Definition
- Extravasation: Accidental leakage of vesicant or irritant drugs from a vein into the surrounding subcutaneous tissue, causing local tissue injury.
- Vesicants → can cause blistering, necrosis, and ulceration.
- Irritants → may cause pain, inflammation, phlebitis, but usually no tissue necrosis.
- Non-vesicants → generally safe, mild irritation at most.
Common Drugs by Category
| Class | Examples | Risk |
|---|---|---|
| Anthracyclines | Doxorubicin, Epirubicin, Daunorubicin | High (severe necrosis) |
| Vinca Alkaloids | Vincristine, Vinblastine, Vinorelbine | High (necrosis, ulceration) |
| Alkylating Agents | Mechlorethamine, Melphalan | High (necrosis possible) |
| Platinum Compounds | Cisplatin (>0.4 mg/mL), Carboplatin | Moderate |
| Taxanes | Paclitaxel, Docetaxel | Moderate |
| Irritants | Oxaliplatin, Cyclophosphamide, Ifosfamide | Mild–moderate |
| Monoclonal Antibodies | Rituximab, Alemtuzumab | Usually mild; infusion reactions more common than extravasation |
Signs and Symptoms
- Pain, burning, or stinging at the injection site
- Swelling, redness, blanching, or tightness
- Blister formation or tissue induration
- Slow resolution or progressive ulceration if severe
Immediate Management (On Suspected Extravasation)
1. Stop infusion immediately – do not remove IV catheter initially.
2. Aspirate residual drug from the IV line if possible.
3. Remove IV catheter carefully after aspiration.
4. Elevate the affected limb.
5. Apply local therapy depending on drug type:
| Drug Type | Recommended Therapy |
|---|---|
| Anthracyclines | Cold packs + dexrazoxane IV or dimethyl sulfoxide (DMSO) topical |
| Vinca Alkaloids | Warm compress + hyaluronidase injection |
| Alkylating agents (non-anthracycline) | Cold or warm per protocol; some use DMSO |
| Taxanes | Cold packs ± topical DMSO |
| Monoclonal antibodies | Usually cold packs; rarely require antidote |
6. Document incident – site, drug, volume, intervention, and follow-up.
Antidotes (Selected Examples)
- Dexrazoxane (Totect®) → anthracyclines
- DMSO topical → anthracyclines
- Hyaluronidase injection → vinca alkaloids, some alkylators
- Sodium thiosulfate → mechlorethamine, cisplatin (specific situations)
Prevention Tips
- Use central venous access for vesicants when possible.
- Ensure good vein selection, preferably large, intact veins.
- Flush IV line thoroughly before and after vesicant administration.
- Educate nursing staff and patients to report burning, pain, or swelling immediately.
Summary:
Extravasation is a potentially serious complication of chemotherapy. Early recognition, stopping the infusion, and applying drug-specific interventions can minimize tissue injury. Vesicants like anthracyclines and vinca alkaloids pose the highest risk.