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.
- Warm versus cold compresses and antidotes are agent-dependent; identify the exact medicine and use the current local cancer-network extravasation table rather than memory.
- Central venous devices reduce repeated peripheral access but can still extravasate through malposition, fracture, disconnection or vessel erosion.
- Line infection may present with fever, rigors during flushing, exit-site inflammation or unexplained sepsis; cultures and immediate sepsis care take priority.
- Catheter-related thrombosis causes arm, neck or facial swelling, pain and collateral veins and needs imaging and anticoagulation review without automatic line removal.
- Document drug, dose, estimated volume, site, actions, photographs and serial follow-up because necrosis can evolve after apparently mild early signs.
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.
- Apply the implicated agent's compress and antidote strategy from the current cancer-network extravasation table, and arrange documented follow-up or plastic-surgical review according to injury risk.
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.Remove cooling at least 15 minutes before infusion and do not combine with topical dimethyl sulfoxide. Check pregnancy, marrow, renal and hepatic status and monitor additive cytotoxic and haematological toxicity.
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.This technique is not interchangeable with anthracycline management. Stop but do not flush the infusion, preserve access for aspiration, identify the exact drug and follow trained-team documentation and serial tissue review.