Chemotherapy

Extravasation

Sahar Nasser| Clinical Pharmacist

NCCCR
Objectives

§ By the end of this presentation you will be able to understand and

recognize extravasation
1. Causes and risk factors
2. Features and symptoms of extravasation
3. Prevention measures
4. Management

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 Definition

§ Extravasation is an accidental
leakage of cancer therapy from
its intended compartment (the
vein) into the surrounding
tissue.
§ This occurs when intravenous
(IV) medication passes from the
blood vessel into the tissue
around the blood vessels and
beyond

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 Risk factors
• Vesicant properties of the drug
Chemotherapy agent • Concentration

Extravasation
• Volume and duration of infusion

• Small and/or fragile vein, lymphedema

Patient factor • Obesity, impaired level of consciousness
• Previous multiple venipunctures

• Training, cannula size & lack of time

Iatrogenic causes • Accidental puncturing of the vein or cannula
movement
• Prolonged peripheral line infusions of vesicants

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Types of Extravasations

§ Cancer drugs can be grouped into 3 broad categories, based on their

potential to cause tissue damage upon extravasation:
o Non-vesicants
o Irritants
o Vesicants

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List of drugs

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Distingue Extravasation from Characteristics Flare reaction Vessel irritation Extravasation

Itchy blotches or hives; pain Aching and Pain and burning are
Presenting and burning uncommon tightness common at site; stinging
symptoms may occur
other conditions

blotches or “hive-like” The full length of the vein may Erythema around area of
erythema along the vessel; be reddened or darkened needle or around the
Coloration diffuse or irregular pattern Venipuncture site

Aching and tightness along the Severe pain, burning at the

Pain No vein needle site and/or along
the vein or catheter
Usually appears suddenly and Usually appears within minutes Severe swelling or “bleb”
Timing dissipates within 30–90 mins after injection. Coloration may formation start to appear
only appear later in the process right after injection

Often; Stay for several days,

Swelling Unlikely Unlikely Ulceration usually occurs
48-96 hr later
Inability to obtain blood
Blood return Usually, but not always intact Usually, but not always intact
return
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Prevention Measures

1. Training
2. Appropriate equipment selection and vascular access
3. Patient education
4. Continuous monitoring at the beginning and during the infusion
every 5 to 10 min
5. Documentation and reporting of any extravasation incident

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Management

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 Stop the infusion immediately. Do not flush the line, and avoid applying
1 pressure to the site while keeping the cannula or port needle in place
Initial non-pharmacologic
2 Notify the physician
management

3 Attempt to aspirate chemotherapeutic agent using a 10 ml syringe

4 Remove the cannula or port needle then the catheter

5 Elevate the affected limb and apply either cold or hot packs as indicated

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Extravasation Tray

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 Vesicant Damage control
Cold Compress Warm Compress

Actinomycin D Doxorubicin Docetaxel

Amsacrine Epirubicin Oxaliplatin
Bendamustine Idarubicin Paclitaxel
Carmustine Mitomycin C Vinblastine
Carbazitaxel Mitoxanthrone Vincristine
Darcarbazine Mustine Vindesine
Dactinomycin Streptozotocin Vinflunine
Daunorubicin Treosulphan Vinorelbine

Apply for 20 min 4 times a day for 1 – 2 days

Non-vesicant : COLD Compress
• To reduce redness and inflammation:
Apply a thin layer of hydrocortisone cream (1%) twice a day until the redness disappears.
Discontinue if the area blisters

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Antidotes

Class/Drug Antidote Availability in NCCCR

Anthracyclines DMSO, Dexrazoxane Not available

Cisplatin, Oxaliplatin,
Sodium thiosulfate Available in the kit
Mechloretamine

Docetaxel, Vinca alkaloids Hyaluronidase Available in the kit

Mytomicin, Mitoxantrone DMSO Not available

*DMSO: Dimethyl sulfoxide

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Summary

Try to aspirate as
Stop infusion
much of the drug as
immediately. DO Inform the
possible from the
NOT remove the physician
cannula with a 10
cannula
ml syringe

Elevate limb and Remove the

apply compressor cannula/needle if
Re-evaluate
or administer pain antidote will not be
relief if required given

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Thank you
Questions?

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References

§ Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention and

management of chemotherapy extravasation. World Journal of Clinical
Oncology. 2016;7(1):87-97.
§ Prevention and management of extravasation of chemotherapy. British
Columbia Cancer Agency, January 2016. Available: URL:
http://www.bccancer.bc.ca/systemic-therapy-
site/Documents/Policy%20and%20Forms/III_20_ExtravasationManagement
_1May2016.pdf
§ Prevention and management of extravasation of chemotherapy. British
Columbia Cancer Agency. January 2016
§ Boschi R, Rostagno E. Extravasation of Antineoplastic Agents: Prevention and
Treatments. Pediatric Reports. 2012;4(3):e28.

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