Clinical nurse specialist and evidence-based practice: managing anthracycline extravasation

The clinical nurse specialist (CNS) is a clinical expert and client advocate in a specialized area of nursing practice, who directs efforts toward the improvement of nursing care. The CNS role is essential in closing the therapeutic gap between the development of science knowledge and its implementation in daily patient care situations. An essential step in developing evidence-based interventions is rating the quality of the evidence. An example of the CNS's role in improving care can be found in a response to an anthracycline extravasation. The clinical standard for extravasation was amended to incorporate new evidence-based guidelines that included prevention of extravasation and a new assessment method and intervention. When an extravasation is suspected with an anthracycline agent, a Wood's lamp (ultraviolet lamp) is shined on the area of interest, in a dark room. The anthracycline extravasation area, if present, will illuminate in the lamp's light. In addition to the standard interventions of topical DMSO applications, current literature also suggests an intravenous infusion of dexrazoxane (Zinecard) as an effective antidote to prevent tissue damage.