Chemotherapy extravasation
Chemotherapy extravasation is leakage of a vesicant or irritant antineoplastic drug from the vein into surrounding tissue, diagnosed clinically by pain, swelling, and loss of blood return during infusion. First-line treatment is immediate cessation of the infusion, aspiration of residual drug, and an agent-specific antidote: dexrazoxane for anthracyclines or hyaluronidase for vinca alkaloids.
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What this article covers
- Overview
Chemotherapy extravasation is inadvertent leakage of an antineoplastic drug from the vein into surrounding subcutaneous tissue during administration.
- Epidemiology
Extravasation is best characterized for antineoplastic agents given through peripheral catheters, since central venous access largely eliminates the risk of subcutaneous leakage.
- Risk factors
Peripheral rather than central venous access: an implanted port or peripherally inserted central catheter (PICC) largely removes the risk for vesicant infusions.
- Pathophysiology
Vesicant antineoplastic drugs are classified by whether they bind DNA once in the extravascular space.
- Clinical features
Onset during infusion: burning, stinging, or sharp pain at the needle site, often before visible change, sometimes with resistance on the syringe.
- Differential diagnosis
Flare reaction: immediate erythema or itching along the vein without pain or swelling, resolves within about an hour with normal blood return throughout, unlike extravasation.
- Diagnosis
The diagnosis is clinical, established by the temporal relationship between an infusing vesicant or irritant drug and new pain, swelling, or induration at the site, with loss of free blood return on…
- Management
First, stop the infusion immediately and disconnect the tubing from the catheter hub without removing the catheter.
- Complications
Blistering and superficial breakdown: can appear within hours of a potent vesicant extravasation.
- Prognosis
With prompt recognition and agent-appropriate treatment, most extravasations resolve over days to a couple of weeks without progressing to necrosis.
- Prevention
Use central venous access for vesicant regimens whenever feasible, particularly for continuous infusions or repeated cycles, removing the risk of subcutaneous leakage.
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