Suspected Chemotherapy Extravasation
Leakage of antineoplastic agent into surrounding tissue
All Pathways
Hematology & OncologyEmergency
Chemotherapy Extravasation Management
Chemotherapy Extravasation Management: Suspected Chemotherapy Extravasation → Immediate Actions → Classify the Extravasated Agent → Anthracycline Extrav...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action Immediate Actions
Stop infusion, do not remove cannula yet
- 1. STOP infusion immediately
- 2. Leave cannula/needle in place initially
- 3. Attempt to aspirate residual drug (3-5 mL)
- 4. Mark the extravasation area with pen
- 5. Remove cannula after aspiration attempts
- 6. Elevate affected limb
- 7. Notify physician immediately
03Decision Classify the Extravasated Agent
Vesicant, Irritant, or Non-vesicant
- VESICANTS (cause necrosis):
- • Anthracyclines: doxorubicin, daunorubicin, epirubicin
- • Vinca alkaloids: vincristine, vinblastine, vinorelbine
- • Nitrogen mustards: mechlorethamine
- • Taxanes: paclitaxel, docetaxel (debated)
- IRRITANTS (inflammation, no necrosis):
- • Etoposide, teniposide, irinotecan
- • Carboplatin, oxaliplatin (cold sensitive)
- NON-VESICANTS:
- • Cyclophosphamide, methotrexate, 5-FU
04Action Anthracycline Extravasation
Dexrazoxane is antidote of choice
- DEXRAZOXANE PROTOCOL:
- • Day 1: 1000 mg/m² IV (max 2000mg)
- • Day 2: 1000 mg/m² IV (max 2000mg)
- • Day 3: 500 mg/m² IV (max 1000mg)
- Start within 6 hours of extravasation
- Give in large vein AWAY from extravasation site
- CRITICAL: Do NOT use DMSO with dexrazoxane
- Do NOT apply ice during dexrazoxane (remove 15 min before)
05Action Documentation & Follow-up
Thorough documentation essential
- DOCUMENT:
- • Drug name, concentration, volume estimated
- • Time of extravasation and detection
- • Description of area (size, erythema, pain)
- • Photograph if possible
- • Treatment administered
- FOLLOW-UP:
- • Daily assessment for first 7 days
- • Watch for: blistering, ulceration, necrosis
06Decision Surgical Consultation Needed?
Assess tissue viability
- CONSULT SURGERY/PLASTICS IF:
- • Ulceration develops
- • Necrosis present
- • Large volume vesicant extravasation
- • Pain persisting >10 days
- • No improvement with conservative management
- Early surgical debridement may prevent spread
07Action Surgical Management
For severe tissue injury
- Debridement of necrotic tissue
- May require skin grafting
- Early intervention better outcomes
- Consider liposuction/saline flush technique
- Wound care and rehabilitation
08Outcome Extravasation Resolved
Resume chemotherapy via different access
09Action Conservative Management
Continue monitoring and local care
- Continue topical treatments as prescribed
- Pain management
- Physical therapy if contracture develops
- Most heal within 2-4 weeks
- Patient education on signs of worsening
- Path rejoins step 08Shared downstream outcome
10Action Vinca Alkaloid Extravasation
Hyaluronidase + warm compress
- HYALURONIDASE PROTOCOL:
- • Inject 150-1500 units (diluted) SC
- • Multiple injections around extravasation site
- • 0.2 mL per injection, clockface pattern
- WARM COMPRESSES:
- • Apply dry warm compresses
- • 15-20 min QID for 24-48 hours
- • Heat disperses drug and increases absorption
- NEVER use cold for vinca alkaloids
- Path rejoins step 05Shared downstream outcome
11Action Other Vesicants / DNA-Binding Agents
DMSO + cold compress (if dexrazoxane not available)
- DMSO 99% topical:
- • Apply to affected area
- • Cover twice the extravasation area
- • Allow to air dry (do not cover)
- • Apply every 8 hours for 7-14 days
- COLD COMPRESSES:
- • Apply for 15-20 min QID
- • For 24-48 hours
- Localize drug, reduce cellular uptake
- Path rejoins step 05Shared downstream outcome
12Action Taxane Extravasation
Management controversial
- Paclitaxel and docetaxel: debated severity
- Some guidelines: hyaluronidase + cold
- Others: warm compresses only
- No clear consensus
- Conservative management often sufficient
- Monitor closely for tissue damage
- Path rejoins step 05Shared downstream outcome
13Action Irritant Extravasation
Supportive care, rarely causes necrosis
- Apply cold or warm compresses as appropriate
- Elevate limb
- Pain management (NSAIDs, topical steroids)
- Monitor for worsening
- Usually resolves without intervention
- Path rejoins step 05Shared downstream outcome
Guideline Source
ONS/ASCO Guideline on Management of Antineoplastic Extravasation
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Dexrazoxane availability may be limited
- Some antidote protocols are based on limited evidence
- Surgery consult timing varies by severity
- DMSO may not be readily available in all settings
Applicable Regions
USEU
Version 1Next review: 2027-01-11
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Calculator
Absolute Neutrophil Count (ANC)
Absolute neutrophil count from CBC for neutropenia grading
Open page
Compare
AttendMe.ai vs OpenEvidence
See how this pathway workflow compares against OpenEvidence.
Open page
Commercial
Start free
Run the pathway in a live AttendMe account with citations and tracked usage.
Start free
Related Resources
Frequently Asked Questions
What is the Chemotherapy Extravasation Management?
The Chemotherapy Extravasation Management is a emergency clinical algorithm for Hematology & Oncology. It provides a structured decision tree to guide clinical decision-making, based on ONS/ASCO Guideline on Management of Antineoplastic Extravasation.
What guideline is the Chemotherapy Extravasation Management based on?
This algorithm is based on ONS/ASCO Guideline on Management of Antineoplastic Extravasation (DOI: 10.1200/OP-25-00579).
What are the limitations of the Chemotherapy Extravasation Management?
Known limitations include: Dexrazoxane availability may be limited; Some antidote protocols are based on limited evidence; Surgery consult timing varies by severity; DMSO may not be readily available in all settings. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Chemotherapy Extravasation Management appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free