Extravasation refers to the escape of a drug into the extravascular space, either by leakage from a vessel or by direct infiltration . Although many drugs are irritating when they are introduced into extravascular tissues, extravasation of a vesicant drug has the potential to cause tissue damage with severe and/or lasting injury. Although the most well known vesicants are cytotoxic chemotherapy drugs (table 1), several non-antineoplastic drugs also have vesicant properties (table 2).
The incidence, risk factors, clinical presentation, prevention, and management of extravasation injury from chemotherapy and non-antineoplastic vesicants are reviewed here, with a focus on chemotherapy extravasation injury. Other cutaneous complications of chemotherapy and venous irritation (chemical phlebitis) that occurs with drug administration into an intact vein (as is seen predominantly with vinorelbine and epirubicin) are discussed elsewhere. (See "Cutaneous complications of conventional chemotherapy agents".)
INCIDENCE AND RISK FACTORS
Incidence — The true incidence of chemotherapy vesicant extravasation is unclear since there is no central reporting mechanism. With an increasing awareness of the risks from extravasation, the frequency appears to have fallen.
Data from MD Anderson Cancer Center indicate that the rate of serious extravasation injury (as determined by referral patterns to a plastic surgery clinic) declined from 0.1 to 0.01 percent over a 15-year period, based upon individual doses of chemotherapy administered . However, this series only includes patients who were referred to plastic surgery rather than all extravasations, while the denominator includes all individual doses of chemotherapy delivered over the six-year study period. As such, this rate probably underestimates the true incidence of chemotherapy extravasation injury. Furthermore, this rate may not reflect the actual rate in other clinical settings.
Infusional administration of vesicant antineoplastic agents is frequently done through a central venous access device (CVAD) to minimize the likelihood of subcutaneous extravasation. While the risk of chemotherapy extravasation through a CVAD is small, it is not zero and extravasation may be due to injection technique or device failure: