Post procedure care
- Apply DMSO 99% solution every 6 hours for a minimum of 7 days or as per medical officer's orders.
- Apply a cold compress for 15 to 20 minutes every 6 hours for 48 hours (no moisture should come into contact with the patient’s skin).
There are no uniform guidelines in the literature on the surgical management of extravasation injuries, including guidelines on the optimal timeframe for referral to a plastic surgeon.
With most patients conservative management (including “watch and wait”, the use of pharmacological measures and the application of topical cooling) is sufficient. However in cases where conservative measures fail or functional damage is suspected, surgical intervention may be required.
Clinical assessment of the individual case is paramount in determining if surgical review is necessary. Referral to a plastic surgeon or other specialist surgeon (according to individual case and site of extravasation) is recommended for:
- vesicant extravasation at the discretion of the medical officer
- extravasation that involves a fractured or displaced CVAD
- in the event that the patient develops pain or the area is not healing
- large volume extravasation (the volume which constitutes a large extravasation is undefined in the literature and clinical judgement must be used).
Follow up care
- The patient is to monitor the affected area daily for any skin changes or breakdown, and to notify medical team immediately if any changes.
- Careful monitoring by a healthcare professional is recommended; the length of monitoring should be at the advice of the medical officer, and will depend on the cytotoxic drug extravasated and the clinical course of the injury.
- It is important to note that early vesicant extravasation signs or symptoms can be subtle, and not always evident until several days or weeks later. Regular patient review is recommended, consider daily or second daily review for the first week, and then weekly until complete resolution of symptoms.
- Patients should be informed about the follow-up policy before leaving the treatment area
- Obtain photographs at follow up appointments.
- Community nurse or GP referral may be required for follow up care.
Link to antineoplastic drug extrvasation assessment tool