Extravasation

Extravasation is when chemotherapy drugs (drugs to treat cancer) leak into tissue during an infusion instead of staying in your blood vessels. This can cause pain or discomfort at the injection site. Your skin may start to swell or redden.

During chemotherapy treatment, IV lines deliver chemotherapy drugs directly into a vein. Or a healthcare provider may place a small tube (cannula) in your arm or hand that delivers chemotherapy via a drip. But with extravasation, the drugs leak into tissue. Chemotherapy drugs that can break down tissue can cause serious issues.

Up to 6 out of every 100 people who get chemo infusions experience extravasation. This means it’s not common, but it can happen. The important thing to know is that your cancer care team is trained to prevent extravasation. They know how to act fast, stop the leaking and counteract the effects.

Symptoms of extravasation

You may have symptoms right away or within a few days of treatment. Experts group them into four grades based on their severity. Signs of extravasation at the injection site include:

• Grade 1: Discomfort and swelling
• Grade 2: Discomfort or pain with swelling, redness and possible blistering
• Grade 3: Pain (may feel like burning or stinging) with swelling, redness, skin discoloration and blisters
• Grade 4: Pain with skin changes like sores, blisters, white or blackened skin (a sign of tissue damage) and skin that’s cool to the touch

In severe cases, the tissue damage may impact limb function. But things rarely progress to this point.

Let the person giving you your infusion know right away if you’re noticing these things during chemotherapy treatment. Seek emergency care if you’re experiencing these symptoms after you’ve left your infusion treatment.

Extravasation causes

Several things can cause extravasation, including:

• A blood vessel breaking during an infusion
• Device failure, like a problem with the IV delivering the drugs
• Errors in how the drug is being administered, like misplacing the needle or giving the drug too fast

Risk factors

You may be at increased risk of extravasation if you have:

• A condition that weakens your blood vessels, like peripheral artery disease
• Blood vessels that are hard or thick because of cancer treatment
• Small or delicate veins
• Veins that move during attempts to insert IV lines

Complications of this condition

Delays in treating extravasation can cause serious issues. Chemotherapy drugs powerful enough to destroy cancer cells can also harm healthy tissue. Leakage from an IV during treatment may cause pain and permanent tissue damage.

This is why cancer care providers are trained to act fast if they suspect extravasation.

How doctors diagnose this condition

Your cancer care team knows the signs to look out for that may mean extravasation. You may need imaging so they can see exactly which tissue has been impacted.

How is extravasation treated?

The members of your care team who administer chemotherapy receive special training to prevent extravasation. They’re also trained to quickly treat any issues. They will:

1. Stop the flow of chemotherapy drugs through the IV
2. Use a syringe to suction out as much of the drugs as possible
3. Administer an antidote through the IV to counteract the effects (if an antidote is available for that specific drug)
4. Remove the IV
5. Elevate the affected arm to reduce swelling
6. Apply cream to ease symptoms
7. Apply a cold or warm compress

With most chemotherapy drugs, a member of your care team will apply a cold compress. The cold shrinks your veins, preventing the spread of the chemo drugs. They use a warm compress with select chemotherapy drugs. The warmth increases blood flow, reducing the amount of drugs near the injection site.

Recovery time

How long it takes to feel better depends on your situation. The type of drug, its concentration and the amount that leaked all impact your recovery time.

In the meantime, your healthcare provider will let you know how to care for yourself. They may recommend you:

• Keep your arm elevated
• Use compresses on your arm for at least one day after extravasation. People recovering often use compresses for 15 to 20 minutes, four to six times a day. Your provider may advise you to use them for longer.

When should I see my healthcare provider?

Contact your provider if you have symptoms that last longer than you expect. You may need treatment for extravasation effects before you can continue with cancer treatment.

What can I expect if I have extravasation?

That depends on your situation. Most people are able to continue chemotherapy treatment. In some cases, healthcare providers may start treatment very soon after extravasation. They’ll choose another site to insert the IV. Or you may need to delay treatment until your symptoms are gone. Your provider can tell you what to expect.

Can it be prevented?

In most cases, yes. Hospital systems have procedures and guidelines to prevent extravasation. Your cancer care team knows the precautions to take to deliver your treatment safely.

Still, extravasation isn’t always preventable. This is why your care team will monitor you closely during treatment. They’ll respond immediately if they see signs of an issue.

What is extravasation vs infiltration?

The difference has to do with the type of drug that leaks into tissue. With extravasation, a vesicant drug leaks. These drugs (like specific chemotherapy drugs) can damage tissue and cause blisters or necrosis (tissue death). With infiltration, a non-vesicant drug, or “irritant,” leaks into tissue. Irritants may be chemotherapy drugs or other types of fluids administered via an IV. The leakage can cause warmth, redness and tenderness. But it doesn’t make tissue die.