Synopsis
Recognise anticancer extravasation and vascular-access complications immediately, stop exposure while preserving diagnostic aspiration, apply agent-specific treatment, and prevent infection, thrombosis, fracture and recurrent device harm.
- Extravasation is unintended leakage of a vesicant or irritant outside the vessel; injury depends on drug, concentration, volume, site and speed of recognition.
- First actions are universal: stop the infusion, leave access in place, disconnect, aspirate where appropriate, mark and photograph the area, and obtain specialist advice.
- Do not flush the line, apply pressure or remove access before checking the protocol, because these actions can spread drug or lose an antidote route.
Key red flags
Chest, shoulder or neck pain, swelling, dyspnoea or unexpected resistance during central infusion can indicate internal leakage.
Investigation priorities
Identify the agent, access, symptoms and estimated tissue exposure.
Management branches
Pain, swelling, leakage or access dysfunction develops during anticancer infusion.
- Stop infusion immediately, disconnect tubing and leave the cannula or device access in place without flushing.
- Identify the drug, aspirate residual medicine as the protocol directs, mark and photograph the site and call the trained chemotherapy team.
Key medicines
Dexrazoxane for anthracycline extravasationStart within 6 hours: 1,000 mg/m² intravenously on day 1, 1,000 mg/m² at 24 hours and 500 mg/m² at 48 hours, infused into an unaffected limb; maximum doses are 2,000 mg, 2,000 mg and 1,000 mg respectively. Reduce by 50% when creatinine clearance is below 40 mL/min.
Hyaluronidase for vinca-alkaloid extravasationWithin 1 hour, dilute 1,500 units in 1 mL water for injection and inject 0.2 mL intradermally or subcutaneously at 3–5 sites around the affected area, changing the needle each time, with the protocol-directed warm pack.