Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Chemotherapy Safety and Extravasation

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In one line

·When chemotherapy leaks out of the vein into the tissue around it, some drugs can kill that tissue and leave a serious wound.

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Normal physiology

·Chemotherapy drugs flow through an IV catheter placed inside a vein, so the medicine travels safely through the bloodstream to reach cancer cells all over the body without touching healthy tissue directly.

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What goes wrong

·The IV catheter slips out of the vein, or the vein tears, so chemotherapy leaks into the tissue around it instead of staying in the bloodstream.

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Hallmark signs

·Swelling at the IV site
·Pain or burning at the IV site
·Redness around the IV site
·Skin feels tight or stretched
·The IV drip slows down or stops
·No blood return when the IV is checked
·Skin blanching (turning white or pale)
·Blistering or skin breakdown (delayed, hours to days later)

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Red flags · escalate now

·Swelling, pain, or burning at the IV site during or right after chemotherapy
·Skin turns pale, blanched, or develops blisters near the IV
·No blood flows back when the IV line is checked
·The IV pump alarm goes off or the drip suddenly slows or stops

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Workup

·Visual inspection and measurement of the extravasation site with a ruler
·Photography of the IV site immediately and every 24 hours
·Tissue hardened tissue (induration) (hardness) assessment by gentle examining by touch (palpation)
·Review of the chemotherapy drug class (vesicant vs. irritant vs. non-vesicant)
·Volume of chemotherapy extravasated (estimated from the infusion pump or IV bag)
·Serial neurovascular checks (sensation, movement, capillary refill, pulses) in the affected limb

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Treatment

·Stop the IV infusion immediately and do not remove the needle yet
·Aspirate (gently pull back) as much fluid as possible through the IV needle before removing it
·For anthracycline extravasation: give dexrazoxane IV within 6 hours (day 1: 1000 mg/m², day 2: 1000 mg/m², day 3: 500 mg/m²) and apply cold packs for 15–20 minutes four times daily
·For vinca alkaloid or taxane extravasation: inject hyaluronidase (150–900 units total, divided into 5–6 small injections around the extravasation site) and apply warm packs for 15–20 minutes four times daily
·Mark the border of the swelling and redness with a pen, take a photograph, and refer to a plastic surgeon within 24 hours
·Elevate the affected limb above the level of the heart
·Use a central venous catheter (port or PICC line going into a large vein near the heart) instead of a peripheral IV for vesicant chemotherapy drugs

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NCLEX trap

·Any burning, stinging, or swelling during chemo means the drug may be leaking out of the vein into the tissue around it. Stop the infusion immediately. Pain or puffiness is never normal during chemo.
·Extravasation (chemo leaking into tissue) is an emergency. You have minutes, not hours. Stop the IV right away, try to pull back a little fluid through the needle, leave the needle in place while you give the antidote through it, then remove it. Mark the spot with a pen, take a photo, and call the doctor and the pharmacy right away. Waiting lets the drug kill deeper layers of skin and muscle.
·Redness and swelling are the early warning signs of extravasation. Blisters come later and mean the damage has already gone deep. If you catch it at the red and puffy stage, you can stop it from turning into blisters and open sores.
·Different chemo drugs need different treatments. Anthracyclines like doxorubicin (Adriamycin) need cold packs and the antidote dexrazoxane. Vinca alkaloids like vincristine need warm packs and the antidote hyaluronidase. Using the wrong treatment can make the injury worse.
·Once extravasation happens, that chemo drug is too dangerous to put through a regular arm or hand vein again. The patient needs a central line, which is a bigger IV that goes into a large vein near the heart, like a PICC line or a port. Marking the site is good, but restarting the same drug in a peripheral vein puts the patient at high risk for another leak.
·Extravasation can kill skin, fat, and muscle deep enough to need surgery and skin grafts. It is a medical emergency. Call the doctor and a surgeon right away, write everything down in detail, and tell your charge nurse and manager. This is a serious safety event that requires immediate action and follow-up.

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