Anyone have experience with a Rituxan IV Infiltration?

[irishponies]

Hello Everyone,

Question: What are effects of Rituxan IV infiltration?

Infiltration: IV medication leaks out of vein into the surrounding tissue.

This infiltration was for more than 1.5 hour of a 7 hour infusion.

December - Rituxan infusion - IV required 8, yes 8, attempts to start the IV. This has NEVER happened before, nurses always have commented how "great" my veins were, including the nurse that gave me both infusions in June. Site #5 was UNDER my left elbow. After 3 hours of the scheduled 7 hour infusion, there was intense burning at the IV site. (Previous Rituxan infusions did not burn.) Nurse examined it, no swelling. After 30 more min of burning, she flushed the IV with saline. Burning continued but no swelling. After 30 more min of burning, I said, please remove the IV, I cannot tolerate the burning. She said it appears fine, no swelling, and just try to finish if you can. After 15 more min, the man across from me, also having an infusion, said "Your arm is swelling up" and he sent his wife to get the nurse. The forearm, side and bottom near the elbow, had a 3 inch puffed-bubble from elbow to mid-wrist.

Nurse shut off infusion, summoned supervising nurse, "You're having an infiltration." She used a marker to outline bubble. IV was saline flushed but left in place. Area packed in ice packs.

Supervising nurse made 2 attempts to re-start IV in right forearm; IV was put in right bicep, stab #8, and infusion completed. Left IV removed and bandaged; swelling remained. She gave me an appt. to return for a check the next day, keep elevated and iced overnight. She was unaware of the effects of a Rituxan infiltration on an ANCA vasculitis/systemic sclerosis patient. She phoned my primary care physician to discuss. The next day, a simple, everyday scratch to the top of the left forearm, near where the IV infiltration bubble had been, resulted in a tear of the skin, bleeding, and a 1.5 inch skin flap. I bandaged that, it bled through and was rebandaged. At the check, supervising nurse noted scratch, skin flap, and redness. Dressing removed from IV area and cleaned. No infection there. Swelling subsided. She advised continue icing and elevation for several days. The scratch skin flap reattached itself and the area is red. It has been outlined with a marker to monitor. She called primary care physician again and notified.

Note: I have no complaints with the nursing staff regarding IV and vein issues.

Second Rituxan infusion in 2 weeks.

Does anyone with vasculitis, any type, have any experience with a Rituxan infusion infiltration?

[Grizzly-bear]

sorry to hear you had this experience. It may not have been leaking the whole 1.5 hours as when I’ve had rituximab when my veins were bad it has burned, so it’s likely that your vein was burning and then collapsed which is when it started to swell. This has happened to me before where they’ve had to move the venflon multiple times during one infusion as my veins kept collapsing.

I believe it’s actually called extravasation and not infiltration when it is something that can irritate the tissue. Infiltration would be if it was saline or something non-irritant. Extravasation typically causes local inflammation but the good news is it sounds like yours hasn’t resulted in anything too bad as you’d likely already see it if it was.

It shouldn’t affect you generally it’s a case of watching the site it happened and seeking treatment if the skin gets more irritated or inflamed. From your description I’m hopeful that not too much actually leaked as it seems to be getting better and not worse which is always what you want to see.

Good luck with it and keep us posted. Any sign of your arm getting worse or not improving call your doctor. Glad you’ve got the marker to monitor it. Hopefully the high dose of methylprednisolone has kept the local inflammation at bay.

[irishponies in reply to Grizzly-bear]

Hi Grizz! Thanks for the info and support. Sorry to hear you've had the Traveling IV Site Blues, too. My veins have always been very good. 6 months ago, the infusion nurse actually got the student nurse to see my "great veins". This was a shock that they could not find any "good veins" and they have never collapsed before this time. The Rituxan did not burn at all during the last 2 infusions but both times later that night and the next few days there was BURNING and a bright red line from the IV spot right up my arm. There was no doubt that it was burning, you could see it! Re: you suspect that not much Rituxan leaked - that is a great relief. I would hate to have gone through all of that and lost a large quantity of Rituxan! The supervising nurse told me that if the tissue is effected, it can be anywhere from 2 to 75 weeks before any symptoms (tissue necrosis - ugh!). She called the manufacturer of Rituxan and they had no information regarding a patient with my diagnoses and an "infiltration" (I'll use the supervising nurse's term for now). The skin tear near the swelling area is a concern, very red, monitoring it. Monitoring all of it! Hopefully, the bubble was all that is going to happen...

I am NOT on a high dose of Prednisone; only 3 mg. No other meds.

No Prednisone was given during infusion. Given Benadryl 50 mg , two Tylenol.

Thanks Grizz! I really appreciate your sharing your Rituxan adventures with me. Phew. I feel better now...thank you.

[Grizzly-bear in reply to irishponies]

Fingers crossed you don’t get necrosis. It’s only happened to me once. Afterwards my arm was painful for a few weeks (felt very badly bruised).

Usually they give a 100mg methylprednisolone alongside the rituxan to prevent a bad reaction. This is standard protocol. If they didn’t do this then it could have contributed to the burning feeling you felt and your bad reaction. Fingers crossed this all works out ok but ask about the methylprednisolone next time. You’re meant to get it on IV before the rituxan starts.

[irishponies in reply to Grizzly-bear]

Good morning Grizz, Necrosis of the forearm tissue is a HUGE concern. That is why I asked the supervising nurse to contact my primary care physician because the PCP would be treating the necrosis.

Before I got the 1st infusion, I read a lot including that you get 100mg methyl prednisone as a standard before the infusion. I asked at the very first one what I was getting: 2 Tylenol tablets & 50 mg Benadryl IV prior to the Rituxan. I ask at EVERY infusion and it is always the same: Benadryl & Tylenol. Nothing else.

I'll ask about adding methylprednisone at the next infusion.

I take Prednisone 3 mg daily. No other meds.

Thank you very much for your support. I will monitor closely for the necrosis. May I ask, how long after the "infiltration" did your reaction/damage appear? Any treatment to remove the tissue or just monitor the bruising? It must of been horribly painful for weeks, so sorry.

[Grizzly-bear in reply to irishponies]

I just monitored it and mine appeared next day. It started to feel better after two weeks. Worst I got was bad bruising and very sensitive touching the skin.

[irishponies in reply to Grizzly-bear]

Thank you, Grizz, That is good to know. I am in no way minimizing your pain and I hope that is the case for me!

The Rituxan web site research reports 2 to 72 weeks (weird number!) for RA patients to have an "infiltration" reaction. No reports on ANCA vasculitis and/or systemic sclerosis.

I'll keep monitoring, I took photos that day and will take more if there are any changes.

I'll let you know if any of the Left Forearm Photo Shoots is exciting.

Thank you so much, I really appreciate your help.

[Icecrea]

A couple of years ago my rituximab infusion leaked. I think it was my own fault as I jerked the venflon. My arm swelled and went hard close to the site. It was monitored, but the swelling went down after a few days and I have had no problems since. I hope this helps to reassure you.

[irishponies in reply to Icecrea]

Thank you very much, yes, that is reassuring! Sorry you had a bad experience. So: I will Monitor monitor monitor! Thanks!

[Galaxy2]

hi there, I had rituximab once where it leaked into the surrounding tissue. Like you I was conscious of burning at the cannula site but thought nothing of it at first , it wasn’t until I actually looked that I noticed a golf ball type lump forming, the nursing staff were really concerned, cold compresses etc , instructed me to monitor etc and I went home quite panicked. However, swelling disappeared, bruising faded and nothing further happened.

Yours sounds unpleasant especially with a skin tear. Do hope it’s ok for you and next time runs without incident

Take care