Management of Extravasation of Cytotoxic Drugs in Children

Peripheral extravasation identified
Stop infusion, Leave cannula in place, Aspirate as much of the drug as possible using a new 10mL syringe, contact senior
member of staff/medical staff, Mark area with pen, Remove cannula, Treat as follows:
Group 1 Drugs
Non-vesicants/neutrals
Asparaginase, Bleomycin, Cladribine,
Cyclophosphamide, Cytarabine, Fludarabine,
Ifosfamide, Melphalan, Rituximab
If large volume seek advice from St. Chad’s
If possible recannulate
in opposite
arm and recommence
chemotherapy
Group 2 & 3 Drugs
Inflammitants & Irritants
Carboplatin, Cisplatin,
Etoposide, Etoposide
Phosphate, Irinotecan,
Methotrexate, Topotecan
Draw up 100mg hydrocortisone and
administer S/C in a clockwise direction
around circumference of the extravasation
site followed by a thin layer of topical
hydrocortisone 1% cream
Use the relevant heat/cold pack to apply warm/cold compression
Apply heat/ cold pack for one hour post incident and then for 20 min four times a day
for 48hrs.
Group 4 & 5
Exfoliants and
Vesicants
Amsacrine,
Carmustine
Dactinomycin
Daunorubicin*
Doxorubicin*,
Epirubicin,
Idarubicin
Mitomycin
Mitoxantrone
Apply topical DMSO every 2
hours at the extravasation
site (DO NOT apply to
healthy skin) followed by
topical hydrocortisone 1%
cream. See also note below.
* for Liposomal preparation
delay DMSO for 8–12 hours
Group 5
Vinca
Alkaloids
Vinblastine,
Vincristine,
Vindesine,
Vinorelbine
Dissolve 1500 units
Hyaluronidase in 1mL water for
injection. Administer
Hyaluronidase 0.1-0.2mL S/C in a
clockwise direction around
circumference of the
extravasation site. Gently
massage area to facilitate
dispersal of drug.
Elevate limb for up to 48 hrs. Give prescribed analgesia & PO chlorphenamine prn for
comfort. If any concerns contact St. Chads, Birmingham for advice (0121 5543801)
Complete necessary documentation (medical notes, DATIX and green card). Ensure
patient has appropriate follow up arrangements.
Drugs requiring heat pack in red, those for
cold pack in blue
Apply heat pack for 1 hour
post & then for 20min every
4hrs for 48hrs. Apply a thin
layer of Hydrocortisone 1%
cream and cover with 2
squares of gauze and
bandage into position
Management of Extravasation of Cytotoxic Drugs in Children
Ratified: Review: 10