Extravasation (paravasation) of anticancer drugs – updated recommendations (2025) for standard care in the Czech Republic based on multidisciplinary cooperation

Czech version

Authors: S. Vokurka ^1,2; V. Maňásek ³; D. Navrátilová Hrabánková ⁴; P. Rozsívalová ^5,6; J. Kletečka ⁷; S. Šípová ¹; V. Pavlicová ⁸; P. Žák ⁸; Š. Kozáková ⁹; A. Vlasáková ¹⁰; D. Brojáčová ¹¹; L. Turková ¹²; B. Víšek ⁸
Authors‘ workplace: Onkologická a radioterapeutická klinika LF v Plzni UK a FN Plzeň ¹; Centrum paliativní a podpůrné medicíny, LF v Plzni UK ²; Kanylační centrum, Komplexní onkologické centrum, Nemocnice Agel, Nový Jičín ³; I. interní klinika – klinika hematologie 1. LF UK a VFN v Praze ⁴; Nemocniční lékárna, Odd. klinické farmacie, FN Hradec Králové ⁵; Farmaceutická fakulta v Hradci Králové, UK ⁶; Klinika anesteziologie, resuscitace a intenzivní medicíny LF v Plzni UK a FN Plzeň ⁷; IV. interní hematologická klinika LF v Hradci Králové UK a FN Hradec Králové ⁸; Nemocniční lékárna, FN Brno ⁹; Centrum cévních vstupů, Klinika anesteziologie, resuscitace a intenzivní medicíny LF v Plzni UK, a FN Plzeň ¹⁰; Oddělení hematologické intenzivní péče, IV. interní hematologická klinika LF v Hradci Králové UK, a FN Hradec Králové ¹¹; Interní hematologická klinika 3. LF UK a FN Královské Vinohrady, Praha ¹²
Published in: Klin Onkol 2025; 38(3): 224-232
Category: Short Communication
doi: https://doi.org/10.48095/ ccko2025224

Overview

Background: Extravasation (paravasation) of chemotherapy and other anticancer drugs represents a significant complication in the patient care. Preventive and therapeutic measures effectively reduce the incidence, severity and extent of extravasation-related complications and its consequences. A working group of authors from expert groups developed recommendations for standard care. Aim: To provide a concise summary of recommended interventions for daily clinical practice. These recommendations are based either on long-term, evidence-based clinical experience or consensus opinions among expert groups representatives. Results: Preventive measures are critical and include early consideration of indications for long-term venous access devices, appropriate selection of the injection and exit sites, thorough venous access device assessment before each anticancer drug administration, and comprehensive patient education. Therapeutic interventions following extravasation primarily involve the administration of specific antidotes (dimethylsulfoxide, hyaluronidase, dexrazoxane) along with the application of dry cold or heat, depending on the specific anticancer agent involved. The use of subcutaneous corticosteroids, moist heat or moist cooling, and compression is not recommended. Conclusion: Adherence to these recommendations significantly decreases the risk and mitigates the consequences of extravasation. Clinical sites may adapt and expand these guidelines based on local policies and specific patient care requirements.

Keywords:

nursing – Chemotherapy – extravasation – Antidotes – anticancer treatment – venous access devices

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