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EUCLID, HILLCREST, HURON AND SOUTH POINTE HOSPITALS
DEPARTMENT POLICY MANUAL
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
ORIGINATED BY: Regional Director, Pharmacy Services
APPROVAL:
Senior Vice President, Medical Management
DISTRIBUTION:
Pharmacy Services,
ORIGINAL DATE:
July, 1996
Oncology
LAST REVIEWED DATE:
SIGNATURE:
Signatures on file
LAST REVISED DATE:
January 12, 2007
.................................................................................................................................
PURPOSE
To provide guidelines to minimize patient harm through prompt detection and treatment in the event of
extravasation of chemotherapeutic agents.
POLICY
Appropriate guidelines will be followed to prevent and treat extravasation of chemotherapeutic
medications. Chemotherapy/Biotherapy Safe Handling Guidelines (Policy NPM-127) will also be
followed during chemotherapeutic medication extravasation treatment/management.
Definitions
Terms
ƒ Extravasation (or infiltration) refers to intravenous fluid and/or medication that has been
misdirected from a vein into interstitial tissue.
ƒ Irritant refers to an agent that causes aching, tightness, and phlebitis along the vein or at
injection site, with or without a local inflammatory reaction, but does not cause necrosis.
ƒ Vesicant refers to an agent that is capable of forming a blister and/or tissue destruction/
necrosis when extravasated.
Risk Factors for Extravasation
ƒ Vascular disease
ƒ Elderly patients
ƒ Vascular obstruction
ƒ Vascular ischemia
ƒ Prior radiation to arm or axilla
ƒ Small vessel diameter
ƒ Venous spasms
Page 1 of 15
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
ƒ
ƒ
ƒ
Traumatic needle or catheter insertion
Decreased lymphatic drainage
Patients unable to communicate discomfort
Recognition of Possible Extravasation
ƒ Immediate stinging or burning sensation at injection site reported by the patient. At times,
extravasations are not immediately evident. Cases have been reported 4 to 12 weeks after
the incident.
ƒ Swelling, redness, or blanching and blistering at injection site. Some extravasations occur
away from injection site. Extravasations have been reported to occur along the track of a
weakened vessel, at the site of previous venipuncture, or areas distant from site of injection
(mitomycin-C)1.
ƒ Loss of vessel patency.
Prevention of Extravasation
ƒ Use central venous catheters (CVC) or implanted ports whenever possible to decrease
incidence of extravasation. (Extravasations may still occur).
ƒ Careful administration is paramount in preventing extravasations with required checks for
blood return every 10-20 minutes for a 30 minute infusion or every 2 to 5 ml for IV push.
Stop infusion immediately if blood return is altered or patient complains of signs/symptoms
of extravasation.
ƒ For new IV site administration:
o Avoid steel needles for vesicant administration
o Establish blood return before administration
o Appropriately secure IV device
o Use veins that are: large, smooth, and pliable
o Avoid veins:
ƒ That are injured, sclerosed, small, fragile, and/or located in areas of flexion
ƒ With altered venous return or lymphedema, decreased sensation, or those located
in the lower extremities
o Use opposite arm if venipuncture is unsuccessful. If attempt on opposite arm is
unsuccessful, use a site proximal to first attempted venipuncture site.
ƒ Administer vesicant drugs proximal to a previous venipuncture site to prevent extravasation
at site of previous injury.
Procedures
General Procedure for Chemotherapeutic Agent Extravasations (See
Algorithm Below)
1. Stop infusion/ injection immediately, notify the physician, and get an extravasation kit.
2. Remove IV tubing, but DO NOT remove needle/ cannula.
3. Aspirate as much of the extravasated drug and blood as possible from the suspected
extravasation site.
Page 2 of 15
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EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
4. Mark the extravasation site with a permanent marker.
5. Apply appropriate treatment as indicated by Table 1.
6. Remove the needle/ cannula.
7. If given through a peripheral line, elevate the limb.
8. Complete documentation, which includes Adverse Drug Event Reporting Process (ADERP)
form or Safety Event Reporting System (SERS) online report and Chemotherapeutic Agent
Record of Extravasation (CARE) Form (include picture). Place CARE form (with photo) in
patient’s chart. Return ADERP form and copy of CARE form to nurse manager.
9. Review extravasation site care with patient/ family
10. Follow-up with physician for further evaluation or other instructions
11. Return extravasation kit to pharmacy for replenishment
Page 3 of 14
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Basic Algorithm for the Treatment of
Chemotherapeutic Agent Extravasations
1.
2.
3.
Stop infusion/ injection immediately
Notify physician
Get extravasation kit
Peripheral
Line
Central
Line
2. LEAVE needle/cannula in place
1. Remove IV tubing
2. LEAVE needle/cannula in place
3. The central line should remain in place
Aspirate the extravasated drug, trying to draw
some blood back from the needle/ cannula
Aspirate the extravasated drug, trying to draw
some blood back from the needle/ cannula
Mark the extravasated
area with a permanent marker
Mark the extravasated
area with a permanent marker
1. Remove IV tubing
Treatment
1.
2.
3.
Apply appropriate treatment as indicated by table 1 of Chemotherapeutic Agent
Extravasation Policy
Remove peripheral needle/cannula or deaccess vascular access device
Elevate limb if extravasation occurred in peripheral line
Documentation
1.
2.
3.
4.
Complete Adverse Drug Event Reporting Process (ADERP) Form or Safety
Event Reporting System (SERS) online report
Complete Chemotherapeutic Agent Record of Extravasation (CARE) form, with
photo of site
Plan of Care form in patients chart
Return ADERP form and copy of CARE form to nurse manager
Follow-up
1.
2.
3.
Page 4 of 14
Review extravasation site care with patient / family
Make follow-up with physician for further evaluation or other instructions
(referral to plastic surgeon, etc.)
Return extravasation kit to pharmacy for replenishment
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Treatment
Specific Treatment for Extravasation of Chemotherapeutic Agents
ƒ Chemotherapeutic agents can be classified as vesicants, irritants or
non-irritant/non-vesicant.
1. A list of known vesicants and irritants, along with specific treatments and other
considerations can be found in Table 1 below. Medications are listed alphabetically by
generic name.
2. A list of known non-irritant / non-vesicant chemotherapeutic agents can be found in
Table 2. Generally speaking, non-irritant/non-vesicant medications do not require
specific treatment measures; however, appropriate documentation should still be
completed (See Documentation of Extravasation section below) if infiltration occurs.
Table 1— Extravasation Management of
Chemotherapeutic Agents
Drug
Irritant (I)/
Vesicant (V)
Treatment
Amsacrine
(M- AMSA®)
V
ƒ Treatment not clearly
defined
bleomycin
(Blenoxane®)
I
ƒ Treatment not clearly
defined
carboplatin
(Paraplatin®)
I
ƒ Apply cold pack for 60
minutes every 8 hours for
three days2
Other considerations
ƒ
Not available in US/ investigational
drug3
ƒ
May be vesicant at high concentrations
(10mg/1ml)2,4
ƒ Literature suggest :
▫ sodium thiosulfate 25% (1.6ml
mixed with 8.4 ml of sterile water for
injection (SWFI), in a 10 ml syringe,
to yield 0.17 moles/L solution).
Note—if 10% sodium thiosulfate
avalible mix 4 ml drug with 6 ml
SWFI). 1.,2
▫ Inject 5 ml SubQ into the
extravasated site2
OR
▫
▫
Page 5 of 14
dimethylsulfoxide (DMSO) 50%
topically to extravasated site and
allow to air dry2,4
Approximate amount should be twice
the size of extravasated area,
applied every 8 hours for 7 days.2
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Drug
Irritant (I)/
Vesicant (V)
carmustine
(BiCNu®)
I
cisplatin
(Platinol®)
I
Treatment
Other considerations
ƒ Inject 150 units of
hyaluronidase SubQ in to
the extravasation site2,3
ƒ Apply warm pack for 1-2
hours2,3
ƒ Local infiltration > 5 millimeters, consider:
▫ sodium thiosulfate 25% (1.6ml
mixed with 8.4 ml of sterile water for
injection (SWFI), in a 10 ml syringe,
to yield 0.17 moles/L solution).
Note—if 10% sodium thiosulfate
avalible mix 4 ml drug with 6 ml
SWFI). 1.,2
▫ Inject 5 ml SubQ into the
extravasated site2
▫ Apply cold pack immediately for 1520 min.2 Repeat four times a day for
24-48 hours2
ƒ Apply cold pack for 60
minutes every 8 hours for
three days2
ƒ
ƒ
ƒ
Vesicant when > 20 ml of 0.5 mg/ml
concentration extravasates1,2
If concentration is less than above, drug
is an irritant1
At vesicant concentrations literature
suggest :
▫ sodium thiosulfate 25% (1.6ml
mixed with 8.4 ml of sterile water for
injection (SWFI), in a 10 ml syringe,
to yield 0.17 moles/L solution).
Note—if 10% sodium thiosulfate
avalible mix 4 ml drug with 6 ml
SWFI). 1.,2
▫ Inject 2 ml SubQ into the
extravasated site for every 100mg of
cisplatin1
OR
▫
▫
cyclophosphamide
(Cytoxan®)
Page 6 of 14
I
ƒ Treatment measures not
clearly defined (see
comments)
dimethylsulfoxide (DMSO) 50%
topically to extravasated site and
allow to air dry2,4
Approximate amount should be
twice the size of extravasated area,
applied every 8 hours for 7 days.2
ƒ Literature suggest the following may be
beneficial:
▫ sodium thiosulfate 25% (1.6ml
mixed with 8.4 ml of sterile water
for injection (SWFI), in a 10 ml
syringe, to yield 0.17 moles/L
solution). Note—if 10% sodium
thiosulfate avalible mix 4 ml drug
with 6 ml SWFI). 1.,2
▫ Inject 5 ml SubQ into the
extravasated site2
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EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Drug
Irritant (I)/
Vesicant (V)
Treatment
Other considerations
dacarbazine
(DTIC-Dome®)
I
ƒ Treatment not clearly
defined (see comments)
ƒ When concentrated dacarbazine
extravasated, literature suggest :
▫ sodium thiosulfate 25% (1.6ml
mixed with 8.4 ml of sterile water for
injection (SWFI), in a 10 ml syringe,
to yield 0.17 moles/L solution).
Note—if 10% sodium thiosulfate
avalible mix 4 ml drug with 6 ml
SWFI). 1.,2
▫ Inject 5 ml SubQ into the injection
site2
dactinomycin
(Cosmegan®)
V
ƒ Apply cold pack
immediately for 15-20
min.1,2 Repeat four times a
day for 24-48 hours1,2
ƒ Elevate site for 48 hours1,2
ƒ
daunorubicin
(Daunorubicin®)
V
ƒ Apply dimethylsulfoxide
(DMSO) 50% topically to
extravasated site and allow
to air dry2,4
ƒ Approximate amount
should be twice the size of
extravasated area.2,4
ƒ Apply cold pack
immediately for 15-20
min.2,4 Repeat four times
a day for 24-48 hours1,2
ƒ
ƒ Apply cold pack
immediately for 15-20
min.2,4 Repeat four times a
day for 24-48 hours1,2
ƒ
daunorubicin
liposomal
(DanuoXome®)
I
denileukin difitox
(Ontak®)
I
ƒ Treatment not clearly
defined
docetaxel
(Taxotere®)
I
ƒ Apply cold pack
immediately for 15-20 min.2
Repeat four times a day for
Page 7 of 14
ƒ
ƒ
ƒ
ƒ
Application of heat may exacerbate
tissue damage1
Application of heat, sodium thiosulfate,
corticosteroids, or hyaluronidase is not
recommended2
Literature suggest using DMSO every 4-6
hours for 3-14 days2
Vesicant potential unclear, published
case reports suggest may only be irritant2
Treatment not clearly defined, but if
ulceration begins or pain, redness, or
swelling persist, treat like daunorubicin
(DMSO in addition to cold pack, see
doxorubicin treatment above)
Vesicant potential has been
documented4
Literature available supporting usage of
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Drug
Irritant (I)/
Vesicant (V)
Treatment
Other considerations
24-48 hours2
doxorubicin
(AdriamycinPFS®,
Adriamycin
RDF®, Rubex®)
doxorubicin
liposomal (Doxil®)
V
I
warm or cold pack2
ƒ Apply dimethylsulfoxide
(DMSO) 50% topically to
extravasated site and allow
to air dry2,4
ƒ Approximate amount
should be twice the size of
extravasated area.2,4
ƒ Apply cold pack
immediately for 15-20
min.2,4 Repeat four times
a day for 24-48 hours2
ƒ
ƒ
ƒ
Apply cold pack
immediately for 15-20
min.2,4 Repeat four times
a day for 24-48 hours2
ƒ
ƒ
ƒ
epirubicin
(Ellence®)
V
ƒ
ƒ
ƒ
Apply dimethylsulfoxide
(DMSO) 50% topically to
extravasated site and
allow to air dry2,4
Approximate amount
should be twice the size of
extravasated area.2,4
Apply cold pack
immediately for 15-20
min.2,4 4 Repeat four
times a day for 24-48
hours2
etoposide, vp-16
(Toposar®,
VePesid®)
I
ƒ Inject four 0.5ml (150
Units/ml) Sub Q doses of
hyaluronidase into
extravasated site2,3
ƒ Apply warm compress for
30 to 60 minutes, then
alternate on and off every
15 minutes for 1 day2
gemcitabine
(Gemzar®)
I
ƒ
Page 8 of 14
ƒ
ƒ
ƒ
Application of heat, sodium thiosulfate,
corticosteroids, or hyaluronidase is not
recommended2
Literature suggest using DMSO every 4-6
2
hours for 3-4 days
Protect extravasated area from sunlight
and heat1
Extravasation data limited, if ulceration
begins or pain, redness, or swelling
persist, treat like doxorubicin (DMSO in
addition to cold pack, see doxorubicin
treatment above)1
Application of heat, sodium thiosulfate,
corticosteroids, or hyaluronidase is not
recommended2
Application of heat, sodium thiosulfate,
corticosteroids, or hyaluronidase is not
recommended2
Literature suggest using DMSO every 4-6
hours for 3-14 days2
Vesicant potential has been
documented4
Treatment not clearly
defined
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Drug
idarubicin
(Idamycin®)
ifosfamide (IFEX®)
Irritant (I)/
Vesicant (V)
V
I
Treatment
Apply dimethylsulfoxide
(DMSO) 50% topically to
extravasated site and
allow to air dry2,4
ƒ Approximate amount
should be twice the size of
extravasated area.2,4
ƒ Apply cold pack
immediately for 15-20
min.2,4
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
Apply cold pack for 60
minutes every 8 hours for
three days2
Apply dimethylsulfoxide
(DMSO) 50% topically to
extravasated site and
allow to air dry2
Approximate amount
should be twice the size
of extravasated area.2
irinotecan
(Camptosar®)
I
ƒ
Apply cold pack
immediately for 15-20
min.2 Repeat four times
a day for 24-48 hours2
melphalan
I
ƒ
Treatment not clearly
defined
Methchlorethamine
(Mustargen®)
V
Page 9 of 14
Other considerations
ƒ sodium thiosulfate 25%
(1.6ml mixed with 8.4 ml
of sterile water for
injection (SWFI), in a 10
ml syringe, to yield 0.17
moles/L solution). Note—
if 10% sodium
thiosulfate available mix
4 ml drug with 6 ml
SWFI). 1.,2
ƒ Inject 2ml of drug sodium
thiosulfate Sub Q into the
extravasated site for every
1mg of drug extravasated1
ƒ
ƒ
Application of heat, sodium thiosulfate,
corticosteroids, or hyaluronidase is not
recommended2
Literature suggest using DMSO every 4-6
hours for 3-14 days2
Application of heat is not
recommended2
Literature suggest using DMSO every 8
hours for seven days2
ƒ warm and cold packs have not proven to
be affective1
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Drug
mitomycin-C
(Mutamycin®)
Irritant (I)/
Vesicant (V)
V
Treatment
ƒ
ƒ
ƒ
mitoxantrone
(Novantorne®)
oxaliplatin
(Eloxatin®)
I
I
ƒ
ƒ
Other considerations
Apply dimethylsulfoxide
(DMSO) 50% topically to
extravasated site and
allow to air dry2,4
Approximate amount
should be twice the size
of extravasated area.2,4
Apply cold pack
immediately for 15-20
min.2,4 Repeat four times
a day for 24-48 hours2
ƒ
Apply cold pack
immediately for 15-20
min. Repeat four times a
day for 24-48 hours
ƒ
ƒ
Treatment not clearly
defined (see comments)
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ Apply cold pack
immediately for 15-20 min.1
Repeat four times a day for
24-48 hours1
ƒ
Vesicant potential has been documented
ƒ
Literature available supporting usage of
hot or cold pack2
ƒ Apply cold pack
immediately for 15-20 min.
ƒ Repeat four times a day for
24-48 hours
ƒ
Literature on irritant / vesicant potential
is limited
Follow same treatment guidelines as
paclitaxel (Taxol®) until further evidence
is available
ƒ
I
paclitaxel proteinbound particles
(Abraxane®)
I
pentostatin
(Nipent®)
I
Page 10 of 14
May act as vesicant (rare)4
Ulcerations reported with higher
concentrations1
Treatment measures not clearly defined
Literature supports using either warm or
cold pack (oxaliplatin-induced acute
neuropathy may be exacerbated by
cold)1
Heat, if used, should be applied for one
hour—excessive heat can lead to tissue
damage2
Literature also supports usage of
sodium thiosulfate 25% (1.6ml mixed
with 8.4 ml of sterile water for injection
(SWFI), in a 10 ml syringe, to yield 0.17
moles/L solution). Note—if 10% sodium
thiosulfate avalible mix 4 ml drug with 6
ml SWFI). 1.,2 Inject 5 ml SubQ into the
extravasation site2
Vesicant potential has been documented
ƒ
paclitaxel (Taxol®)
Literature suggest using DMSO every 46 hours for 14 days1,2
Protect extravasated area from
sunlight1
Delayed skin reaction reported at areas
distant from extravasation site1
ƒ
1,2,4
1,4
ƒ Treatment not clearly
defined
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Drug
Irritant (I)/
Vesicant (V)
Treatment
plicamycin
(Mithramycin®)
V
streptozocin
(Zanosar®)
I
ƒ Treatment not clearly
defined
teniposide, VM-26
(Vumon®)
I
ƒ Inject four 0.5ml (150
Units/ml) Sub Q doses of
hyaluronidase into
extravasated site2,3
ƒ Apply warm compress for
30 to 60 minutes, then
alternate on and off every
15 minutes for 1 day2
topotecan
(Hycamtin®)
I
ƒ Apply cold pack
immediately for 15-20
min.2
ƒ Repeat four times a day for
24-48 hours2
vinblastine
(Velban®)
V
vincristine
(Oncovin®)
Vindesine
Page 11 of 14
Other considerations
ƒ Treatment not clearly
defined
ƒ
Vesicant potential has been
documented4
ƒ Inject four 0.5ml (150
Units/ml) Sub Q doses of
hyaluronidase into
extravasated site2,3
ƒ Apply warm pack for 1520 minutes 4 times per
day for 1-2 days1-3
ƒ
Topical cooling is NOT recommended for
treatment2
V
ƒ Inject four 0.5ml (150
Units/ml) Sub Q doses of
hyaluronidase into
extravasated site2,3
ƒ Apply warm pack for 1520 minutes 4 times per
day for 1-2 days1-3
ƒ
Topical cooling is NOT recommended for
treatment2
V
ƒ Inject four 0.5ml (150
Units/ml) Sub Q doses of
hyaluronidase into
extravasated site2,3
ƒ Apply warm pack for 1520 minutes 4 times per
day for 1-2 days1-3
ƒ Not Available in the US
ƒ topical cooling is NOT recommended for
treatment2
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Drug
Irritant (I)/
Vesicant (V)
vinorelbine
(Navelbine®)
V
Treatment
Other considerations
ƒ Inject four 0.5ml (150
Units/ml) Sub Q doses of
hyaluronidase into
extravasated site2,3
ƒ Apply warm pack for 1520 minutes 4 times per
day for 1-2 days1-3
ƒ
Topical cooling is NOT recommended for
treatment2
Table 2— Non-irritant / Non-vesicant
Chemotherapeutic and Biotherapeutic Agents
aldesluekin (Prokine®)
alemtuzumab (Campath®)
alemtuzumab (Campath®)
amifostine (Ethyol®)
aresenic trioxide (Trisenox®)
asparaginase (Elspar®)
azacitidine (Vidaza®)
BCG Live (Tice BCG®)
bevacuzimab (Avastin®)
bortezomib (Velcade®)
busulfan (Busulfex®)
cetuximab (Erbitux®)
cladribine (Leustatin®)
clofarabine (Clolar®)
cytarabine (Cytosar-U®)
cytarbine liposomal (DepoCyt®)
decitabine (Dacogen®)
Page 12 of 14
dexrazoxane (Zinecard®)
floxuridine (FUDR®)
fludarabine (Fludara®)
fluorouracil, 5-FU (Adrucil®)
interferon alfa 2a (Roferon A®)
interferon alfa 2b (Intron A®)
leucovorin (Leucovorin®)
mesna (Mesnex®)
methotrexate
nelarabine (Arranon®)
pamidronate (Aredia®)
pemetrexed disodium (Alimta®)
rituximab (Rituxan®)
thiotepa (Thioplex®)
tositumomab (Bexxar®)
trastuzumab (Herceptin®)
zoledronic acid (Zometa®)
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
Documentation of Extravasation
Adverse Drug Event Reporting Process (ADERP) Form
ƒ Adverse Drug Event Reporting Process (ADERP) Form will be completed in accordance
with the adverse drug event reporting policy (HPM1038)
ƒ ADERP forms are available in all patient care areas, in the drug extravasation kit, as well as
from Pharmacy Services
ƒ The completed ADERP form will be returned to the nurse manager, who will then return the
form to Pharmacy Services or complete online reporting in Safety Event Reporting System
(SERS).
Chemotherapeutic Agent Record of Extravasation (CARE) Form
ƒ Chemotherapeutic Agent Extravasation Record Form will be completed after treatment of
drug extravasation.
ƒ CARE forms are available in all patient care areas, in the drug extravasation kit, as well as
from Pharmacy Services
ƒ Once completed, the original will be placed in the patients chart and a copy will be given to
the nurse manager.
Extravasation Kit
ƒ
Extravasation kits shall be kept in the pharmacy and the oncology unit(s) as per hospital
policy. Each kit will be labeled with an expiration date and sealed by pharmacy. When the
kit is opened, it will be returned to the pharmacy for replenishment. The enclosed charge
slip should be marked with the patient’s name and returned to the pharmacy with the box.
Extravasation Kit Contents:
Quantity
ƒ
dimethylsulfoxide (DMSO) 50%
1
ƒ
sodium thiosulfate (10% or 25%)
1
ƒ
hyaluronidase
In Refrigerator
ƒ
Sterile water for injection (no preservatives) (SWFI) 10ml
2
ƒ
Alcohol swabs
6
6
ƒ
Needles 25G 5/8
ƒ
Syringes 5 ml
2
ƒ
Syringes 10ml
2
ƒ
TB Syringes
6
ƒ
Gauze pads 2x2
4
ƒ
Gauze pads 4x4
4
ƒ
Chemotherapy gloves
2
ƒ
Permanent marker
1
ƒ
Charge Slip
1
ƒ
Chemotherapeutic Agent Extravasation Policy
1
ƒ
Adverse Drug Event (ADE) form
1
ƒ
Chemotherapeutic Agent Record at Extravasation
1
(CARE) form
Page 13 of 14
DPM7413 Revised 1/12/07
EXTRAVASATION PROCEDURE FOR CHEMOTHERAPEUTIC AGENTS
References
1. Polovich M, White JM, Kelleher LO. Chemotherapy and Biotherapy Guidelines. 2nd ed, 2005,
Pittsburgh: ONS Press.
2. Thompson Micromedex Healthcare Series, Vol 129. 2006.
3. Lexi-Comp online. 2006.
4. Ener RA, Meglathery SB, Styler M. Extravasation of systemic hemato-oncological therapies.
Ann of Oncology. 15: 858-862, 2004.
Revised:
January 12, 2007
Reviewed:
(Signature/Date)
Page 14 of 14
DPM7413 Revised 1/12/07
Date/Time of Extravasation:
EXTRAVASATED MEDICATION INFORMATION
Drug:
Dose:
Concentration:
Approximate Volume Extravasated (ml):
DESCRIPTION OF SITE
Location:
Skin Color:
(Staple Polaroid Photo Here)
Size of Extravasation (cm):
Edema
G Yes
G No
Blood Return
G Yes
G No
Pain
G Yes
G No
Other Signs/Symptoms:
VASCULAR ACCESS
PRE-TREATMENT ASSESSMENT
G Peripheral
Vein:
G PICC
G Soft/Pliable
G Hickman
Yes
No
Blood Return
G
G
G Fragile/Thin
Site Intact
G
G
G Portacath
G Thready
Patient without
G
G
G Other:
G Hard/Knotty
Complaint
NEEDLE SIZE AND TYPE
METHOD OF ADMINISTRATION
G Butterfly, #
G Sidearm IV Push
G Angiocath, #
G Piggyback
G Huber, #
G Continuous Infusion
- OVER EUCLID, HILLCREST, HURON, AND SOUTH POINTE HOSPITALS
CHEMOTHERAPEUTIC AGENT RECORD OF
EXTRAVASATION (CARE)
1206-047
PAGE 1 OF 2
(F) MR-1378 3/07
MANAGEMENT OF EXTRAVASATED SITE
1.
IVP or infusion stopped at first complaint of pain, burning, pressure or edema
2.
Dr.
3.
Get extravasation kit
G Yes G No
4.
Residual drug aspirated
G Yes G No
5.
Area of extravasation marked on skin using a permanent marker
G Yes G No
notified at
G Yes G No
a.m./p.m.
Amount (ml)
6.
Needle removed and limb elevated (if peripheral line)
7.
Treatment (check all that apply)
G
G
G
G
G
G
G
8.
G Yes G No
Cold pack, time (minutes)
Warm pack, time (minutes)
Cold/heat not applied
Hyaluronidase (as indicated in Table 1 of extravasation policy)
Approximate amount (ml)
Dimethylsulfoxide (DMSO) 50% (as indicated in Table 1 of extravasation policy)
Approximate amount (ml)
Sodium Thiosulfate (as indicated in Table 1 of extravasation policy)
Approximate amount (ml)
Other
Approximate amount (ml)
Patient instruction given (check all that apply)
Care for extravasated area (as indicated in Table 1 of extravasation policy)
minutes every
hours for
G Cold pack
G Warm pack
minutes every
hours for
G Dimethylsulfoxide (DMSO) 50%
ml every
G Other
Call Cancer Center for any new or persistent:
a. Pain, burning, redness, swelling at the IV site
b. Skin breakdown or new brown/black scabs near IV site
c. Difficulty moving involved hand, wrist, or shoulder
9.
G Yes G No
G Yes G No
G Yes G No
at
Patient notified of return appointment for
hours for
a.m./p.m. with
Dr.
10. Patient/family vocalized understanding
G Yes G No
NOTES
EUCLID, HILLCREST, HURON, AND SOUTH POINTE HOSPITALS
CHEMOTHERAPEUTIC AGENT RECORD OF
EXTRAVASATION (CARE)
1206-047
PAGE 2 OF 2
(F) MR-1378 3/07