Algorithm – extravasation management
of intravenous anti-cancer therapies
PRIMARY ACTIONS:
S STOP the injection or intravenous infusion immediately and SEND for assistance
(notify senior nurse, medical staff, pharmacist)
Nearest extravasation kit is located:
L LEAVE the vascular access device (VAD) in situ
A ASPIRATE any residual drug from VAD
P PLAN next actions
SECONDARY ACTIONS:
• complete assessment of affected area: size, colour, oedema, sensation, pain
• collect the extravasation kit
• outline the affected area with a marker pen
• photograph affected area for medical record
• initiate appropriate drug specific management measures
VESICANT IRRITANT with vesicant properties IRRITANT
DNA binding Non-DNA binding e.g. Bendamustine, e.g. e.g. e.g. Cabazitaxel,
e.g. Amsacrine, Daunorubicin*, e.g. Vinblastine, Vincristine, Carmustine, Cisplatin > Oxaliplatin Etoposide, Carboplatin, Cisplatin≤
Doxorubicin*, Epirubicin*, Vindesine, Vinflunine, 0.5 mg/mL, Docetaxel**, Etoposide 0.5 mg/mL, Dacarbazine,
Mitomycin Vinorelbine Doxorubicin Liposomal, phosphate, Fluorouracil,
Nab-paclitaxel, Paclitaxel** Teniposide Gemcitabine, Ifosfamide,
Zoledronic acid
Refer here for a summary of the treatments for extravasation of intravenous anti-cancer therapies
Neutralise & localise Disperse & dilute Localise Localise
• Neutralise: • Administer pain relief prior • Apply COLD compress • Apply a WARM • Apply a COLD
− apply thin layer topical DMSO to as appropriate to affected area for 15 compress to affected compress to affected
99% solution to marked area • Reconstitute - 20 minutes every 6 area for 15 - 20 area for comfort
as soon as possible (within hyaluronidase 1500 hours for 48 hours minutes every 6 hours measures
10 - 25 minutes) international units in for 48 hours
** If hyaluronidase used Note: There is no
− continue every 6 hours for 2-5 mL sterile water or
for extravasation – do not evidence for use of
7 days sodium chloride 0.9%
apply compress warm or cold compress
− use cotton bud / swab stick • Administer solution 0.2
for trastuzumab
soaked solution OR - 0.4 mL subcutaneously
emtansine extravasations
− glass dropper (4 drops around marked area
of solution per 10 cm2 of using the “pin cushion”
affected area) technique at “2 hourly
intervals” on an imaginary
− allow to air dry
“clock face”
• Localise: • Gently massage area to
− apply COLD compress to facilitate dispersal Pain management
affected area for 15 - 20 • Apply a WARM compress
minutes every 6 hours for 48
• Discuss regularly with patient and treating medical team.
to affected area for 15 - 20
hours minutes every 6 hours for • Medications will vary according to the individual patient and
− elevate limb 48 hours extravasation.
NOTE: • Elevate limb
− ensure skin is dry before
Consider specialist referral e.g. surgical, plastics
applying DMSO 99%
solution • Provide verbal and written patient information
− do not cover with dressing • Organise post-acute assessment and management
*Alternatively, consider • Replace items/extravasation kit including drugs from pharmacy if required
dexrazoxane for anthracycline • Complete documentation and incident report as per local policy
extravasations (must be • Refer here for the clinical procedure
administered within 6 hours). • Refer to extravasation management for a comprehensive list of the
Refer here for more information. references used to develop this flow chart.
EQ-0211-08.22 | SHPN (CI) 220704
© Cancer Institute NSW 2022. While every effort has been made to provide accurate information,
this document is not intended as a substitute for medical advice. Contact your doctor if you have any concerns.
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