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Extravasation injury is the severe complication of infusion therapy and requires nurses to assess and manage it appropriately. This comparative study was aimed to determine the accuracy and usability of two extravasation injuries assessment tools. The participants were 50 nurses from a tertiary hospital. Each nurse was asked to review two parallel sets of photos (72 photos/set) and assessed for occurrence and the severity of extravasation injuries using the following tools: (A) Extravasation Assessment Tool and (B) Extravasation Scale. Photos taken from 72 patients who had normal condition (no extravasation) and three severity levels: mild, moderate, and severe extravasation (18 photos/condition/set) were used. Using the known diagnosis of extravasation injury of these patients made by trained dermatologists as a reference standard, the accuracy of these tools when used by nurses were determined. There were 3600 observed data for each tool (50 nurses*72 photos/tool). It was revealed that use of the Extravasation Assessment Tool and the Extravasation Scale produced 2,898 (80.5%) and 3,386 (94.1%) accurate results, respectively with a significant difference in number of defectives or inaccurate ratings (13.6%, 99% upper bound = 11.77, p < .001). The sensitivity and specificity of the Extravasation Scale were 0.96 and 0.88, respectively. The usability of the tools were compared and found that the Extravasation Scale was more usable as indicated by more nurses being satisfied and very satisfied, less nurses requiring consultation and less time consuming. These results supported that the Extravasation Scale could be used to accurately assess the occurrence and severity of extravasation injuries better than the Extravasation Assessment Tool. Nurses should use this tool to help identify its occurrence and severity in clinical practice. It would be helpful to early detect and promptly manage extravasation injuries.
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Infusion Nurses Society [INS]. Infusion therapy standards of practice. J Infus Nurs [Internet]. 2016 Feb [cited 2020 Dec 14].; 39(1S):s 98-100. Available from: https://source. yiboshi.com/20170417/1492425631944540325.pdf
West Midlands Expert Advisory Group for Systemic Anti-Cancer Therapy. Guidelines for the management of extravasation of a systemic anti-cancer therapy including cytotoxic agents [Internet]. 2017 Jul 19 [cited 2020 Dec 14]. Available from: https://www.england.nhs.uk/midlands/wp-content/ uploads/sites/46/ 2019/05/ management-extravasationof- a-systemic-anti-cancer-therapy-including-cytotoxicagents.pdf
Chiu K, Tindholdt TT, Tønseth, KA. Extravasation injuries. Tidsskr Nor Legeforen. 2016; 136(3):233-5. doi:10.4045/tidsskr.15.0230.
Infusion Nurses Society [INS]. Policies and procedures for infusion therapy of the older adult. 3rd ed. Infusion Nurses Society: setting the standards for infusion care. INS; 2016, pp. 172-81.
Infusion Nurses Society [INS]. Policies and procedures for infusion therapy: ambulatory infusion centers. 1st ed. Infusion Nurse Society: setting the standards for infusion care. INS; 2019, pp. 135-41.
David V, Christou N, Etienne P, Almeida M, Roux A, Taibi A, Mathonnet M. Extravasation of noncytotoxic drugs. Ann Pharmacother. 2020; 54(8):804-14. doi: 10.1177/ 1060028020903406.
Odom B, Lowe L, Yates C. Peripheral infiltration and extravasation injury methodology: a retrospective study. J Infus Nurs. 2018; 41(4):247-52. doi:10.1097/NAN. 0000000000000287.
Park C, Kim H. Acute compartment syndrome due to extravasation of peripheral intravenous blood transfusion. Saudi J Anaesth. 2020 Apr-Jun; 14(2):221-3. doi: 10.4103/sja.SJA_565_19.
Pathomjaruwat T. Impact of a nursing care guideline on prevention and management of extravasation. J Nurs Council [Internet]. 2016 May 31 [cited 2021 Jan 14]; 31(2):81-95. Available from: https://he02.tci-thaijo. org/index.php/TJONC/article/view/47539 (in Thai)
The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing): extravasation injury management [Internet]. 2020 Jan [cited 2021 Jan 14] Available from: https://www.rch.org.au/rchcpg/hospital_clinical_ guideline_index/Extravasation_injury_management/
Kim JT, Park JY, Lee HJ, Cheon YJ. Guidelines for the management of extravasation. J Educ Eval Health Prof. 2020;17:21. doi:10.3352/jeehp.2020.17.21.
Rachel Hopper Clinical Matron Cancer Services. Prevention and management of the extravasation of systemic anti-cancer therapy in adults clinical guideline. V5.1. [Internet]. 2019 Jun [cited 2021 Jan 20] Available from: https://www.doclibrary-rcht.cornwall.nhs.uk/ GET/d10208522
Kreidieh FY, Moukadem HA, Saghir NA. Overview, prevention and management of chemotherapy extravasation. World J Clin Oncol 2016 February. 10; 7(1): 87-97. doi: 10.5306/wjco.v7.i1.87.
Pathomjaruwat T. Prevention and management of extravasation in infusion therapy. Songklanagarind J Nurs [Internet]. 2017 Jun 30 [cited 2021 Jan 20];37(2):169- 81. Available from: https://he02.tci-thaijo.org/index. php/nur-psu/article/view/91366 (in Thai)
Soukup SM. The Center for Advanced Nursing Practice evidence-based practice model: promoting the scholarship of practice. Nurs Clin North Am [Internet]. 2000 Jun [cited 2021 Jan 20];35(2):301-9. Available from: https:// pubmed.ncbi.nlm.nih.gov/10873242/
Infusion Nurses Society [INS]. Infusion nursing standards of practice. J Infus Nurs [Internet]. 2011 Feb [cited 2021 Jan 20]; s66-9. Available from: http://www.incativ.es/ documentos/guias/INS_Standards _of_Practice_2011 %5B1%5D.pdf
Culverwell E. Peripheral intravenous cannulation self learning package. 1st ed. updated September 2013. Canterbury District Health Board intravenous cannulation handbook 2010 [Internet]. 2013 Sep [cited 2021 Jan 20] Available from: https://edu.cdhb.health.nz/HospitalsServices/Health-Professionals/Education-and-Development/ Study-Days-and-Workshops/Documents/SELF%20 LEARNING%20Cannulation%20Package%20011013. pdf
Wengstrom Y, Foubert J, Mtrgulies A, Roe H, Bugeia S. Extravasation guidelines 2007. Guidelines implementation Toolkit [Internet]. 2007 [cited 2021 Jan 20] Available from: https://docplayer.net/6167460-Extravasation-guidelines2007-implementation-toolkit.html
Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008; 56(1):45-50. doi:10.4103/0301-4738.37595.
Bujang MA, Adnan TH. Requirements for minimum sample size for sensitivity and specificity analysis. J Clin Diagn Res. 2016; 10(10):YE01-YE06. doi:10.7860/JCDR/ 2016/18129.8744.
Minitab 18 Support. Kappa statistics for attribute agreement analysis [Internet]. 2019 [cited 2021 Jan 20] Available from: https://support.minitab.com/en-us/minitab/18/helpand-how-to/quality-and-process-improvement/measurementsystem-analysis/how-to/attribute-agreement-analysis/ attribute-agreement-analysis/interpret-the-results/allstatistics-and-graphs/kappa-statistics/
Lim EYP, Wong CYW, Kek LK, Suhairi SSBM, Yip WK. Improving the visibility of intravenous (IV) site in pediatric patients to reduce IV site related complications - an evidencebased utilization project. J Pediatr Nurs. 2018 Apr; 11: S0882- 5963(18)30005-8. doi: 10.1016/j.pedn.2018. 04.004.
Bochaton N, Ramelet AS, Rimensberger P, Januel JM. Improving the extravasation assessment of peripheral venous catheters by nurses, with the establishment of a standardized instrument suitable for children. Rech Soins Infirm [Internet]. 2016 Sep [cited 2021 Jan 20];(126):51-64. Available from: https://pubmed.ncbi.nlm.nih.gov/28169811/ (in French)
Ingram, J., Copeland, M., Johnson, D.et al. The development and evaluation of a picture tongue assessment tool for tonguetie in breastfed babies (TABBY). Int Breastfeed J. 2019; 14(31). doi.org/10.1186/s13006-019-0224-y.
Matsui Y, Murayama R, Tanabe H, Oe M, Motoo Y, Wagatsuma T, et al. Evaluation of the predictive validity of thermography in identifying extravasation with intravenous chemotherapy infusions. J Infus Nurs. 2017 Nov/Dec; 40(6): 367-74. doi: 10.1097/NAN.0000000000 000250.
Daya S. Study design for the evaluation of diagnostic tests. Semin Reprod Endocrinol. 1996; 14(2):101-9. doi: 10.1055/s-2007-1016317.