Table of ContentsView AllTable of ContentsIrritant ExtravasationVesicant ExtravasationPrevention TipsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Irritant Extravasation
Vesicant Extravasation
Prevention Tips
Frequently Asked Questions
Extravasationis when achemotherapy drugleaks from a blood vessel or tube onto the surrounding skin and tissue, causing adverse symptoms. The leakage most occurs at the site where an intravenous (IV) needle is inserted into a vein to deliver the drugs.
This article explores the causes and symptoms of irritant and vesicant extravasation, including how they are treated and prevented.
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What Is Irritant Extravasation?
Certain drugs in chemotherapy are classified as irritants because they can cause temporary, superficial injury to tissues. These drugs are also sometimes referred to as non-vesicants.
If there is extravasation of an irritant medication, symptoms often include:
In some cases, the drugs can cause skin ulcers, but generally if the leakage is prolonged or excessive. Some skin types are also more sensitive than others.
Examples of irritant drugs used in chemotherapy include:
If one of these medications leaks, your healthcare provider will stop the drug, start a new IV line, and give the remainder of the drug through a fresh site.
The treatment may involve mild pain killers such as Tylenol (acetaminophen) andcold compressesto help reduce localinflammation.
The terminfiltrationis sometimes used rather thanextravasationwhen an irritant chemotherapy drug is involved.
What Is Vesicant Extravasation?
Vesicants are drugs that have the potential to cause serious tissue damage if they leak. In this case, the inflammation and discomfort at the IV site will be more noticeable.
Some of the signs of extravasation may not be visible until several hours or days after the leakage. Depending on the amount of drug that is extravasated, symptoms may include:
People with skin necrosis usually have a high fever and are in intense pain. If not treated aggressively withantibioticsand thesurgical removal of dead tissue, limb amputation may be needed. Death is also possible.
Examples of vesicant drugs used in chemotherapy include:
If there are signs of vesicant extravasation, your healthcare team may outline the affected area with a marker so that they can tell if it is getting better or worse. If it worsens, your healthcare provider will clean the affected area and give the remainder of the chemotherapy medications through a fresh IV site.
If there are signs or the risk of tissue damage due to extravasation, a drug called Zinard (dexrazoxane) may be given intravenously to limit the damage. It should be administered within six hours of an extravasation accident.
Preventing Chemotherapy Extravasation
Althoughoncologynurses are trained in administering chemotherapy drugs, accidents can and do occur.
If the risk of extravasation is high, your healthcare provider may choose to insert acentral venous catheter (CVC)rather than using an IV drip.
A CVC is a thin, flexible tube that is inserted into a vein, usually below the right collarbone, and threaded into a large vein just above the heart called thesuperior vena cava. Extravasations from CVCs, while still a possibility, are exceedingly rare.
There are a few things you can also do to prevent an extravasation injury:
If you notice any redness or swelling after leaving the cancer center, call your healthcare provider immediately.
A Word From Verywell
Chemotherapy extravasation is relatively uncommon. And, while every measure is taken to prevent an accident, they still do occur.
As such, never hesitate to speak up if any part of your chemo infusion feels odd or uncomfortable. A rapid response is the best way to avoid injury if and when an extravasation accident occurs.
Frequently Asked QuestionsIt depends on the chemotherapy drug used. If the drug is a vesicant, meaning that it has the potential to cause blisters, prolonged or excessive leakage onto the skin can cause tissue damage, including the risk of tissue death (necrosis).In chemotherapy, infiltration is used to describe the leakage of milder irritant drugs onto the skin, while extravasation is the leakage of stronger and potentially harmful vesicant drugs onto the skin. Even so, some people apply the termextravasationto both irritant and vesicant drugs.If tissue injury occurs as a result of extravasation, a drug called Zinecard (dexrazoxane) may be administered to treat and limit the tissue damage. The drug is given intravenously (into a vein) over one or two hours.
It depends on the chemotherapy drug used. If the drug is a vesicant, meaning that it has the potential to cause blisters, prolonged or excessive leakage onto the skin can cause tissue damage, including the risk of tissue death (necrosis).
In chemotherapy, infiltration is used to describe the leakage of milder irritant drugs onto the skin, while extravasation is the leakage of stronger and potentially harmful vesicant drugs onto the skin. Even so, some people apply the termextravasationto both irritant and vesicant drugs.
If tissue injury occurs as a result of extravasation, a drug called Zinecard (dexrazoxane) may be administered to treat and limit the tissue damage. The drug is given intravenously (into a vein) over one or two hours.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Boschl R, Rostagno E.Extravasation of antineoplastic agents: prevention and treatments.Pediatr Rep.2012 Jul 31;4(3):e28. doi:10.4081/pr.2012.e28Odom B, Lowe L, Yates C.Peripheral infiltration and extravasation injury methodology: a retrospective study.J Infus Nurs. Jul/Aug 2018;41(4):247-52. doi:10.1097/NAN.0000000000000287Al-Benna S, O’Boyle C, Holley J.Extravasation injuries in adults.ISRN Dermatol. 2013;856541. doi:10.1155/2013/856541Pérez Fidalgo JA, García Fabregat L, Cervantes A, et al.Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines.Ann Oncol. 2012;23(Suppl 7):vii167-73. doi:10.1093/annonc/mds294
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Boschl R, Rostagno E.Extravasation of antineoplastic agents: prevention and treatments.Pediatr Rep.2012 Jul 31;4(3):e28. doi:10.4081/pr.2012.e28Odom B, Lowe L, Yates C.Peripheral infiltration and extravasation injury methodology: a retrospective study.J Infus Nurs. Jul/Aug 2018;41(4):247-52. doi:10.1097/NAN.0000000000000287Al-Benna S, O’Boyle C, Holley J.Extravasation injuries in adults.ISRN Dermatol. 2013;856541. doi:10.1155/2013/856541Pérez Fidalgo JA, García Fabregat L, Cervantes A, et al.Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines.Ann Oncol. 2012;23(Suppl 7):vii167-73. doi:10.1093/annonc/mds294
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Boschl R, Rostagno E.Extravasation of antineoplastic agents: prevention and treatments.Pediatr Rep.2012 Jul 31;4(3):e28. doi:10.4081/pr.2012.e28Odom B, Lowe L, Yates C.Peripheral infiltration and extravasation injury methodology: a retrospective study.J Infus Nurs. Jul/Aug 2018;41(4):247-52. doi:10.1097/NAN.0000000000000287Al-Benna S, O’Boyle C, Holley J.Extravasation injuries in adults.ISRN Dermatol. 2013;856541. doi:10.1155/2013/856541Pérez Fidalgo JA, García Fabregat L, Cervantes A, et al.Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines.Ann Oncol. 2012;23(Suppl 7):vii167-73. doi:10.1093/annonc/mds294
Boschl R, Rostagno E.Extravasation of antineoplastic agents: prevention and treatments.Pediatr Rep.2012 Jul 31;4(3):e28. doi:10.4081/pr.2012.e28
Odom B, Lowe L, Yates C.Peripheral infiltration and extravasation injury methodology: a retrospective study.J Infus Nurs. Jul/Aug 2018;41(4):247-52. doi:10.1097/NAN.0000000000000287
Al-Benna S, O’Boyle C, Holley J.Extravasation injuries in adults.ISRN Dermatol. 2013;856541. doi:10.1155/2013/856541
Pérez Fidalgo JA, García Fabregat L, Cervantes A, et al.Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines.Ann Oncol. 2012;23(Suppl 7):vii167-73. doi:10.1093/annonc/mds294
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