Knowledge is power when treating extravasation reactions

Knowing beforehand the agents that do or may cause an extravasative reaction expedites its management. Have a treatment protocol ready.

By Lisa McDonald, PharmD, Pharmacology Section Editor

An extravasation reaction is one of those situations in oncology therapy that everyone wants to avoid and no one ever feels they have enough information to deal with.

The situations can pass without much harm to the patient, but some can cause devastating injuries. Some, but not all, chemotherapy agents can cause tissue necrosis when the drug solution inadvertently leaks from the vein, a process known as extravasation.

Symptoms

These agents that can cause necrosis after extravasation are called vesicants. Some nonchemotherapy medications can also cause extravasation reactions. Some of these include calcium chloride, phenytoin, TPN solutions, contrast media and vasopressors.

Symptoms of extravasation reactions range from pain and self-limited, localized inflammation to full-thickness necrosis, ulceration and sloughing of skin and underlying structures. Lesions may expand in size over weeks to months. Most heal poorly and slowly. In extensive ulceration, plastic surgery may be needed to remove trapped drug from the tissue, as well as skin grafting. The extent of symptoms also depends on the infusion site, condition of the tissue, concentration and volume of the vesicant and any treatments that may have been applied.

From: Hem/Onc Today December 2001