Extravasation of epirubicin/vincristine and ifosfamide/mesna from a central venous catheter
Penelope Jane Webster, BPharm, Dip Hosp Pharm
Deirdre D'Souza, BPharm

A 50-year-old female diagnosed with high-grade infiltrating ductal carcinoma of the left breast was planned for insertion of a central venous catheter for a 6-week continuous infusion regimen including weekly ifosfamide/mesna alternating with weekly epirubicin/vincristine via a CADD portable infusion pump; then radiotherapy followed by a further 6 weeks of VIE infusional chemotherapy. The initial 6 weeks of therapy was complicated by infected central venous catheter during week 2. Central venous catheter was removed and chemotherapy was administered peripherally. After completion of XRT, a new central venous catheter was inserted and the second cycle of epirubicin/vincristine chemotherapy was commenced.
During week 3 of the second cycle the patient developed right neck pain and swelling, which was diagnosed as a haemotoma and cellulitis which was treated with cephalexin. The following week she was admitted for intravenous antibiotics and drainage of the haematoma. Exploration of the neck swelling revealed fat necrosis and extravasation of chemotherapy into the subcutaneous tissues. Chemotherapy was stopped and treatment was commenced for extravasations of an unknown volume of ifosfamide/mesna administered weeks 1 and 3, and epirubicin/vincristine administered weeks 2 and 4 for unknown period, possibly 3 weeks.
The extravasation was treated as per the institutional policy for anthracycline extravasation; topical dimethyl sulphoxide and cold packs were applied every 6 hours for 14 days and plastic surgeons were consulted. Central venous catheter was removed 10 days after detection of the extravasation. Inflammation and pain resolved slowly over 4 weeks. The patient has had no further chemotherapy, and remains in CR. There have been no long-term sequelae from the extravasation.

J Oncol Pharm Practice Vol1, No3, 1995;pp41-44