Extravasation

What is extravasation?

The term “extravasation” is based on Latin (“extra” refers to being outside something and“vas” refers to vessel). Extravasation is both a process and a medical condition:

• Extravasation is the multistep process cells use to move from your bloodstream into your tissues.
• Extravasation is the condition that may happen if fluids spill from IV (intravenous) lines during chemotherapy treatment. Extravasation may also refer to blood from blood vessels or lymph from damaged lymph vessels leaking into surrounding tissue.

Extravasation as a process

In the process of extravasation, white blood cells travel through blood cell walls and tissues to locate and manage injuries and infections. It’s also part of the process cancer cells use to spread (metastasize).

Extravasation in cancer cells starts when cells break away from the original tumor. Cancer cells typically use your capillaries to move through your bloodstream. The cells attach to the thin membrane called the endothelium, which lines your blood vessels.

At first, the cancer cells roll or slide along your endothelium. Eventually, the cells form a tight bond with your endothelium. (Certain white blood cells and platelets participate in this process. Medical researchers are studying this process in hopes what they learn may help prevent metastasis.) Eventually, cancer cells break through the blood cell lining to reach tissue. Once in tissue, cancer cells may go dormant, die or begin to build new tumors.

Would I know if my body was going through extravasation?

In the case of white blood cells, you may notice changes as your white blood cells gather to combat infection or manage injury. Cancer that metastasizes or spreads may not cause immediate changes or symptoms.

Can medical tests show extravasation?

Not directly, although blood tests can monitor white blood cell levels and signs of cancer in your bloodstream.

Extravasation as a medical condition

When healthcare providers refer to extravasation as a medical condition, they’re referring to issues that happen when you receive chemotherapy drugs via an intravenous (IV) line or cannula. Cannulas are small tubes placed in your hand or arm.

IV lines deliver chemotherapy directly into a vein. If you’re receiving chemotherapy via an IV line, your provider inserts a plastic needle into a vein in your lower arm. Chemotherapy drugs flow from a plastic bag through tubing into your bloodstream. If you’re receiving chemotherapy via a cannula, chemotherapy drips into your bloodstream over a set time period.

Some chemotherapy drugs called vesicants can damage tissue if they leak from an IV or cannula. When that happens, people receiving chemotherapy via IV lines may notice a burning sensation or pain. If drugs leak from a cannula, the area around it may feel hard, swollen or red.

It’s important to remember that your healthcare providers know if you’re receiving a chemotherapy that’s a vesicant (causes irritation). Hospital systems have policies and guidelines to prevent extravasation. They’ll monitor your treatment very carefully and move quickly to resolve any issues.

Is extravasation in cancer treatment common?

It’s not common, but it does happen. One study found that about 6% of all cancer treatments involved some type of extravasation. Healthcare providers who administer chemotherapy via IV lines are trained to prevent and promptly treat extravasation.

Is extravasation in cancer treatment a serious issue?

It can be. Chemotherapy drugs powerful enough to destroy cancer cells can also damage healthy tissue. Chemotherapy drugs leaking from an IV during treatment may cause pain and damage tissue. You may have symptoms right away or within a few days of treatment. Chemotherapy extravasation symptoms include:

• Sudden pain where the IV or cannula is placed.
• Stinging or burning sensations.
• Reddened skin.
• Blisters.
• Sores.
• White skin, which may be a symptom of tissue damage.

Certain risk factors increase the chance of extravasation in cancer treatment. Healthcare providers know these risk factors and take steps to eliminate the risk of extravasation. People with the following characteristics may have an increased risk of extravasation:

• Small or fragile veins.
• Blood vessels that burst more easily than usual.
• Blood vessels that are thick or hard due to cancer treatment.
• Blood vessels that move during attempts to place IV lines.

How is extravasation treated?

Healthcare providers who administer chemotherapy receive special training that emphasizes keeping people safe during treatment. Their priority is preventing extravasation in cancer treatment. But they’re also trained to rapidly resolve and treat any issues that extravasation may cause. Here are steps providers may use:

• Stopping the flow of chemotherapy drugs through the IV.
• As much as possible, removing the spilled drugs from the affected area.
• Removing the IV.
• Elevating the affected arm.
• Applying cream to ease symptoms.
• Applying cold compresses. Cold compresses help with pain. They also help your blood vessels shrink (contract), reducing the risk any remaining chemotherapy drugs will spread.
• Applying warm compresses. Warm compresses increase blood flow. This may help to remove or reduce the amount of chemotherapy drugs near the injection site.

What happens after extravasation?

That depends on your situation. Your healthcare providers will treat any issues caused by extravasation. Then, they’ll monitor your condition for any signs of new or more serious issues.

In some cases, you may be able to resume treatment, with providers using another site to insert an IV. In other instances, providers monitoring your condition may recommend you reschedule your treatment while you recover. Either way, your providers will provide detailed instructions on how you can take care of yourself at home. For example, they may recommend you:

• Use cold or warm compresses on your arm for at least one day after extravasation. Your provider will share specific instructions. People recovering from extravasation may use compresses for 15 to 20 minutes, four to six times a day.
• Elevate your affected arm.

Will I be able to continue treatment?

That depends on your situation. Studies show that most people can continue treatment. In some cases, providers may start treatment very soon after extravasation, placing the IV in another injection site. Other times, people delay treatment until their extravasation symptoms are gone.

When should I contact my healthcare provider?

Contact your provider if you have extravasation symptoms that last longer than you expect.

A note from Cleveland Clinic

Cancer has a language all its own. “Extravasation is an example of a cancer term with different meanings. Extravasation is the process cancer cells use to spread. But it’s also a medical condition that may happen during cancer treatment. Extravasation in cancer treatment happens when chemotherapy drugs spill or leak from intravenous (IV) lines or cannulas. Extravasation in cancer treatment isn’t common but it can happen. Healthcare providers receive special training on how to prevent and promptly treat extravasation. If your cancer treatment includes chemotherapy, ask your providers what to expect so you know what you’re experiencing is a typical side effect.