Management of Extravasation of Cytotoxic Drugs

See the CDHB Cytotoxic and Biotherapy Procedures on administration, safe handling, and disposal of cytotoxic drugs. This must be referred to for full details. Please read before administering chemotherapy.

Vesicant Drugs

Vesicant drugs are capable of causing extensive tissue necrosis, ulceration, and pain.

For extravasation of vesicant drugs, use a cold ice compress to the area for 15 minutes (except vincristine, vinblastine, or vinorelbine). This should be repeated four times a day, avoiding undue pressure.

For vinca alkaloids (vincristine, vinblastine, and vinorelbine) use a warm compress instead.

Irritant Drugs (This List is Not Exhaustive)

Irritant drugs are likely to cause inflammation, pain, and swelling, but the effects are less severe than with DNA-binding vesicant drugs.

Extravasation of any of these drugs requires a cold compress to the area for 30 minutes, avoiding any undue pressure. Give pain relief as required.

Note: A Safety First Incident Form (CDHB) must be completed when extravasation of a cytotoxic drug occurs.


About this Canterbury DHB document (5724):
Document Owner:	Timothy Vincent (see Who's Who)
Last Reviewed:	March 2020
Next Review:	March 2023
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Examples of DNA - BINDING (this list is not exhaustive)
Amsacrine	Epirubicin	Mitomycin C
Dactinomycin	Idarubicin	Mitoxantrone (irritant with vesicant properties)
Daunorubicin	Melphalan (irritant with vesicant properties)	Paclitaxel (irritant with vesicant properties)
Doxorubicin
Examples of NON DNA - BINDING (this list is not exhaustive)
Vinblastine	Vincristine	Vinorelbine