Copyright ©The Author(s) 2016.
World J Clin Oncol. Feb 10, 2016; 7(1): 87-97
Published online Feb 10, 2016. doi: 10.5306/wjco.v7.i1.87
Table 1 The different types of the above mentioned drugs according to their vesicant potential
NeutralsInflammitantsIrritantsExfoliants (may have low vesicant potential)Vesicants
Asparaginase Bevacizumab bleomycin Bortezomib cetuximab, CyclophosphamideBortezomibBendamustineAclacinomycin cisplatin Docetaxel liposomal Doxorubicin mitoxantrone Oxaliplatin paclitaxelActinomycin D
Cytarabine eribulin Fludarabine gemcitabine Ifosfamide5-Fluorouracil methotrexate raltitrexedBleomycinDactinomycin daunorubicin Doxorubicin epirubicin Idarubicin mitomycin C Vinblastine vindesine
Melphalan rituximabCarboplatin dexrasoxaneVincristine vinorelbine
Table 2 Grades of Infusion site extravasation according to common terminology criteria for adverse events (V4.0, May 2009)
Adverse eventGrade
Infusion site extravasation-Erythema with associated symptoms (e.g., edema, pain, induration, phlebitis)Ulceration or necrosis; severe tissue damage; operative intervention indicatedLife-threatening consequences; urgent intervention indicatedDeath
Table 3 Overall summary of guidelines for prevention of chemotherapy extravasation
Continuous education of the medical team about all policies and protocols regarding chemotherapy administration
Classification of chemotherapeutic drugs: Knowledge of characteristics of the drug and compliance to the manufacturer’s recommendations
Appropriate vascular access
In case a central vascular access is not possible, an adequate peripheral vein is used[16]
Veins that are small and/or fragile should be avoided[2,20]
It is not recommended to use veins located at the dorsum of the hand, the antecubital fossa, and the radial and ulnar aspects of forearm[2,20]
Appropriate peripheral arm assessment[1,2,16]
Palpation of the vein
History of previous venipunctures
Available extremities where veins can be punctured
Level of consciousness of the patient
Appropriate equipment selection[42,43]
Use of the smallest size of cannula in the largest available vein
Use of 1.2-1.5 cm long small bore plastic cannula
Use of a clear dressing
Avoiding the use of a butterfly needle
Educating the patient about all risks associated with chemotherapy administration
Devising and updating standards and policies regarding chemotherapy administration at each healthcare center
Documentation and reporting of any extravasation incident
Table 4 Non-pharmacological management of chemotherapy extravasation
Institutions should always ensure availability of “extravasation kits” at floors in which chemotherapy can be given
Initial non-pharmacologic management
Continuous monitoring at the beginning and during the infusion is essential every 5 to 10 min
Aspiration of the vesicant by a 10 mL syringe, percutaneous needle aspiration, liposuction, simple squeeze maneuver, or by surgical fenestration and irrigation
Elevation of the affected limb and thermal application (cold or hot)
Table 5 Pharmacological management of chemotherapy extravasation
Dexrazoxane as an antidote to anthracyclines extravasation has level III-B evidence[16]
Hyaluronidaseas an antidote to vinca-alkaloids and to taxanes extravasation has level V-C evidence[16]
Topical DMSO (99%) as an antidote to anthracycline extravasation and to Mytomicin C has level IV-B evidence[16]
Sodium thiosulfate as an antidote to mechlorethamine extravasation has level V-C evidence[16]