Chemotherapy Extravasation means that the chemotherapy drug escapes outside the blood vessel i.e. into the extravascular space. This is caused by leakage from a blood vessel or direct infiltration. This can be predicted with certain symptoms like change in the rate of infusion, pain, swelling at the site, no blood return, etc.

Cytotoxic drugs are classified into two types based on the local toxicity they cause- irritant drugs and vesicant drugs.

• An irritant drug causes a reaction that leads to inflammation, pain, burning and tightness at the injection site or all along the vein. It causes warmth, redness, and tenderness in the extravascular area. However, there is no tissue damage or necrosis. These symptoms are usually temporary.
• Some irritant chemotherapy agents are bleomycin, carboplatin, carmustine, cisplatin, dacarbazine, denileukin diftitox, doxorubicin, doxorubicin liposome, etoposide, ifosfamide, streptozocin, thiotepa, and vinorelbine.
• Vesicant drug mostly causes tissue necrosis with a more severe injury. This Extravasation damages the entire thickness of the skin along with the underlying structures.
• Some vesicant chemotherapy agents are dactinomycin, daunorubicin, doxorubicin, epirubicin, idarubicin, mechlorethamine, mitomycin, mitozantrone, paclitaxel, streptozocin, etoposide, vinblastine, vincristine and vinorelbine.

This usually happens when antineoplastic drugs are used although some other drugs also cause Extravasation when injected in the subcutaneous tissues. Among cytotoxic chemotherapy agents, anthracyclines cause Extravasation, as they tend to cause severe necrosis.

It is important that chemotherapy infusion  should be given by highly skilled oncology professionals to avoid extravasation especially in case of certain vesicant drugs. It is even better if the patients get a catheter or a PICC line fitted. This would reduce the chance of Extravasation and would make the infusion process less painful.

Treatment for Chemotherapy Extravasation

It is best to prevent it from happening. However if it happens, withdraw the drug out as much as possible and remove the IV especially in case of severe reactions. Apply cold or ice compresses to the injection site. If Extravasation is caused by vinca alkaloid drugs like vincristine, vinblastine or vinorelbine then apply warm compresses. There are various antidotes available based on the type and amount of the drug infused.

Extravasation due to vesicant chemotherapy drugs results in significant tissue damage, alteration in limb function and pain that can hamper the quality of life especially of long-term cancer survivors. Early detection and immediate intervention by the medical professional is extremely important to stop the tissue damage and reduce the chances of permanent disability, deformity, or disfigurement of the limb.

Extravasation through Ports

Sometimes, even a port or a PICC line can cause Extravasation due to some reasons. Extravasation from ports occurs in four ways-

• Incomplete needle placement and needle dislodgement
• Thrombus or fibrin sheath formation
• Perforation of the superior vena cava
• Catheter fracture

The degree of tissue injury varies. However, it could be severe enough to perform a mastectomy to repair the chest wall necrosis. Extravasation is one of the chemotherapy risks  of administration via implanted ports.

It is essential that a vesicant drug should be administered only after a blood return is obtained and the needle inserted into the port septum is sufficiently secured.

Chemotherapy Extravasation has now a relatively lower incidence. Increasing awareness regarding various infusion techniques and understanding other complication has led to a significant reduction in this condition.