (Paravasation) of Chemotherapy Drugs - Recommendations for Standard Care in the Czech Republic based on Consolations between Representatives of the Supportive Care Group of the Czech Society for Oncology, Oncology Section of the Czech Nurses Association, and the Society for Ports and Permanent Catheters.

BACKGROUND: Extravasation (paravasation) of chemotherapy drugs is a very significant complication in the treatment of cancer patients. Preventive and therapeutic interventions reduce the risk of this complication or the extent of its consequences. A working group of authors from expert groups prepared recommendations for standard care. PURPOSE: To prepare a basic summary of recommended interventions for daily practice, based on knowledge from long-term, proven, evidence-based practice or on consensus opinions of representatives of expert groups. RESULTS: Preventive measures are essential and include early consideration of long-term venous access device indications, choice of injection site, venous line control before each chemotherapy drug application, and patient education. Interventions in cases of extravasation mainly involve the application of antidotes (dimethylsulfoxide, hyaluronidase, and dexrazoxane) and the application of dry cold or heat, depending on the type of cytostatic drug. Corticosteroids injected subcutaneously, moist heat or cooling, and compression, are not recommended. CONCLUSION: The recommended procedures will contribute to reducing the risk and consequences of extravasation. The range of recommended interventions can be expanded depending on individual clinical workplace policy and needs. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 28. 9. 2019 Accepted: 13. 10. 2019.

The Impact of High Protein Nutritional Support on Clinical Outcomes and Treatment Costs of Patients with Colorectal Cancer.

BACKGROUND: The primary objective of this study was to investigate the impact of high protein oral nutrition support (ONS) on clinical outcomes in patients with colorectal cancer (CRC). The secondary aim was to compare the cost of treatment and length of stay (LoS) for CRC patients taking high protein ONS vs. patients on conventional nutritional support. MATERIALS AND METHODS: The study was conducted on adult patients with CRC undergoing colorectal surgery. Informed consent was obtained before the study. The study group (SG; n = 52) was instructed to take high protein ONS (600 kcal, 40 g protein per day) in addition to a normal diet for at least 10 days before and two weeks after surgery. Data from the comparative group (CG; n = 105) were collected retrospectively. RESULTS: A relative reduction in the frequency of the following complications was observed in SG: wound dehiscence (2.2 times lower), infections (4.3 times lower), anastomosis dehiscence (2.0 times lower), and rehospitalization (1.7 times lower). The mean LoS was shorter in SG (9.4 ± 4.97 vs. CG 12 ± 6.4 days), which resulted in significantly lower treatment costs during hospitalization (SG 479 vs. CG 538 EUR; p = 0.01) and at six months after surgery (SG 4,862 vs. CG 6,456 EUR). CONCLUSION: Pre- and postoperative high protein ONS reduces LoS, treatment costs, postoperative complications, and re-hospitalizations in CRC, regardless of initial nutritional status.Key words: high protein oral nutritional support - colorectal cancer - perioperative care.

[Extravasation of Cytostatic Drugs - Prevention and Best Practices]. / Extravazace cytostatik -  prevence a doporucené postupy.

Extravasation is the leakage of a drug (intended primarily for intravenous administration) into tissues surrounding the vascular system. The damage to surrounding varies depending on the nature and volume of extravasation. Cytostatic extravasation is associated with poor outcomes for patients. This paper summarizes the types of risk associated with cytostatic extravasation, and the preventative measures that can be used when such an event occurs. We also provide information on potential treatments. However, justification for their use has only been substantiated in papers with different levels of significance and these papers are not available in all countries. We summarize current international recommendations for actions to be taken in the event of extravasation.

[Psychological Aspects of Intravenous Treatment in Oncology and Permanent Venous Access Devices Tolerance]. / Psychologické aspekty nitrozilní lécby v onkologii a tolerance dlouhodobých zilních vstupu.

BACKGROUND: This paper deals with the psyche of patients during intravenous therapy. Since any intervention in the physical integrity of individuals are necessarily reflected in their mental level, we decided to conduct a survey dealing with tolerance of intravenous therapy in cancer patients. Especially, we focused on long-term venous access devices tolerance. PATIENTS AND METHODS: The aim of this study was to evaluate descriptively patients´ awareness of the administration of parenteral drugs, risks in the application and the differences between the administration of drugs to the central and peripheral venous system. To collect data, own questionnaire containing 21 questions was compiled. It was distributed to patients in the oncology department and outpatient oncology ward at the hospital Novy Jicin. Patients signed an informed consent for data collection. One hundred valid questionnaires were evaluated in the analysis of the data. RESULTS: The results of the study generally indicate that patients do not tolerate venous sampling and intravenous therapy optimally. Patients who have some form of venous access device are mostly satisfied, as it fulfills its mandate of maximum patient comfort. CONCLUSION: The results indicate that most patients know alternatives to peripheral drugs application. However, awareness of this issue is inadequate. The vast majority of patients would recommend the introduction of long-term venous access device to other patients.

Cluster of patients with Familial Mediterranean fever and heterozygous carriers of mutations in MEFV gene in the Czech Republic.

Familial Mediterranean fever (FMF) is a well-described monogenic autosomal recessive disorder with highest occurrence in the Mediterranean region. In this article, we describe the experience of a center in the Czech Republic that follows four families with members bearing mutations in MEFV gene without provable ancestry from the Mediterranean region. We also discuss the clinical picture of the heterozygous variants that were present in our cohort. The typical clinical presentation in heterozygotes corresponds to data described in the international literature. The possibility of combination of mutations and/or polymorphisms in different genes and epigenetic or environmental influences on the clinical symptoms are taken into account.

[Venous access devices in oncology]. / Zilní vstupy v onkologii.

Specific anti-cancer therapy is administered mainly via the parenteral route, Adequate venous access is, therefore, a topical issue in oncology In some patients on long-term therapy, the peripheral venous system is extensively burdened We present an overview of risk factors associated with parenteral application of medicins We provide a comparison of different types of venous access devices and discuss recommendations on general indications for permanent venous access devices We suggest an approach to the choice of the most appropriate venous access device for an oncology patient available to date We present our experience with PICC (peripherally implanted central catheters) implantations used in 30 oncology patients in our centre In addition to venous ports, PICCs represent another safe method of permanent venous access with low rate of complications Indications for the use of a specific permanent venous access device (PICC or port) partly overlap and evidenced-based recommendations are lacking However, we discuss the few suggestions that have been formulated on this issue.