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of Vancouver General Hospital. Prepared by the Pharmaceutical Sciences Clinical Services Unit by authority of the Drugs & Therapeutics Committee and the Medical & Academic Advisory Committee. |
APPENDIX VII: EXTRAVASATION OF ANTINEOPLASTIC AGENTS
All antineoplastic agents in this Appendix have been categorized according to their vesicant potential. Vesicant agents are those which are destructive to the subcutaneous tissues and can cause extensive tissue necrosis upon extravasation. Most antineoplastic agents are non-vesicant and their inadvertent infiltration into subcutaneous tissues will, at most, cause only temporary local swelling and mild discomfort. Highly vesicant agents however, are extremely destructive and extensive tissue necrosis, often with permanent disability and a need for skin grafting, may result from even small interstitial leaks. It is essential that vesicant agents be given either through central lines or through large peripheral veins with rapidly running IV's. In particular, the small veins on the hand or foot are to be avoided. Placement of the intravenous needle must be performed carefully and observation for signs of any interstitial leakage must be made frequently during the infusion. The needle must be flushed thoroughly at the end of the injection prior to withdrawal. If at any time there is any question about the puncture site, the infusion should be promptly stopped. Pain at the injection site occurs frequently with these drugs, even with a properly established IV, but will ease off quickly if the injection is slowed or stopped. If pain persists, or if there is any swelling at the IV site, then it should be assumed that extravasation has occurred.
|
VESICANT |
|
NONVESICANT5 |
|
|
IRRRITANT |
MINIMAL |
NONE |
|
|
amsacrine1 |
bortezomib |
methotrexate |
asparaginase |
1 follow protocol for
extravasation of vesicant agents
2 follow specific extravasation protocol
(daunorubicin, doxorubicin, epirubicin, mitomycin)
3 follow specific extravasation protocol
(methlorethamine)
4 follow specific extravasation protocol
(vinblastine, vincristine)
5 follow protocol for extravasation of nonvesicant
agents
Rev. Jan 2007
1. Discontinue the drug injection immediately and notify physician.
2. Leave the needle in place to aspirate as much of the infiltrated agent as possible.
3. Obtain extravasation kit from Pharmacy. (Note: at VGH kits are available on BMT nursing unit and BMT MDCU .)
4. For extravasations >1-2 mL: Physician to inject 1-5 mL of 1/6 molar sodium thiosulfate solution given through the existing IV line. (If this is to be helpful, it must be done immediately after the extravasation and preferable through the same needle injection into the same tissue plane as the extravasation.)
5. Remove the needle.
6. Elevate the limb with the site of injury.
7. Apply ice pack wrapped in a towel or cold compresses to the extravasation site for 1 hour. Care must be taken to avoid tissue injury from excessive cold.
8. Restart an I.V. in another site away from the limb of injury to complete the chemotherapy.
9. Observe the site for tissue breakdown and signs that an early surgery consult may be warranted.
10. Hydrocortisone 1% cream applied twice daily may be helpful on reddened skin.
11. Inform patient (if an outpatient) to observe the site regularly for several weeks for signs of tissue breakdown such as pain, redness and swelling.
Rev. July 2003
1. Discontinue the drug injection immediately and notify physician.
2. Disconnect the IV tubing leaving the needle in place and aspirate as much of the infiltrated agent as possible.
3. Remove the needle.
4. Elevate the limb with the site of injury.
5. Apply ice pack wrapped in a towel or cold compresses to the extravasation site for 1 hour. Care must be taken to avoid tissue injury from excessive cold.
6. Restart an I.V. in another site away from the limb of injury to complete the chemotherapy.
7. Observe the site for signs of tissue breakdown.
8. Inform patient (if an outpatient) to observe the site closely, and to report to their physician any redness and pain persisting longer than 2-3 days.
Rev. September 1998
1. Discontinue the drug injection immediately and notify physician.
2. Disconnect the IV tubing leaving the needle in place and aspirate as much of the infiltrated agent as possible.
3. Remove the needle.
4. Obtain extravasation kit from Pharmacy. (Note: at VGH kits are available on BMT nursing unit and BMT Day Care Unit.)
5. Elevate the limb with the site of injury.
6. Apply ice pack wrapped in a towel or cold compresses to the extravasation site for 1 hour. Care must be taken to avoid tissue injury from excessive cold.
7. Restart an I.V. in another site away from the limb of injury to complete the chemo.
8. Observe the site for tissue breakdown and signs that an early surgery consult may be warranted.
9. Hydrocortisone 1% cream applied twice daily may be helpful on reddened skin.
10. Inform patient (if an outpatient) to observe the site regularly for several weeks for signs of tissue breakdown such as pain, redness and swelling.
Rev. July 2003
1. Discontinue the drug injection immediately and notify physician.
2. Disconnect the IV tubing leaving the needle in place and aspirate as much of the infiltrated agent as possible.
3. Obtain extravasation kit from Pharmacy. (Note: at VGH kits are available on BMT nursing unit and BMT Medical Day Care Unit)
4. Remove the needle.
5. Apply dimethylsulfoxide (DMSO) 99% topical solution using latex gloves to an area twice that affected by the extravasation, allow to air dry, do not cover. Repeat 4 times daily for at least 7 days. (Air drying is required as DMSO may cause blisters with occlusion.)
6. Elevate the limb with the site of injury.
7. Restart an I.V. in another site away from the limb of injury to complete the chemo.
8. Observe the site for tissue breakdown and signs that an early surgery consult may be warranted.
9. Hydrocortisone 1% cream applied twice daily may be helpful on reddened skin.
10. Inform patient (if an outpatient) to observe the site regularly for several weeks for signs of tissue breakdown such as pain, redness and swelling.
Rev. July 2003
1. Discontinue the drug injection immediately and notify physician.
2. Disconnect the IV tubing leaving the needle in place and aspirate as much of the infiltrated agent as possible.
3. Obtain extravasation kit from Pharmacy. (Note: at VGH kits are available on BMT nursing unit and BMT Medical Day Care Unit).
4. Remove the needle.
5. Elevate the limb with the site of injury.
6. Apply warm compresses to the extravasation site for 1 hour. Care must be taken to avoid tissue injury from excessive heat.
7. Restart an I.V. in another site away from the limb of injury to complete the chemotherapy.
8. Observe the site for tissue breakdown and signs that an early surgery consult may be required.
9. Hydrocortisone 1% cream may be applied twice daily to decrease redness of the site.
10. Inform the patient (if an outpatient) to observe the site regularly for several weeks for signs of tissue breakdown such as pain, redness and swelling.
Rev. July 2002