This leaflet provides information for patients whose chemotherapy has leaked from the vein into which it was being given (extravasation). It will explain what extravasation is, what complications may occur and how we will treat it. This leaflet will also provide you with contact telephone numbers.
What is extravasation?
Extravasation is when chemotherapy leaks from the vein into the skin or surrounding tissues. If extravasation occurs you will usually notice pain, swelling or redness near the site of the drip used for your chemotherapy.
What are the possible complications of extravasation?
The complications will vary depending on which chemotherapy drug has caused the problem. Most patients experience few problems following extravasation. However some chemotherapy drugs may damage the skin and surrounding tissues if they leak. This may result in swelling, redness, pain or the development of blisters or ulcers. Very rarely plastic surgery may be required to repair skin and tissue damage.
What treatment is given for extravasation?
The treatment given will depend on which chemotherapy drug has caused the problem. You will be given treatment by your nurses and doctors in hospital. You will also be given advice about what you should do when you go home. The treatment you will be given in hospital may include some of the following:
These treatments are given to prevent or minimise any damage that the chemotherapy may cause.
What should I do when I go home?
Depending on which chemotherapy drug has caused the problem you will be asked to follow different instructions. The chemotherapy drugs are divided into five groups A,B,C,D and E. Instructions for each group are on pages 3 - 5.
Your doctor or nurse will tick which instructions you should follow. Follow all the instructions for your group of drugs.
Group A chemotherapy drugs
We will give you two creams to take home, Dimethylsulfoxide (DMSO) cream and hydrocortisone cream. You should gently spread a thin layer of cream to the affected area every 3 hours while you are awake. First using the DMSO cream then the hydrocortisone cream 3 hours later. Continue applying the alternate creams every 3 hours for 7 days.
You should place something cold on the affected area for 15 -20 minutes three to four times in the first 24 hours after the extravasation. You may use a commercial ‘cold pack’ or use crushed ice in a plastic bag. The ice should not be placed straight onto the skin but on top of a layer of gauze or a clean tea towel or pillow case.
You should also try to keep your arm raised for as much time as possible for the first 24 hours. While this is difficult to do all of the time you could raise your arm on pillows or cushions while sitting down and when in bed.
Group B chemotherapy drugs
You should use a heat source, such as a hot water bottle (with a cover) or electric heat pad, on the affected area for as much time as possible for the first 24 hours.
You should also try to keep your arm raised for as much time as possible for the first 24 hours. While this is difficult to do all of the time you could raise your arm on pillows or cushions while sitting down and when in bed.
Group C chemotherapy drugs
You should use a heat source, such as a hot water bottle (with a cover) or electric heat pad, on the affected area for as much time as possible for the first 24 hours.
You should also try to keep your arm raised for as much time as possible for the first 24 hours. While this is difficult to do all of the time you could raise your arm on pillows or cushions while sitting down and when in bed.
We will give you an anti inflammatory cream to take home. You should gently spread a thin layer of cream to the affected area four times a day for the next 7 days.
Group D chemotherapy drugs
You should place something cold on the affected area for 15 -20 minutes three to four times in the first 24 hours after the extravasation. You may use a commercial ‘cold pack’ or use crushed ice in a plastic bag. The ice should not be placed straight onto the skin but on top of a layer of gauze or a clean tea towel or pillow case.
If an extravasation of topotecan or irinotecan has occurred we will give you hydrocortisone cream to take home. You should gently spread a thin layer of cream to the affected area twice a day for the next 7 days or until any redness has settled.
You should also try to keep your arm raised for as much time as possible for the first 24 hours. While this is difficult to do all of the time you could raise your arm on pillows or cushions while sitting down and when in bed.
Group E chemotherapy drugs
You should place something cold on the affected area for 15 -20 minutes three to four times in the first 24 hours after the extravasation. You may use a commercial ‘cold pack’ or use crushed ice in a plastic bag. The ice should not be placed straight onto the skin but on top of a layer of gauze or a clean tea towel or pillow case.
8 -12 hours after the extravasation has occurred, you should gently spread a thin layer of Dimethylsulfoxide (DMSO) cream to the affected area. For the first 24 hours you should repeat this every 2 hours. After this you should apply the cream 4 times daily for a further 10 days. Please take care to only apply to the affected area. If any blistering of the skin occurs please stop using the cream and contact the nurse with the chemotherapy pager at Velindre cancer centre.
You should also try to keep your arm raised for as much time as possible for the first 24 hours. While this is difficult to do all of the time you could raise your arm on pillows or cushions while sitting down and when in bed.
When should I contact the hospital?
Contact Velindre Cancer Centre if you have any of the following symptoms at, or near, the site of the extravasation:
Who will check that my arm is getting better?
A nurse from Velindre will arrange a time to telephone you a day or two after the extravasation to check how you are. If you have any concerns before the nurse phones please do not hesitate to contact us. The telephone number is on page 6 of this leaflet.
Contact telephone numbers
Further information and advice is available from:
Velindre Cancer Centre 029 2061 5888
If you are unwell at home and need immediate attention at any time of the day or night ask for the treatment helpline
Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines
Velindre Cancer Centre
Velindre Road
Whitchurch
Cardiff
CF14 2TL
This information leaflet was written by health professionals. The information contained in this leaflet is evidence based. The leaflet has been approved by a team of doctors, nurses and patients. It is reviewed and updated every 2 years.