Dr. Namosha Mohite - Skincare & Anticancer Drugs PPT (Part I)

Chemotherapy Extravasation Management

Chemotherapy extravasation refers to the accidental leakage of chemotherapy drugs from the intended vein into surrounding tissues during the administration process. This can lead to damage to the surrounding tissues and may cause various complications. Extravasation can occur due to factors such as improper placement of the intravenous (IV) catheter, infiltration of the drug into the surrounding tissue, or issues with the vascular system. Chemotherapy drugs are potent and can be toxic, so when they leak into the surrounding tissues, they may cause irritation, inflammation, and tissue damage. The severity of the complications depends on factors such as the type and amount of chemotherapy drug, the location of extravasation, and the patient's overall health.

Healthcare professionals involved in administering chemotherapy are trained to prevent extravasation and to promptly recognize and manage it if it occurs. Immediate actions may include stopping the infusion, aspirating any residual drug from the affected site, and applying appropriate measures to minimize tissue damage. In some cases, antidotes or specific treatments may be administered to counteract the effects of the extravasated drug.

Highlighting a crucial aspect, the primary objective in managing chemotherapy extravasation is swift localization or dispersion of the leaked agent. The decision between localization and dispersion hinges on the specific chemotherapeutic agents involved. Utilizing a cold compress facilitates the constriction of local blood vessels, thereby aiding in localizing tissue damage. Conversely, a warm compress serves to disperse the chemotherapeutic agent into the surrounding tissues. The secondary goal is to neutralize the localized chemotherapeutic or dilute the agent, facilitating absorption and subsequent metabolism.

I will discuss some common chemotherapy agents that may cause extravasation. The first treatment goal we will discuss is localizing and neutralizing it. This would be for a vesicant like doxorubicin or an irritant like cisplatin. Localizing would occur by using a dry cold compress, and only doxorubicin has an antidote that can neutralize it: Dimethyl sulfoxide (DMSO) or Dexrazoxane. Another treatment goal for a vesicant like Vincristine would be to disperse and dilute it. Dispersing would occur by using a dry warm compress and diluting it with hyaluronidase. The final treatment goal for a nonirritant drug like Cyclophosphamide would be to monitor for mild inflammation and apply a dry cold compress. 

Every instance of extravasation necessitates comprehensive documentation and reporting. Documentation serves a multifaceted role, encompassing the provision of an accurate chronological record, safeguarding the healthcare professionals involved, collecting data on extravasations, and pinpointing practice deficiencies. Additionally, reporting adverse drug reactions and medication errors to the appropriate authorities is a proactive measure by pharmacists to avert future occurrences. The information provided from reported incidents can serve as valuable educational tools, enabling a systematic review of the underlying mechanisms contributing to such events. The adherence to local procedures and protocols is crucial for the prompt identification, management of extravasation, and the prevention of consequential tissue damage.

While chemotherapy extravasation is a serious concern, advancements in medical practices and increased awareness have contributed to improved prevention, early detection, and management of this complication in cancer treatment.

References:

1. https://www.aaha.org/aaha-guidelines/oncology-configuration/implementation-toolkit/chemotherapy-extravasation-management/

2. https://www.uspharmacist.com/article/management-of-chemotherapy-extravasations