Immediate management of an extravasation Your nearest extravasation STOP: the injection or intravenous infusion immediately. kit is located at: LEAVE: the venous access device (VAD) in place. ASPIRATE: any residual drug from VAD. PLAN: call for assistance: notify medical officer, pharmacist or a senior nurse; collect the extravasation kit; assess the affected area, trace with a marker pen, photograph the area; remove the IV cannula or port needle, do not apply pressure; initiate appropriate drug specific management measures as per flowchart below. Vesicant – DNA Vesicant – non-DNA Irritant with Irritant with Irritant binding binding vesicant properties vesicant properties • Bortezomib • Amsacrine • Vinblastine • Bendamustine • Oxaliplatin • Busulfan • Dactinomycin • Vincristine • Cisplatin >0.5 mg/mL • Cabazitaxel (actinomycin D) • Vindesine • Docetaxel • Carboplatin • Daunorubicin* • Vinflunine • Doxorubicin • Carmustine Liposomal • Doxorubicin* • Vinorelbine • Cisplatin ≤0.5 mg/mL • Melphalan • Epirubicin* • Dacarbazine • Mitozantrone • Idarubicin* • Etoposide • Nab-paclitaxel • Mitomycin • Etoposide phosphate • Paclitaxel* • Fluorouracil • Fotemustine • Gemcitabine Localise and Disperse and dilute Localise No warm or • Ifosfamide • Irinotecan neutralise • Administer pain relief • Apply a COLD cold compress • Neutralise by applying a prior to starting if recommended • Irinotecan compress to the nanoliposomal thin layer of topical required affected area for 15 to DMSO 99% solution to • Reconstitute 20 minutes every 6 • Romidepsin the marked area as hyaluronidase 1500 IU hours for 48 hours. • Teniposide soon as possible in 2-5 mL of sterile * There have been some • Topotecan (ideally within 10 to 25 water or sodium clinical reports of positive minutes) and continue chloride 0.9% • Trastuzumab outcomes with using emtansine* every 6 hours for 7 days • Administer hyaluronidase as an - use a cotton bud or hyaluronidase solution antidote for paclitaxel • Zoledronic acid swab stick that has subcutaneously in 0.2 extravasation. If been soaked in to 0.4 mL volumes hyaluronidase is DMSO 99% solution around the marked area administered, no OR using the “pin cushion” compress is Localise - a glass dropper (4 technique at “2 hourly recommended. drops of DMSO 99% • Apply a COLD 2 intervals” on an solution per 10 cm of imaginary “clock face” compress to the affected area) affected area for • Gently massage area to comfort measures • Ensure skin is dry facilitate dispersal before applying DMSO only. 99% solution (to • Apply a WARM * There is no evidence for prevent blistering) compress to affected the use of either warm or area for 15 to 20 • Allow to air dry and do cold compress for minutes every 6 hours trastuzumab emtansine. not cover with a for 48 hours dressing • Elevate limb • Apply a COLD compress to the affected area for 15 to 20 minutes every 6 Consider referral to plastic surgeon hours for 48 hours • Elevate limb • Complete Antineoplastic Drug Extravasation Assessment Tool and incident form as per individual institutional guidelines *For large volume • Referral for an urgent surgical review should be discussed and organised if appropriate anthracycline • Educate patient and provide information with appropriate treatment guidelines including signs and symptoms to monitor for and extravasations consider when to present to emergency dexrazoxane (must be • Arrange patient follow up appointments to ensure extravasation injury is reviewed regularly – ranging from hours to weekly – based administered within 6 upon agent extravasated and degree of extravasation hours). Refer to • Replace items in the extravasation kit including drugs from pharmacy if required supporting document for • Please refer to the Supporting Document – ID 157 Extravasation Management for a comprehensive list of the references used to further information. develop this flow chart. Cancer Institute NSW cancer.nsw.gov.au t +61 (0)2 8374 5600 f +61 (0)2 8374 3600 e [email protected] © Cancer Institute NSW 2019. While every effort has been made to provide accurate information, this document is not intended as a substitute for medical advice. Contact your doctor if you have any concerns..