Extravasation: Symptoms, Treatment, and Prevention

Extravasation is when a chemotherapy drug leaks from a blood vessel or tube onto the surrounding skin, causing adverse symptoms. The leakage most occurs at the site where an intravenous (IV) needle is inserted into a vein to deliver the drugs.

Extravasation symptoms can vary by the types of drugs used. Some people experience irritant extravasation in which the surrounding skin is mildly irritated, while others experience vesicant extravasation in which skin injury is severe, possibly leading to tissue death (necrosis).

This article explores the causes and symptoms of irritant and vesicant extravasation, including how they are treated and prevented.

What Is Irritant Extravasation?

Certain drugs in chemotherapy are classified as irritants because they can cause temporary, superficial injury to tissues. These drugs are also sometimes referred to as non-vesicants.

If there is extravasation of an irritant medication, symptoms often include:

• Redness
• Swelling
• Itchiness or mild burning

In some cases, the drugs can cause skin ulcers, but generally if the leakage is prolonged or excessive. Some skin types are also more sensitive than others.

Examples of irritant drugs used in chemotherapy include:

• Bleomycin
• Carboplatin
• Carmustine
• Cisplatin
• Dacarbazine
• Etoposide
• Ifosfamide
• Streptozocin
• Teniposide
• Thiotepa

If one of these medications leaks, your healthcare provider will stop the drug, start a new IV line, and give the remainder of the drug through a fresh site.

The treatment may involve mild pain killers such as Tylenol (acetaminophen) and cold compresses to help reduce local inflammation.

What Is Vesicant Extravasation?

Vesicants are drugs that have the potential to cause serious tissue damage if they leak. In this case, the inflammation and discomfort at the IV site will be more noticeable.

Some of the signs of extravasation may not be visible until several hours or days after the leakage. Depending on the amount of drug that is extravasated, symptoms may include:

• Pain or burning sensation
• Redness and swelling at the puncture site
• Blistering and peeling
• The darkening of the skin

Prolonged or excessive exposure to certain vesicant drugs can lead to tissue necrosis (death). Symptoms of necrosis include a crackling sensation beneath the skin followed by increased warmth, a reddish or bronze discoloration, and the formation of gas bubbles under the skin.

People with skin necrosis usually have a high fever and are in intense pain. If not treated aggressively with antibiotics and the surgical removal of dead tissue, limb amputation may be needed. Death is also possible.

Examples of vesicant drugs used in chemotherapy include:

• Actinomycin
• Dactinomycin
• Daunorubicin
• Doxorubicin
• Idarubicin
• Mitomycin C
• Vinblastine
• Vindesine
• Vincristine
• Vinorelbine

If there are signs of vesicant extravasation, your healthcare team may outline the affected area with a marker so that they can tell if it is getting better or worse. If it worsens, your healthcare provider will clean the affected area and give the remainder of the chemotherapy medications through a fresh IV site.

Preventing Chemotherapy Extravasation

Although oncology nurses are trained in administering chemotherapy drugs, accidents can and do occur.

If the risk of extravasation is high, your healthcare provider may choose to insert a central venous catheter (CVC) rather than using an IV drip.

A CVC is a thin, flexible tube that is inserted into a vein, usually below the right collarbone, and threaded into a large vein just above the heart called the superior vena cava. Extravasations from CVCs, while still a possibility, are exceedingly rare.

There are a few things you can also do to prevent an extravasation injury:

• Treat your IV line or CVC with care.
• Avoid touching the IV site or tubing during your infusion.
• Advise the clinic staff immediately if you feel burning, stinging, or itching at the IV site.

If you notice any redness or swelling after leaving the cancer center, call your healthcare provider immediately.

A Word From Verywell

Chemotherapy extravasation is relatively uncommon. And, while every measure is taken to prevent an accident, they still do occur.

As such, never hesitate to speak up if any part of your chemo infusion feels odd or uncomfortable. A rapid response is the best way to avoid injury if and when an extravasation accident occurs.