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  Related eLearning: Extravasation

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Evidence in the area of extravasation management for anti-cancer agents is extremely limited. Recommendations regarding the treatment of anti-cancer agent extravasation are based on animal models, case reports and a limited number of small uncontrolled studies, and are often conflicting. eviQ has reviewed all the available literature and attempted to provide some guidance in this area.

Drug name Class/clinical procedure Warm or cold compress Antidote
Aflibercept Non-irritant (neutral) Not indicated Not indicated
Alemtuzumab Non-irritant (neutral) Not indicated Not indicated
Amifostine Non-irritant (neutral) Not indicated Not indicated
Amsacrine Vesicant COLD compress apply 15 to 20 minutes FOUR times daily for 48 hours Dimethyl sulfoxide (DMSO 99% solution)
Antithymocyte globulin (horse) (ATGAM®) Non-irritant (neutral) * Not indicated Not indicated
Antithymocyte globulin (rabbit) (Thymoglobulin®) Non-irritant (neutral) * Not indicated Not indicated
Arsenic trioxide Non-irritant (neutral) Not indicated Not indicated
Asparaginase
(L-aspariginase)		 Non-irritant (neutral) Not indicated Not indicated
Atezolizumab Non-irritant (neutral) Not indicated Not indicated
Azacitidine Non-irritant (neutral)
(this does not preclude subcutaneous therapy)		 Not indicated Not indicated
Bendamustine Irritant with vesicant properties* COLD compress apply 15 to 20 minutes FOUR times daily for 48 hours Not indicated
Bevacizumab Non-irritant (neutral) Not indicated Not indicated
Bleomycin Non-irritant (neutral) Not indicated Not indicated
Blinatumomab​ Non-irritant (neutral) * Not indicated Not indicated
Bortezomib Irritant
(this does not preclude subcutaneous therapy)		 COLD compress
(initial for comfort measures)		 Not indicated
Brentuximab Non-irritant (neutral) Not indicated Not indicated
Busulfan Irritant COLD compress
(initial for comfort measures)		 Not indicated
Cabazitaxel Irritant* COLD compress
(initial for comfort measures)		 Not indicated
Calcium leucovorin Non-irritant (neutral) Not indicated Not indicated
Carboplatin Irritant COLD compress
(initial for comfort measures)		 Not indicated
Carfilzomib Non-irritant (neutral) Not indicated Not indicated
Carmustine Irritant COLD compress
(initial for comfort measures)		 Not indicated
Cetuximab Non-irritant (neutral) Not indicated Not indicated
Cisplatin ≤ 0.5 mg/mL Irritant COLD compress
(initial for comfort measures)		 Not indicated
Cisplatin > 0.5 mg/mL Vesicant (treated as an irritant with vesicant properties) COLD compress apply 15 to 20 minutes FOUR times daily for 48 hours No recommended antidote
Cladribine Non-irritant (neutral) Not indicated Not indicated
Cyclophosphamide Non-irritant (neutral) Not indicated Not indicated
Cytarabine Non-irritant (neutral) Not indicated Not indicated
Dacarbazine Irritant COLD compress
(initial for comfort measures)
(Phlebitis and pain not to be confused with extravasation)		 Not indicated
Dactinomycin (Actinomycin D) Vesicant COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour Dimethyl sulfoxide (DMSO 99% solution)
Daunorubicin Vesicant COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour Dimethyl sulfoxide (DMSO 99% solution)
Denosumab Non-irritant (neutral) Not indicated Not indicated
Docetaxel Irritant with vesicant properties COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour No recommended antidote
Doxorubicin Vesicant COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour Dimethyl sulfoxide (DMSO 99% solution)
Doxorubicin liposomal Irritant with vesicant properties* COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour No recommended antidote
Do not use DMSO 99% solution
Durvalumab Non-irritant (neutral) Not indicated Not indicated
Epirubicin Vesicant COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour Dimethyl sulfoxide (DMSO 99% solution)
Eribulin mesilate Non-irritant (neutral) Not indicated Not indicated
Etoposide Irritant COLD compress
(initial for comfort measures)		 Not indicated
Etoposide phosphate Irritant* COLD compress
(initial for comfort measures)		 Not indicated
Fludarabine Non-irritant (neutral) Not indicated Not indicated
Fluorouracil Irritant COLD compress
(initial for comfort measures)		 Not indicated
Fotemustine Irritant COLD compress
(initial for comfort measures)		 Not indicated
Ganciclovir Non-irritant (neutral) Not indicated Not indicated
Gemcitabine Irritant COLD compress
(initial for comfort measures)
(phlebitis and pain not to be confused with extravasation)		 Not indicated
Idarubicin Vesicant COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour Dimethyl sulfoxide (DMSO 99% solution)
Ifosfamide Irritant COLD compress
(initial for comfort measures)		 Not indicated
Interferon Non-irritant (neutral) Not indicated Not indicated
Ipilimumab Non-irritant (neutral) Not indicated Not indicated
Irinotecan Irritant COLD compress
(initial for comfort measures)		 Not indicated
Irinotecan nanoliposomal Irritant COLD compress
(initial for comfort measures)		 No recommended antidote
Melphalan Irritant with vesicant properties COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour No recommended antidote
Mesna Non-irritant (neutral) Not indicated Not indicated
Methotrexate Non-irritant (neutral) Not indicated Not indicated
Mitomycin Vesicant COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour Dimethyl sulfoxide (DMSO 99% solution)
Mitozantrone Irritant with vesicant properties COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour No recommended antidote
Nivolumab Non-irritant (neutral) Not indicated Not indicated
Obinutuzumab Non-irritant (neutral) Not indicated Not indicated
Ofatumumab Non-irritant (neutral) Not indicated Not indicated
Oxaliplatin Irritant with vesicant properties No warm or cold compress recommended No recommended antidote
Paclitaxel Irritant with vesicant properties COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour There have been some clinical reports of positive outcomes with using hyaluronidase.
If hyaluronidase is administered no compress is recommended.
Paclitaxel nab (Abraxane®) Irritant with vesicant properties COLD compress apply 15 to 20 minutes FOUR times daily for 48 hour No recommended antidote
Pamidronate Non-irritant (neutral) Not indicated Not indicated
Panitumumab Non-irritant (neutral) Not indicated Not indicated
Pegasparaginase  Non-irritant (neutral) Not indicated Not indicated
Pembrolizumab Non-irritant (neutral) Not indicated Not indicated
Pemetrexed Non-irritant (neutral) Not indicated Not indicated
Pertuzumab Non-irritant (neutral) Not indicated Not indicated
Pralatrexate Non-irritant (neutral)​* Not indicated Not indicated
Raltitrexed Non-irritant (neutral) Not indicated Not indicated
Ramucirumab Non-irritant (neutral) Not indicated Not indicated
Rituximab Non-irritant (neutral) Not indicated Not indicated
Romidepsin Irritant COLD compress
(initial for comfort measures)		 No recommended antidote
Temsirolimus Non-irritant (neutral) Not indicated Not indicated
Teniposide Irritant COLD compress
(initial for comfort measures)		 Not indicated
Thiotepa Non-irritant (neutral) Not indicated Not indicated
Topotecan Irritant COLD compress
(initial for comfort measures)		 Not indicated
Trastuzumab (Herceptin®) Non-irritant (neutral) Not indicated Not indicated
Trastuzumab emtansine (Kadcyla®) Irritant Not indicated Not indicated
Vinblastine Vesicant WARM compress apply 15 to 20 minutes FOUR times daily for 48 hour Hyaluronidase
Vincristine Vesicant WARM compress apply 15 to 20 minutes FOUR times daily for 48 hour Hyaluronidase
Vindesine Vesicant WARM compress apply 15 to 20 minutes FOUR times daily for 48 hour Hyaluronidase
Vinflunine Vesicant WARM compress apply 15 to 20 minutes FOUR times daily for 48 hour Hyaluronidase
Vinorelbine Vesicant WARM compress apply 15 to 20 minutes FOUR times daily for 48 hour Hyaluronidase
Zoledronic acid Irritant* COLD compress
(initial for comfort measures)		 Not indicated

 * The classification of these drugs is based upon limited evidence and has been extrapolated from drugs within the same class.
This table is not an exhaustive list of anti-cancer agents used in the clinical setting. There are other drugs in use which have not yet been classified and for which the risk of extravasation injury is not known. For investigational drugs, information on extravasation management may be available from the trial sponsor or the clinical trials pharmacist.
Please read the extravasation management document for a comprehensive list of references used to develop this table.

Version 4

Date Summary of changes
19/10/2007 Originally approved
28/05/2009 Information rewritten and reviewed 2009 NRC and pharmacy.
Miscellaneous drug category changed to irritant with vesicant properties.
Safety information around DMSO 99% solution added.
All vinca alkaloid management changed to warm compress.
01/10/2009 Transferred to eviQ.
29/10/2010 Changes to Extravasation table - Tomudex changed to raltitrexed
09/12/2010 Changes to Extravasation table - amsacrine added
17/01/2011 Action bar changed from hot to warm.
13/05/2011 All eviQ extravasation documents discussed and reviewed at the combined nurse/pharmacist extravasation meeting.
21/10/2011 All eviQ extravasation documents updated with amendments from meeting and published.
04/09/2015 All eviQ extravasation documents reviewed and updated by pharmacist/nursing committee and two clinicians and published
31/05/2017 Transferred to new eviQ website. Version number changed to V.3.
12/04/2019 eviQ extravasation documents reviewed and updated by pharmacist/nursing committee and published. Version number changed to V.4. 

This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information source. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/1002

19 Oct 2021