When chemotherapy drugs accidentally leak into the tissues surrounding your veins or catheter, it’s called extravasation. While it doesn’t happen very often, it’s a serious complication.
Chemotherapy can be given in pill form or intravenously (through your veins).
Very rarely, chemotherapy drugs may leak outside your veins or catheter into surrounding tissues. Doctors call this “extravasation.”
When this happens, you may experience a burning sensation and discomfort. It’s important to let the clinician administering your chemo know as soon as possible if you feel anything unusual. Extravasation requires immediate treatment.
In this article, we take a closer look at chemotherapy extravasation, including symptoms, causes, treatment, and prevention.
Chemotherapy extravasation happens when the liquid medication from chemotherapy accidentally leaks from your catheter or your veins into the tissues under your skin. Extravasation is rare, it happens in about 0.5–6% of people receiving chemotherapy. But it’s very serious.
The complications of chemotherapy extravasation
If you’re undergoing chemotherapy, the clinician administering the chemo will ask you to tell them if you experience any change in sensations during administration. This is particularly important if you are receiving a vesicant drug.
If you notice any symptoms that might indicate extravasation during chemotherapy, your clinician will stop infusion immediately.
Common symptoms of extravasation include:
- tingling
- burning feeling
- swelling
- discomfort or pain
- redness at the injection site
You may also experience later extravasation symptoms, such as:
- ulceration
- blistering
- necrosis
Other signs of suspected extravasation that a chemotherapy clinician may notice include:
- changes in blood return from the IV device
- interruptions of the free flow of an infusion
- resistance on the plunger of the syringe during an injection
If your clinician suspects extravasation, they’ll stop administering the chemo and treat the leakage by aspirating (withdrawing) as much extravasated solution as possible.
They may also elevate the limb, apply cold or warm compresses, and administer the appropriate antidote or drug to reduce the risk of complications.
Doctors divide causes and risk factors for chemotherapy extravasation into
Patient-related factors
Causes and risk factors that may be linked to the patient themselves include:
- vessels that may burst easily
- small and fragile veins, which is more common in children and older patients
- hardened and thickened vessels due to frequent venipuncture
- patients with vessels that move easily during venipuncture attempts
- patients who move around a lot
- patients with obesity who have a more difficult peripheral venous access
- patients with closed vena cava, limb amputation, or excised lymph nodes
Procedure-related factors
Causes and risk factors that occur during a procedure can involve:
- inexperienced staff
- high flow pressure
- multiple attempts at cannulation
- inadequate dressing
- poor cannula fixation
- inadequate choice of equipment
Product-related factors
Causes and risk factors for chemotherapy extravasation may also be linked to the properties of the drug or drugs you are being given. Categories of chemotherapy drugs include:
| Product | Risk factors | Examples |
|---|---|---|
| Exfoliants | These drugs can cause blisters, inflammation, or skin peeling without causing tissue death. | aclacinomycin, cisplatin, docetaxel, liposomal doxorubicin, mitoxantrone, oxaliplatin, and paclitaxel |
| Inflammitants | These drugs can cause inflammation or erythema at the extravasation site. | bortezomib, 5-fluorouracil, methotrexate, and raltitrexed |
| Irritants | These drugs can cause inflammation and pain at the extravasation site. You may feel a burning sensation in your vein if extravasation occurs. | bendamustine, bleomycin, carboplatin, dexrazoxane, etoposide, teniposide, and topotecan |
| Neutrals | These drugs do not cause inflammation or damage at the extravasation site. | asparaginase, bevacizumab, bleomycin, bortezomib, cetuximab, cyclophosphamide, cytarabine, eribulin, fludarabine, gemcitabine, ifosfamide, melphalan, rituximab, and trastuzumab |
| Vesicants | These drugs can cause blisters or necrosis if they come in contact with the tissue that surrounds your veins. | actinomycin D, dactinomycin, daunorubicin, doxorubicin, epirubicin, idarubicin, mitomycin C, vinblastine, vindesine, vincristine, and vinorelbine |
If you experience chemotherapy extravasation, the clinician administering the chemotherapy will follow a strict procedure to reduce the risk of complications. These steps are:
- Stop and disconnect the infusion while leaving the needle in place.
- Try to aspirate (remove) the maximum amount possible of the extravasated liquid.
- Mark the extravasated area with a pen and remove the needle while avoiding pressure on the area.
- Administer the drug-specific antidote (see table below).
- Elevate the limb with the extravasation.
- Administer painkillers if necessary.
Warm or cooling treatments may also be applied topically to the site of the extravasation to decrease tissue reaction and absorption of the drug.
Drug-specific antidotes for extravasation
The following chart includes examples of chemotherapy drugs and the antidotes that doctors may use to treat extravasation:
| Drug name | Medication antidote | Nonmedical treatment |
|---|---|---|
| Anthracyclines | Dexrazoxane, intravenously administered for 3 days. Doctors need to give the first dose within 6 hours from when the extravasation happened. You’ll also need to apply 1–2 milliliters (mL) of topical DMSO three times per day to the site for 7–14 days. | The clinician will apply a cold compress at the extravasation site for 20 minutes, four times per day, for 3 days. |
| Mechlorethamine | Sodium thiosulfate 1/6M. Doctors will use a needle to inject the antidote multiple times under your skin. | N/A |
| Mitomycin C | You’ll need to apply 1–2 mL of topical DMSO three times a day to the site, for 7–14 days. | The clinician will apply a cold compress at the extravasation for 20 minutes, four times per day, for 3 days. |
| Taxanes | Doctors will use a needle to inject between 150–1500 units of the antidote hyaluronidase under your skin. | The clinician will apply a warm compress at the extravasation for 20 minutes, four times per day, for 3 days. |
| Vinca alkaloids | Doctors will use a needle to inject you with between 150–1500 units of hyaluronidase. | The clinician will apply a warm compress at the extravasation for 20 minutes, four times per day, for 3 days. |
If your doctor believes you or the chemotherapy drug you’re taking puts you at high risk of extravasation, they may recommend a central venous catheter (CVC) instead of an intravenous catheter drip. CVCs, also called “central lines” are inserted into large veins in your upper arm or chest.
It’s worth noting that, while extravasations are more likely to occur with an intravenous catheter drip, they can also occur with a CVC.
Strict and regulated protocols help prevent most extravasations
Healthcare professionals that administer chemotherapy are highly trained to minimize the risk of extravasation. They follow strict protocols surrounding the equipment they use, the administration procedures they follow, and the training they provide to help those undergoing chemotherapy recognize symptoms of extravasation.
If you’re concerned about the possibility of extravasation, have a conversation with your doctor about your risks and how to minimize those risks. You can also discuss any fears you may have with the clinician administering your chemo.
Undergoing chemotherapy for the first time can be frightening, even without the possibility of extravasation. Please know that extravasation is a rare occurrence that chemotherapy clinicians are trained to recognize, prevent, and promptly manage if they do occur.
Depending on the type of drug that you are receiving, you may have mild to severe complications. If you experience an irritant extravasation, you may develop a temporary superficial injury. Symptoms include:
- redness
- swelling
- itchiness or mild burning
Your healthcare team may treat your condition with mild painkillers and other medications to reduce your local inflammation.
If you experience vesicant extravasation, you may develop more serious injuries to your tissues. Symptoms of necrosis include:
- skin discoloration
- edema
- burning sensation
- intense pain
Necrosis needs immediate treatment with antibiotics and the surgical removal of the dead tissue.
However, if your healthcare team recognizes and intervenes promptly in your extravasation injury, they
Chemotherapy extravasation is uncommon. Doctors who recommend chemotherapy and clinicians administering chemotherapy follow specific procedures to reduce extravasation risks.
Vesicant drugs can cause the most dangerous type of extravasation because they can cause tissue damage.
If you experience swelling, pain, and a tingling sensation while you are receiving chemotherapy, let the clinician administering your chemo know immediately. They’ll stop the chemotherapy infusion, treat the extravasation with the appropriate antidote, and give you pain relievers if you’re experiencing pain.
Prompt treatment is the most effective way to reduce the potential complications of extravasation.