Extravasation

Abstract

The accidental extravasation of anticancer drugs into the perivenous tissues can cause significant tissue damage if vesicants are being administered. Strategies to prevent damage include adequate training of staff who administer these drugs, selecting appropriate venous access or using central venous access devices and closely monitoring the patient during therapy administration. The signs and symptoms commence with burning at the injection site and then redness and oedema progressing to induration and sometimes ulceration. There are guidelines from groups such as ASCO and ONS, but often the literature only has low-level evidence of the efficacy of treatment. Management encompasses general measures including stopping the infusion, withdrawing as much of the extravasated drug through the needle as possible, and then elevating and immobilising the limb. Measures to reduce damage include either heating or cooling depending on the drug extravasated and then administering the appropriate antidote such as dexrazoxane for anthracycline extravasation or topical DMSO for anthracycline or mitomycin C extravasations. Hyaluronidase is often recommended for vinca alkaloid extravasation and sodium thiosulphate for mechlorethamine extravasation. There are experimental studies using growth factors such as GM-CSF to promote healing. Surgical debridement is used if these conservative measures fail to control the tissue damage.