Felis ISSN 2398-2950

Chemotherapy: extravasation

Contributor(s): Francesca Fabrizio, Jane Dobson

Introduction

  • Extravasation occurs when a drug accidentally leaks into the subcutaneous or subdermal tissue surrounding the intravenous administration site.
  • Due to their nature, many chemotherapeutical agents can cause significant tissue injury after extravasation.
A chemotherapeutic extravasation is considered an oncology emergency.
  • Extravasated chemotherapeutic drugs can be classified, according to their potential for causing damage, in vesicants, irritants, non-irritants:

1. Vesicants

  • Vesicants can cause tissue necrosis and blister formation after extravasation. They include:       
  • Doxorubicin and epirubicin are considered to have the greatest vesicant potential when compared to other chemotherapeutical agents. This is due to their ability of entering the cells and binding to DNA causing immediate and continuous tissue damage, potentially lasting for months.  On the other hand, vinca-alkaloids are able to cause direct damage to cells but they cannot bind to DNA, causing only immediate damage.

2. Irritants

  • Irritants can cause pain, inflammation and erythema at the extravasation site without blisters formation. They include:

3. Non-irritants

Preventing extravasation

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Managing chemotherapy extravasation (general treatment)

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Managing chemotherapy extravasation (specific treatment)

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Pérez Fidalgo JA, García Fabregat L, Cervantes A et al (2012) Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol 23 (Suppl 7), vii167-vii173 PubMed.
  • Venable R O, Saba C F, Endicott M M et al (2012) Dexrazoxane treatment of doxorubicin extravasation injury in four dogs. JAVMA 240 (3), 304-307 PubMed.
  • Mouridsen H T, Langer S W, Buter J et al (2007) Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicenter studies. Ann Oncol 18 (3), 546-550 PubMed.
  • Bertelli G, Dini D, Forno G B et al (1994) Hyaluronidase as an antidote to extravasation of Vinca alkaloids: clinical results. J Cancer Res Clin Oncol 120 (8), 505-506 PubMed.
  • Olver I N, Aisner J, Hament A et al (1988) A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol (11), 1731-1735 PubMed.

Other sources of information

  • AAHA Oncology Tookit: https://www.aaha.org/professional/resources/oncology_toolkit.aspx
  • European Oncology Nursing Society (EONS) Extravasation guidelines 2007.
  • Vail D M (2006) New supportive therapies for cancer patients. 24th Annual ACVIM Forum Proceedings.
  • Alwood M, Stanley A, Wright P (2002) The Cytotoxics Handbook. 4th edn. UK; Radcliffe Medical press Inc.
  • Kisseberth W C, MacEwen E G (2001) Complications of Cancer and Its Treatment. Chapter14, In: Small Animal Clinical Oncology, 3rd edn, S.J. Withrow & E.G. MacEwen (eds), W B Saunders Co., 2 pp 198-219.


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