Collaborative Intravenous Nursing Service (CINS) Guidelines

11Step 5Step 6Step 7Step 8Step 9Step 10Mark the affected areaElevate the limb and encourage movementFor Mustine, anthracyclines, other vesicants , vinka alkaloids, and otherdrugs FOLLOW SPECIFIC ANTIDOTE GUIDANCE. (See below for furthernotes)Inform consultantProvide analgesia if requiredMeasure the area of extravasation, document any treatment as per local policyand photograph injury if possibleStep 11 Provide patient information leaflet with documented measurements of injury –The practitioner must be aware of the possibility of delayed injury. Ensure thatthe patient knows to contact chemotherapy unit if symptoms worsen or persist.Advise the patient to elevate the affected limb as often as possible for the next2-3 days. Arrange a follow up appointment if needed.Subsequent StepsStep 12Step 13Step 14Complete Green Card, trust incident form and any other local documentation asrequired. Send copy of green card to trust pharmacist who will send to thenetwork pharmacistConsider referral to physiotherapistRefill extravasation kit – local policy to detail procedure for refill9.0 Further notes on treatments for cytotoxic extravasationsSee appendix 3 for evidence base for specific treatments.Treatment principles• Localise and neutralise uses pulsed cold compression with or without a specifictreatment to stop the further spread of the drug and prevent further injury.• Spread and dilute uses warm compression with or without hyaluronidase to facilitatedispersal of the extravasated drug thus reducing its concentration and potential fortissue damage.As a general rule cold compression is used except in the case of vinca alkaloids where warmcompression is used. The practitioner must check the specific antidote table (appendix 2)before proceeding with any intervention.The CINs group hereby assert their moral rights tothe works herein in accordance with the Data Protection Act 1988.Policy review date 01/10/10