Extravasation of Cytostatic Drugs – Prevention and Best Practices

Authors: V. Maňásek
Authors‘ workplace: Společnost pro porty a permanentní katetry, Praha Onkologické oddělení, Komplexní onkologické centrum Nový Jičín, Nemocnice Nový Jičín, a.  s.
Published in: Klin Onkol 2016; 29(2): 93-99
Category: Review
doi: 10.14735/amko201693


Extravasation is the leakage of a drug (intended primarily for intravenous administration) into tissues surrounding the vascular system. The damage to surrounding varies depending on the nature and volume of extravasation. Cytostatic extravasation is associated with poor outcomes for patients. This paper summarizes the types of risk associated with cytostatic extravasation, and the preventative measures that can be used when such an event occurs. We also provide information on potential treatments. However, justification for their use has only been substantiated in papers with different levels of significance and these papers are not available in all countries. We summarize current international recommendations for actions to be taken in the event of extravasation.

Key words:
extravasation – cytostatic agents – soft tissues injuries – antidotes – catheterization

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

23. 6. 2015

9. 1. 2016


1. Fidalgo JA, Fabregat LG, Cervantes A et al. Management of chemotherapy extravasation: ESMO‑ EONS clinical practice guidelines. Eur J Oncol Nurs 2012; 16(5): 528– 534.

2. Allwood M, Stanley A, Wright P (eds). The cytotoxics handbook. 4th ed. UK: Radcliffe Medical Press Inc 2002.

3. Larson DL. Treatment of tissue extravasation by antitumor agents. Cancer 1982; 49(9): 1796– 1799.

4. Bertelli G, Gozza A, Forno GB et al. Topical dimethylsulfoxide for the prevention of soft tissue injury after extravasation of vesicant cytotoxic drugs: a prospective clinical study. J Clin Oncol 1995; 13(11): 2851– 2855.

5. Mader I, Fürst‑ Weger P, Mader R (eds). Extravasation of cytotoxic agents; compendium for prevention and management. 2nd ed. New York: Springer Verlag 2009.

6. Schulmeister L. Extravasation management: clinical update. Semin Oncol Nurs 2011; 27(1): 82– 90. doi: 10.1016/j.soncn.2010.11.010.

7. Olver IN, Schulmeister L. Extravasation. In: Olver IN (ed.). The MASCC Textbook of Cancer Supportive Care and Survivorship. Heidelberg: Springer 2011.

8. European Oncology Nursing Society (EONS) [online]. Extravasation Guidelines 2007. Available from: http://www.cancernurse.eu/documents/EONSClinicalGuidelinesSection6–en.pdf#search=”extravasation.

9. Langstein HN, Duman H, Seelig D et al. Retrospective study of the management of chemotherapeutic extravasation injury. Ann Plast Surg 2002; 49(4): 369– 374.

10. WOSCAN Cancer Nursing and Pharmacy Group [online]. Chemotherapy Extravasation Guideline2009. Avail­able from: http://www.beatson.scot.nhs.uk/content/mediaassets/doc/Extravasation%20guidance.pdf.

11. Wangström Y, Marquiles A. European Oncology Nurs­ing Society extravasation guidelines. Eur J Oncol 2008; 12(4): 357– 361. doi: 10.1016/j.ejon.2008.07.003.

12. Maňásek V, Soumarová R, Kociánová I et al. Žilní vstupy v onkologii. Klin Onkol 2012; 25(1): 9– 16.

13. Maňásek V. Žilní přístupy pro střednědobou a dlouhodobou protinádorovou léčbu. Onkologie 2015; 9(5): 260.

14. Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA Cancer J Clin 2008; 58(6): 323– 346. doi: 10.3322/CA.2008.0015.

15. Langer SW, Sehested M, Jesen PB. Anthracycline extravasation: a comprehensive review of experimental and clinical treatments. Tumori 2009; 95(3): 273– 282.

16. Sukl.cz [internetová stránka]. Státní ústav pro kontrolu léčiv. Dostupné z: http://www.sukl.cz/modules/medication/search.php?data[search_for]=doxorubicin&data[code]=&data[atc_group]=L01DB01&data[material]=&data[path]=&data[reg]=&data[radio]=none&data[rc]=&data[chbox][0]=braill‑yes&data[chbox][1]=braill‑no&data[chbox][2]=braill‑def&data[with_adv]=0&data[listing]=20&search=Vyhledat&page=3.

17. Mechl Z, Brančíková D. Nežádoucí účinky protinádorové léčby a jejich léčba. Med Pro Praxi 2009; 6(6): 325– 329.

18. Tsavaris NB, Karagiaouris P, Tzannou I et al. Conservative approach to the treatment of chemotherapy‑induced extravasation. J Dermatol Surg Oncol 1990; 16(6): 519– 522.

19. Belada D, Trněný M (eds) a kolektiv autorů Kooperativní lymfomové skupiny. Dia­gnostické a léčebné postupy u nemocných s maligními lymfomy. 8. doplněné a přepracované vydání. Hradec Králové: HK CREDIT s.r.o 2014.

20. Dorr RT, Soble M, Alberts DS. Efficacy of sodium thiosulfate as a local antidote to mechloretamine skin toxicity in mouse. Cancer Chemother Pharmacol 1988; 22(4): 299– 302.

21. Dorr RT, Alberts DS. Failure of DMSO and vitamin E to prevent doxorubicin skin ulceration in the mouse. Cancer Treat Rep 1983; 67(5): 499– 501.

22. Olver IN, Aisner J, Hament A et al. A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation. J Clin Oncol 1988; 6(11): 1732– 1735.

23. Wiseman LR, Spencer CM. Dexrazosane. A review of its use as a cardioprotective agent in patients receiving anthracycline‑based chemotherapy. Drugs 1998; 56(3): 385–403.

24. Hensley ML, Schuchter LM, Lindley C et al. American Society of Clinical Oncology clinical guidelines for the use of chemotherapy and radiotherapy protectants. J Clin Oncol 1999; 17(10): 3333– 3335.

25. Langer SW, Sehested M, Jensen P. Treatment of anthracycline extravasation with dexrazoxane. Clin Cancer Res 2000; 6(9): 3680– 3686.

26. Langer SW, Thougaard AV, Sehested M. Treatment of experimental extravasation of amrubicin, liposomal doxorubicin, and mitoxantrone with dexrazoxane. Cancer Chemother Pharmacol 2012; 69(2): 573– 576. doi: 10.1007/s00280‑011‑1794‑ 6.

27. Mouridsen HT, Langer SW, Buter J et al. Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicentre studies. Ann Oncol 2007; 18(3): 546– 550.

28. Langer SW. Treatment of anthracycline extravasation from centrally inserted venouos catheters. Oncol Rev 2008; 2: 114– 116.

29. Disa JJ, Chang RR, Muci SJ et al. Prevention of adriamycin‑induced full‑ thickness skin loss using hyaluronidase infiltration. Plast Reconstr Surg 1998; 101(2): 370– 374.

30. Bertelli G, Dini D, Forno GB et al. Hyaluronidase as an antidote to extravasation of vinca alkaloids: clinical results. J Cancer Res Clin Oncol 1994; 120(8): 505– 506.

31. Sukl.cz [internetová stránka]. Státní ústav pro kontrolu léčiv. Dostupné z: http://www.sukl.cz/modules/medication/detail.php?code=0200245&tab=texts.

32. Tsavaris N, Komitsopoulou P, Karagiaouris P et al. Prevention of tissue necrosis due to accidental extravasation of cytostatic drugs by a conservative approach. Cancer Chemother Pharmacol 1992; 30(4): 330– 333.

33. Steiert A, Hille U, Burke W et al. Subcutaneous wash‑ out procedure (SWOP) for the treatment of chemotherapeutic extravasations. J Plast Reconstruct Aesthet Surg 2011; 64(2): 240– 247. doi: 10.1016/j.bjps.2010.04.040.

34. Narducci F, Jean‑ Laurent M, Boulanger L et al. Totally implantable venous access port systems and risk factors for complications: a one‑year prospective study in a cancer centre. Eur J Surg Oncol 2011; 37(10): 913– 918. doi: 10.1016/j.ejso.2011.06.016.

35. Guarneri V, Conte PF. Acute and subacute toxicities of medical anticancer treatment. In: Handbook of Cancer Dia­gnosis and Treatment evaluation. ESMO 2009; 91– 107.

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