Professional Documents
Culture Documents
Extravasation and Its Management
Extravasation and Its Management
➢ Alkylating agents
➢ Antimetabolites
➢ Other
- Cancer patients with hardened and thickened vessels due to frequent venipuncture
- Inadequate dressings
Pallor can be difficult to detect in dark skin, so healthcare professionals may check
the eyes, palms, and nail beds for signs of discoloration.
GRADE IV :
GRADE V : Death
0 1 2 3 4
Color Normal Pink Red Blanched Blackened
Integrity Unbroken Blistered Superficial skin Tissue loss Tissue loss
loss exposing exposing
subcutaneous muscle/bone
tissue with a deep
crater or
necrosis
1. Stop the infusion and leave the cannula in place. (Put on sterile gloves)
2. Remove as much of the drug as possible using a 10–20-milliliter syringe
(connected to the cannula). Slowly aspirate back blood back from the arm,
preferably with as much of the infusion solution as possible.
3. Alleviate any pressure on the affected area.
4. If there are blisters on the arm, aspirate content of blisters with a new thin
needle
5. Take out the cannula and mark the affected area with a pen.
6. Alert a doctor if they have not done so already so that treatment can begin.
● Depending on the type of drug that has leaked into the tissue, doctors may
warm or cool the affected area to stop the drug from spreading.
● If, for the extravasated medication, substance-specific measures apply, carry
them out (e.g. topical cooling, DMSO, hyaluronidase or dexrazoxane may be
appropriate).
WARM AND COLD COMPRESSION
● Generally cold compresses are recommended for extravasation of all irritant
and vesicant drugs except vinca alkaloids (vincristine, vinblastine,
vinorelbine), epipodophyllotoxins (etoposide), oxaliplatin, and vasopressors,
as cold worsens tissue ulceration caused by these drugs.
● Cold compresses cause vasoconstriction, limiting the spread of the
extravasated drug. Additionally, cold reduces local inflammation and pain.
● Warm compresses are preferred for extravasation of specific drugs including
vinca alkaloids, etoposide, vasopressors, and oxaliplatin to increase local
blood flow and enhance drug removal.
● Apply compresses for 20 to 60 minutes 3 or 4 times daily for the first 24 to 72
hours after extravasation occurs.
ANTIDOTES
Vesicant agent Antidote Local treatment
Alkylating agent (nitrogen mustard) Sodium thiosulfate Cooling pack
Extremity elevation
Anthracyclines (daunorubicin, Dexrazoxane Cooling pack
doxorubicin, epirubicin, idarubicin) Extremity elevation
Antitumor antibiotics NA Cooling pack
(dactinomycin, mitomycin C)
Plant alkaloids (vinblastine, Hyaluronidase Heating pack
vincristine, vindesine, vinorelbine) Extremity elevation
Alkylating agent:
Give sodium thiosulfate as prescribed.
i. Administer sodium thiosulfate immediately after extravasation.
ii. Inject 2 ml of the antidotal solution (with a 25-G or smaller needle) for each
milligram of mechlorethamine extravasated.
Sodium thiosulfate neutralizes nitrogen mustard extravasation to form non-toxic
thioesters that are excreted in urine.
Anthracyclines:
Administer dexrazoxane intravenously as prescribed within 6 hours of
extravasation or as soon as possible.
Systemic dexrazoxane treatment prevents anthracycline-induced wound formation
by binding to iron and preventing the formation of free radicals.
i. Apply ice over tissue that is extravasated with an anthracycline.
ii. Remove ice 15 minutes before initiating the dexrazoxane treatment to allow blood flow
to the area of extravasation.
iii. Administer a daily dexrazoxane dose of 1000 mg/m2 intravenously over 1 to 2 hours;
then on the third day, administer one dose of 500 mg/m2 within 24 hours for a total of 3
days.
iv. Administer dexrazoxane intravenously away from the extravasation site (e.g., on the
opposite arm).
v. Monitor the complete blood count, including granulocyte and platelet counts, and liver
enzyme levels.
Bone marrow suppression and elevated liver enzyme levels are potential side effects of
dexrazoxane.
Vinca alkaloids and microtubule inhibitors:
Hyaluronidase degrades hyaluronic acid, promotes drug diffusion, and enhances drug
absorption.
ii. The usual dose is 1 ml of hyaluronidase solution for every 1 ml of extravasated agent.
No known antidote is available. Care includes ice pack application for 15 to 20 minutes
at least four times a day for the first 24 hours
Vesicant or Irritant Administration with Suspicion of Extravasation
● Schedule the patient for follow-up assessments of the site at, minimally, 24
hours, 48 hours, and 1 week after the extravasation, preferably by the same
practitioner or nurse.
● Follow-up should continue for at least 3 weeks or until complete resolution of
the extravasated site.
● Photograph the site at each assessment.
● Document the site’s appearance, the patient’s reports, and functional changes
at each assessment.
● Instruct the patient to keep the affected extremity elevated.
PREVENTION
● Implement standardized, evidenced-based techniques when inserting
cannulas
● Avoiding inserting needles into joints or areas that are difficult to secure
● Choosing a different IV route or alternative vein if possible
● Removing and resecuring a cannula if it seems unstable
● Looking out for swelling when administering medication
● Asking a person if they feel any pain when administering a medication or
solution
● Delivering drugs at the correct rate
● Checking for blood flowing backward through the cannula
● Choose a large, intact vein with good blood flow for the venipuncture and
placement of the cannula. Place the smallest gauge and shortest length
catheter to accommodate the infusion.
● The infusion should consist of a suitable carrier solution with an appropriately
diluted medicinal/chemotherapy drug inside.
● After the IV infusion has finished, flush the cannula with the appropriate fluid.
● Ensure that the extravasation kit, antidote, and spill kit are accessible.
DOCUMENTATION
(1) Patient name and number
(3) Name of the drug extravasated and the diluent used (if applicable)
(6) Extravasation area (and the approximate amount of the drug extravasated)