Suspected extravasation
Acute Oncology Guidelines
Audience
Suspected extravasation guidelines for non-oncologists
Peripheral extravasation (from a previous peripheral cannulation)
The following signs and symptoms could indicate a peripheral extravasation:
- Burning, stinging or any other acute change around the previous cannula site,
- There is swelling, leakage or induration around the previous cannula site,
- There is redness or blanching of tissue at the site,
- There is blistering and/or peeling at the site.
Central extravasation (from an in-situ or previous central line, PICC line, Hickman line or Port-a-Cath)
The following signs and symptoms could indicate a central extravasation:
- Leakage at the line entry site,
- Swelling of chest wall,
- Patient complains of aching/discomfort in the shoulder and neck,
- Patient complains of pain, breathlessness, dizziness,
- There is blistering, redness and/or peeling at the line entry site.
For all suspected extravasation, please consider the following:
- All suspected extravasations must be discussed with oncology – they will advise next steps on management (note that this guidance is only for INITIAL management; it is likely more will be required).
- Is there any evidence of infection and are antibiotics indicated?
- Swab any ulcerated or blistering sites for microbiology,
- Elevate the arm, where possible,
- Mark the erythematous area with a black ink pen to monitor its progress,
- DATIX the event,
- Ensure the patient has suitable follow up,
- Depending on the extravasated agent, further actions are shown below.
Vesicants – capable of pain, inflammation and blistering of local skin, underlying flesh and structures, leading to tissue death and necrosis. |
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| Anti-cancer agent | Timeframe to contact Oncology | Recommended immediate actions |
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DNA-binding compounds: doxorubicin, epirubicin, dactinomycin, mitomycin C |
If evidence of skin breakdown or ulceration – immediately. If evidence of blistering and/or rash – within 6 hours. |
Firmly apply a cold pack to the extravasated area for 30 minutes. every 4 hours for the first 24 hours. Never use heat on doxorubicin extravasations. Refer urgently to Plastic Surgical Team. This is time critical – within 6 hours of extravasation. |
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Non-DNA-binding compounds: vincristine, vinblastine, vinorelbine, |
If evidence of skin breakdown or ulceration – immediately. If evidence of blistering and/or rash – within 6 hours. |
Firmly apply a heat pack to the extravasated area for 20 minutes every 6 hours for the first 24 hours. Refer urgently to Plastic Surgical Team. This is time critical – within 6 hours of extravasation. |
Exfoliants – capable of inflammation and shedding of the skin, but less likely to cause tissue death |
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| Anti-cancer agent | Timeframe to contact Oncology | Recommended immediate actions |
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cisplatin, cabazitaxel, docetaxel, oxaliplatin, paclitaxel, nab-paclitaxel (abraxane), topotecan, pegylated liposomal doxorubicin (caelyx), dacarbazine |
Within 6 hours | Firmly apply a heat pack to the extravasated area for 20 minutes every 6 hours for the first 24 hours. |
Irritants – capable of inflammation and irritation, rarely proceeding to breakdown of the tissue |
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| Anti-cancer agent | Timeframe to contact Oncology | Recommended immediate actions |
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etoposide, carboplatin, irinotecan, traztuzamab emtansine (kadcyla) |
If evidence of skin breakdown or ulceration – within 6 hours. If evidence of blistering and/or rash – within 12 hours. |
Firmly apply a cold pack to the extravasated area for 30 minutes every 4 hours for the first 24 hours. Apply topical hydrocortisone cream 1% every 6 hours, for up to 7 days or as long as erythema continues. |
Inflammitants – capable of causing mild to moderate inflammation and flare in local tissue |
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| Anti-cancer agent | Timeframe to contact Oncology | Recommended immediate actions |
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fluorouracil (5-FU), methotrexate, raltitrexed, trabectedin. |
Within 6-12 hours. | Firmly apply a cold pack to the extravasated area for 30 minutes every 4 hours for the first 24 hours. |
Neutrals – ostensibly inert or neutral compounds that do not cause inflammation or damage |
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| Anti-cancer agent | Timeframe to contact Oncology | Recommended immediate actions |
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bleomycin, cladribine, cyclophosphamide cytarabine, gemcitabine, ifosfamide, ipilimumab, monoclonal antibodies including traztuzamab, cetuximab and panitumumab, nivolumab, pembrolizumab, pemetrexed. |
Within 6-12 hours | Firmly apply a heat pack to the extravasated area for 20 minutes every 6 hours for the first 24 hours. |