Managing Extravasation During Chemotherapy Administration

Management

Guidelines have been published by the Oncology Nursing Society (ONS) and the American Society of Clinical Oncology (ASCO) for the prevention and treatment of extravasation. Initial management begins by immediately stopping the infusion as soon as extravasation is suspected. The IV cannula should be left in place, and aspiration of the vesicant should be attempted. For some vesicants, an antidote may be administered to the area. Dexrazoxane is an antidote given via IV infusion for an anthracycline extravasation. Hyaluronidase is a medication that is given subcutaneously for extravasations resulting from the IV administration of taxanes and vinca alkaloids. Dimethyl sulfoxide is a topical medication used for preventing ulcerations caused by extravasation.

Nonpharmacologic interventions include elevating the affected extremity and applying either heat or cold packs to the affected area. Cold packs should not be used in a vinca alkaloid extravasation because doing so may cause further tissue damage. Heat or cold packs should be used 4 times a day for approximately 20 minutes during the first few days following extravasation. Other treatments that may be required for severe cases of extravasation include surgical procedures such as debridement of necrotic tissue, skin grafting, placement of vacuum-assisted closure devices, and hyperbaric oxygen.²               

The erythematous area should be marked with a pen to assess the progression of tissue damage. If possible, pictures should be taken of the affected area to be used for comparison. The extravasation should be well documented and include the date and time of occurrence, which medication was administered, an estimation of the volume of the medication extravasated, a description of interventions that were taken, and a description of signs and symptoms that the patient experienced.

Prevention

Measures can be taken to prevent extravasation. If possible, vesicants should be given through a central venous access device, as the risk of extravasation is decreased with this type of IV access. Nursing staff should be educated and trained in chemotherapy safety and how to manage a suspected extravasation. They also should be educated in how to properly select a vein and the size of the IV cannula needed for peripherally administered vesicants or irritants that are associated with vesicant potential. The IV site should be monitored frequently during administration of the vesicant for signs of extravasation. Extravasation kits should be present during the infusion and should contain IV needles, syringes, saline, antidotes, sterile water, and heat and cold packs.³

References

1. Jackson-Rose J, Del Monte J, Groman A, et al. Chemotherapy extravasation: establishing a national benchmark for incidence among cancer centers. Clin J Oncol Nurs. 2017;21(4):438-445. doi:10.1188/17.CJON.438-445
2. Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention and management of chemotherapy extravasation. World J Clin Oncol. 2016;7(1):87-97. doi:10.5306/wjco.v7.i1.87
3. Kim JT, Park JY, Lee HJ, Cheon YJ. Guidelines for the management of extravasation. J Educ Eval Health Prof. 2020;17:21. doi:10.3352/jeehp.2020.17.21
4. U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE). Version 5.0. Published November 27, 2017. Accessed May 13, 2021. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf