Management of Extravasation of Cytotoxic Drugs in Children

8. Treatment of Extravasation from Central Venous
Access Devices: PICC’s, Hickman Lines & Portacaths
8.1 Although less likely to occur an extravasation occurring from an indwelling
central line can be particularly problematic because of the depth of the line and
the potential of slower development of signs and symptoms.
8.2 Extravasation can either occur in the tunnelled section or in the deep section of
the implanted line:
8.3 Extravasation can occur due to fracture of the catheter, perforation of the
superior vena cava, formation of a fibrin sheath on catheter or incomplete
placement or dislodgement of the needle.
8.4 Patients should be educated to the possibility of this happening and that burning
or pain on administration is not normal and should be reported immediately.
8.5 Follow steps as above, leaving the central line in place. The line should be x-ray
and removed as soon as clinically appropriate.
8.6 Referral to plastic surgeon should be made
Immediate Action
1 Stop the administration of the cytotoxic drug
immediately, leaving the central line in place.
Rationale
To prevent further infiltration.
Prompt action to minimise damage is important.
2 Explain what has been suspected of happening
and next procedure to the
patient/parent/guardian.
To obtain patient’s and/or carer’s co-operation and
consent.
3 Attempt to aspirate as much drug as possible
with a new syringe.
To remove any residual drug.
4 Mark the area with a pen and take digital pictures
if possible
To enable the size of the area to be evaluated and
recalled at first presentation.
5 Immediately refer to a senior member of medical
staff
The potential for damage is much greater than with
a peripheral line.
6 Refer to plastic surgeon For specialist input
7 Complete all documentation. Green Card
(available in the extravasation kit), DATIX,
medical and nursing notes
Record all actions taken (see below)
Management of Extravasation of Cytotoxic Drugs in Children
Ratified: Review: 12