Warning

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.

Anti-cancer agent Timeframe to contact Oncology Recommended immediate actions

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.

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

Anti-cancer agent Timeframe to contact Oncology Recommended immediate actions

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

Anti-cancer agent Timeframe to contact Oncology Recommended immediate actions

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 

Anti-cancer agent Timeframe to contact Oncology Recommended immediate actions

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

Anti-cancer agent Timeframe to contact Oncology Recommended immediate actions

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.

Editorial Information

Last reviewed: 05/01/2024

Next review date: 05/01/2027

Author(s): El-Shakankery K, Hopkins S.

Version: 1.0

Author email(s): karim.el-shakankery2@nhs.scot, samantha.hopkins@nhslothian.scot.nhs.uk.

Approved By: Oncology Directorate