Occasionally a chemotherapeutic agent may extravasate during intravenous infusion. The risk of a severe injury depends on the nature of the of the chemotherapeutic agent, the amount of extravasate and any therapeutic interventions.
|
Agents Usually Not Causing a Local Reaction |
Agents Associated with Local Irritation |
Vesicant Agents Associated with Ulceration |
|
asparginase |
carmustine |
actinomycin D (dactinomycin) |
|
bleomycin sulfate |
cyclophosphamide |
cisplatin |
|
cytarabine |
dacarbazine |
daunorubicin HCl |
|
etoposide |
streptozocin |
doxorubicin HCl |
|
methotrexate |
teniposide |
5-fluorouracil (5-FU) |
|
thioguanine |
thiotepa |
mithramycin |
|
|
ifosamide |
mitomycin |
|
|
liposomal doxorubicin |
mitozantrone HCl |
|
|
menogaril |
mustine HCl |
|
|
paclitaxel |
vinca alkaloid (vinblastine, vincristine, vindesine) |
|
|
|
epirubicin |
from page 186 (Cox et al) with additional drugs added
where:
• Cox et al raise questions about the risk of ulceration for cisplatin, 5-FU, and mitozantrone
Responses to reduce complications of an extravasation:
(1) Prevent by careful administration and close monitoring during chemotherapy infusions.
(2) Stop the infusion as soon as possible once an extravasation is suspected.
(3) Estimate the clinical significance of the extravasation.
(4) Try to aspirate any fluid collections.
(5) Intervene to reduce toxicity (see table below).
(6) Consider liposuction or normal saline washout (see Chapter 32, under "Techniques of Gault for Prevention of Extravasation Injury")
(7) Document injury and photograph site.
|
Agent |
Antidote |
Hot or Cold Compress |
Elevate Limb |
Protect from Sunlight |
|
cisplatin |
STS |
|
|
|
|
dacarbazine |
|
|
|
yes |
|
dactinomycin |
|
ice |
yes |
|
|
daunorubicin |
? DMSO |
ice |
|
|
|
doxorubicin |
? DMSO |
ice |
|
yes |
|
etoposide |
|
warm |
|
|
|
mitomycin |
? DMSO |
|
|
yes |
|
nitrogen mustard |
STS |
|
|
|
|
paclitaxel |
|
ice |
|
|
|
vinca alkaloid |
|
heat |
yes |
|
where:
• STS = sodium thiosulfate, 10% or 25% is diluted in sterile water for injection
• For nitrogen mustard 4 mL 10% STS is mixed with 6 mL sterile water. 2 mL of this mixture is injected for each 1 mg of drug extravasated.
• For cisplatin 4 mL 10% STS is mixed with 6 mL sterile water. 5 mL of this mixture (2 mL 10% STS) is injected for each 100 mg of cisplatin extravasated.
• DMSO = dimethyl sulfoxide 99%, 1-2 mL applied to site every 6 hours
Purpose: To evaluate a patient who has had extravasation of a chemotherapeutic agent from an infusion into adjacent soft tissue.
Specialty: Hematology Oncology, Dermatology
Objective: risk factors, adverse effects
ICD-10: T45.1,
