Introduction

• Extravasation occurs when a drug accidentally leaks into the subcutaneous or subdermal tissue surrounding the intravenous administration site Chemotherapy complications.
• Due to their nature, many chemotherapeutical agents can cause significant tissue injury after extravasation Chemotherapy: safe handling.

• Extravasated chemotherapeutic drugs can be classified, according to their potential for causing damage, in vesicants, irritants, non-irritants:

Vesicants

• Vesicants can cause tissue necrosis and blister formation after extravasation.
• Doxorubicin Doxorubicin is considered to have the greatest vesicant potential when compared to other chemotherapeutical agents. This is due to its ability to enter the cells and bind to DNA causing immediate and continuous tissue damage, potentially lasting for months.  

Irritants

• Irritants can cause pain, inflammation and erythema at the extravasation site without blisters formation. They include:
  • Carboplatin Carboplatin/cisplatin
  • 5-Fluorouracil.

Non-irritants 

• Non-irritants do not cause inflammation or tissue damage after extravasation. They include:
  • L-asparaginase.
  • Bleomycin.

Preventing extravasation

Managing chemotherapy extravasation

Further Reading

Publications

Refereed Papers

• Recent references from PubMed and VetMedResource.
• Pérez Fidalgo J A, García Fabregat L, Cervantes A et al (2012) Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol 23 (Suppl 7), vii 167-vii 173 PubMed.
• Wengström Y, Margulies A & European Oncology Nursing Society Task Force (2008) European Oncology Nursing Society Extravasation Guidelines. Eur J Onc Nurs 12 (4), 357-361 PubMed.
• Olver I N, Aisner J, Hament A et al (1988) A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol 6 (11), 1732-1735 PubMed.

Other sources of information

• Vail D M (2006) New Supportive Therapies for Cancer Patients. In: Proc 24^th Annual ACVIM Forum.
• Alwood M, Stanley A & Wright P (2002) The Cytotoxic Handbook. 4th edn. CRC Press, USA.
• Kisseberth W C & MacEwen E G (2001) Complications of Cancer and its Treatment. In: Small Animal Clinical Oncology. 3rd edn. Eds: Withrow S J & MacEwen E G. W B Saunders, USA. pp 198-219.