To see all protocols that comply with the WHO Essential Medicine List 
 Extravasation of a vesicant is a medical emergency. Prompt action ('SLAP') is required to minimise patient harm:

S      Stop
the injection or intravenous infusion immediately & Send for assistance
L      Leave the vascular access device (VAD) in situ
     Aspirate any residual drug or solution from the VAD with a syringe
P      Plan subsequent actions

All clinicians who prescribe, supply and administer intravenous anti-cancer therapies should be educated and competent in extravasation management.  

Early detection, assessment and prompt management is key to minimising patient harm. This clinical procedure outlines the extravasation management of the following drug classes:

Classification Management Examples*
VESICANT Dimethyl sulfoxide (DMSO) 99% topical solution - for DNA-binding vesicants
e.g. amsacrine, dactinomycin (actinomycin D), daunorubicin, doxorubicin, epirubicin, idarubicin and mitomycin
Hyaluronidase - for non-DNA binding vesicants
vinca alkaloids e.g. vincristine, vinblastine, vindesine, vinflunine or vinorelbine
IRRITANT WITH VESICANT PROPERTIES Topical application of cold compress
e.g. bendamustine, docetaxel, liposomal doxorubicin, melphalan, mitozantrone, paclitaxel or nab-paclitaxel, cisplatin > 0.5 mg/mL
Topical application of warm compress
oxaliplatin
Hyaluronidase
consider for use with paclitaxel or docetaxel. If used for taxane extravasation, no compress recommended.
IRRITANT Topical application of warm compress
etoposide, etoposide phosphate
  Topical application of cold compress
e.g. gemcitabine, cabazitaxel, carboplatin, fluorouracil, irinotecan

* This list of drug examples is not exhaustive.

This clinical procedure is to be used in conjunction with the following eviQ resources: Extravasation management, Algorithm - extravasation management of intravenous anti-cancer therapies, Quicklink summary table - treatments for extravasation of intravenous anti-cancer therapies and Extravasation assessment and documentation tool. See Extravasation management document for a comprehensive list of references used to develop this resource.

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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https://www.eviq.org.au/p/4156

09 Dec 2022