Treating Extravasation Injuries
The many papers on this subject present a diversity of views
but there is not enough consensus to formulate an algorithmic approach to
treatment based on the physicochemical properties of the groups of agents
or to predict which cases may progress to significant tissue necrosis. The
following information is based on current available evidence. Units are advised
to formulate a policy to deal promptly with extravasation which is relevant
to the drugs and infusates used regularly.
To view the West Midlands Regional Chemotherapy Services extravasation
treatment protocol, formulated by St. Chad's Unit, City Hospital, Birmingham
UK, click here
To view details of David Gault's 'flush-out' technique,
please click here
Heat and Cold
These have been used on the principle that:
- Heat induces vasodilation, increasing drug distribution and absorption 60,88
and decreasing local drug concentrations.59,64
- Cold causes vasoconstriction, localising the extravasation 60
and allowing time for local vascular and lymphatic systems to disperse the
- With the exception of vinca alkaloids, topical cooling seems to be more
effective than topical warming in the management of cytotoxic and non-cytotoxic
In practice, the application of moist heat has lead to maceration and necrosis.62
These have been used to reduce inflammation
- As intradermal or subcutaneous injections and topically as steroid creams.
- As single treatments and in combination with other agents.
- Evidence suggests that corticosteroids are not helpful in the extravasation
of antineoplastic agents because inflammation is not prominent in the aetiology
of tissues necrosis.
Some of these are recommended by the drug manufacturers.
- Phentolamine (an alpha-adrenergic blacking agent relaxing smooth vascular
muscles) has been used as an antidote to vasopressor extravasation. (ABPI
- Topical glyceryl trinitrate (vasodilator) for parenteral nutrition. 93
- Sodium thiosulphate (direct inactivation) for mustine.(ABPI
- Dimethyl sulphoxide (an oxygen-free radical scavenger) for daunorubicin,
11 mitomycin 4
and doxorubicin. 94
- Dexrazoxane (Savene TM) for anthracycline
Indications for surgical excision of the extravasated area:
- Clear cut full-thickness skin necrosis with or without frank ulceration
92 or intractable pain.
- Wide excision including a margin of normal tissue ensures a satisfactory
graft or flap 61although
deep ulceration may involve tendons or nerves. 92
- Patients frequently end up with extension contractures regardless of how
wound closure is achieved. 92
- Early surgical excision is controversial since only about a third of known
vesicant extravasations will ulcerate.96
This page last updated 8th May 2006
© The National Extravasation
Information Service, 2000-2006.