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"Infiltration and Extravasation" (Emergency, August) by Lynn Hadaway erroneously said "Extravasation injury from cancer chemotherapy is reported to be 11% in children and 22% in adults," citing as its source a 2000 article by Kassner.1 But Kassner's article cited as its source for the statistic a 1998 article by Disa and colleagues.2 Disa and colleagues, in turn, cited a 1979 article by Brown and colleagues3 and a 1968 article by Riyami,4 neither of which was specifically about chemotherapy infiltration. The correct incidence of infiltration and extravasation from cancer chemotherapy is unknown; a literature search performed at the AJN offices found several secondary sources that cite estimates of 0.1% to 6%.


Also in the same article, in Table 1, "Vesicant Medications and Solutions Reported to Cause Extravasation Injuries," the brand names given for the cytotoxic agent doxorubicin were Adriamycin and Doxil. But Doxil is a liposomal formulation of doxorubicin and should not have been listed. In 1998 the Institute for Safe Medication Practices issued a warning stating that lipid formulations should not be confused with conventional ones, saying, "Accidental administration of the pegylated liposomal form of doxorubicin (Doxil), instead of the conventional form, doxorubicin hydrochloride, has resulted in severe side effects and death."5


AJN thanks Lisa Schulmeister for bringing these errors to our attention.




1. Kassner E. Evaluation and treatment of chemotherapy extravasation injuries. J Pediatr Oncol Nurs 2000;17(3):135-48. [Context Link]


2. Disa JJ, et al. Prevention of Adriamycin-induced full-thickness skin loss using hyaluronidase infiltration. Plast Reconstr Surg 1998;101(2): 370-4. [Context Link]


3. Brown AS, et al. Skin necrosis from extravasation of intravenous fluids in children. Plast Reconstr Surg 1979;64(2):145-50. [Context Link]


4. Riyami A. Complications of intravenous infusions. J Ir Med Assoc 1968;61(367):23-5. [Context Link]


5. Institute for Safe Medication Practices. Hazard alert!! Medication errors with certain lipid-based drug products. Medication Safety Alert 18 Aug 1998. [Context Link]