Extravasation Treatment

Extravasation is a serious, infusion-related complication in which the drug being infused into the body through an IV escapes the vein and intrudes into the surrounding tissue.

By making contact with the tissue, so-called vesicant drug—which in the context of cancer will likely be some form of chemotherapy, such as doxorubicin, vinblastine, or vincristine, can do a lot of damage (non-chemotherapeutic vesicant drugs might include calcium chloride, dopamine, or concentrated potassium chloride, among others).

Tissue damage from extravasation depends on the concentration of the drug in the tissue. Therefore, the best extravasation treatment is for the medical staff to be vigilant and assess an infusion of a vesicant drug every 15-20 minutes or so.

Even under those circumstances, extravasation can occur. When it does, the medical staff might choose to treat it using sodium thiosulfite and DMSO, despite the fact that neither of these options have demonstrated a whole lot of success. Other treatment options include subcutaneous steroid injections or applying a steroid cream to the affected area.

Often, there are specific treatment options in place for specific types of drugs. For example:

-- If the vesicant drug that extravasates is the commonly used chemotherapy drug doxorubin, the manufacturer recommends applications of cold packs to the affected areas.

- If the vesicant drug that extravasates is a vinca alkaloid, warm packs are often applied to to the affected areas.

The presiding physician is notified immediately of the extravasation, and should be told of the vesicant drug and the concentration given. The reason is because this is a very serious potential complication: patients who experience extravasation find that it can be extremely painful. Some require a skin graft over the affected area because necrosis occurs. At the very far end of the spectrum, the tissue damage could be so severe that amputation may be required.

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