Evaluation of the Predictive Validity of Thermography in Identifying Extravasation With Intravenous Chemotherapy Infusions.
Yuko Matsui, Ryoko Murayama, Hidenori Tanabe and 9 others
PMID 29112585WHAT IT FOUND
Thermography during chemotherapy detected more extravasation cases than nurses' visual checks, but false positives occurred at vein junctions or bony sites, so it should be used alongside observation.
Key findings
01A temperature decrease of less than 0.7°C per centimeter from the margin to the center of a low-temperature region predicted extravasation, with an area under the curve of 0.94.
02Nurses failed to detect extravasation in 14 of 26 cases, while thermography failed in 4 of 26 cases, a significant difference (P = .008).
03Thermography false positives were associated with vein confluence, bifurcation, or placement over a bony prominence, and false negatives included cases with sudden swelling.
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How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no confirmatory test such as ultrasound for extravasation, so some patients called nonextravasation may have had leakage without visible skin signs. Only 26 true extravasation cases were analysed, and only 4 were thermography false negatives, so the limits of the test are not well defined. The paper reports different analysed counts: 104 consented, an 80-patient analysis set, and later 257 patients analysed. False positives were linked to vein confluence, bifurcation, or placement over a bony prominence, so site anatomy matters. Sudden swelling was missed by thermography but visible to nurses, so the test does not replace observation. It was a single-center study in Japan, so results may not apply to other infusion settings.
Declared interests
The authors report no conflicts of interest. The work was supported by JSPS KAKENHI grant number 26670939.
The easy way to misread this
Do not use thermography as a stand-alone test for extravasation. It failed to detect 4 of 26 cases and gave false-positive results in 12 cases, and the study had no gold standard for confirming extravasation.