Post procedure care
For the drugs bendamustine, docetaxel, liposomal doxorubicin, melphalan, mitozantrone, paclitaxel (do not use a cold compress if hyaluronidase is administered), nab-paclitaxel and cisplatin (> 0.5 mg/mL):
- apply a cold compress for 15 to 20 minutes every 6 hours for 48 hours.
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.
In most patients conservative management (including “watch and wait”, the use of pharmacological measures and the application of topical heating or cooling) is sufficient. However in those 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 extravasations at discretion of medical officer
- extravasations that involve a fractured or displaced CVAD
- in the event that the patient develops pain or the area is not healing
- large volume extravasations (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 there are 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.
Access the antineoplastic drug extravasation assessment tool