Extravasation — Accidental Leakage of Chemotherapy

Extravasation describes the inadvertent infiltration of an intravenous solution into perivascular or subcutaneous tissues during administration. In oncology, this event is classified based on the chemical properties of the drug: irritants cause inflammation, warmth, and aching along the vein, whereas vesicants can cause severe cellular injury, blistering, and tissue necrosis.

Contributing factors include fragile veins, movement during infusion, or displacement of an intravenous cannula or central line needle. Clinical teams follow strict infusion safety protocols, including frequent site monitoring and blood return checks, to prevent and rapidly manage any suspected leakage.

Recognising extravasation early prevents long-term soft-tissue complications, scarring, or delays in your cancer treatment. While modern nursing protocols make extravasation rare, immediate action allows clinicians to stop the infusion, aspirate residual drug, and administer specific antidotes. Clear awareness empowers you to speak up the second something feels uncomfortable, ensuring small issues are resolved before significant injury develops.

Extravasation is diagnosed clinically by immediate visual inspection and symptom assessment rather than laboratory tests. If leakage occurs around an implanted central line or port, radiographic studies, such as fluoroscopy or contrast venography, may be performed to assess line integrity and determine the extent of fluid leakage.

Extravasation is not limited to a specific cancer type but can occur during the systemic intravenous administration of chemotherapy across breast, gastrointestinal, lung, haematological, and gynaecological cancers. It is particularly relevant when infusing vesicant drugs, such as anthracyclines, vinca alkaloids, or taxanes, whether given via peripheral cannulas or central venous access devices.

Management requires immediately stopping the infusion, attempting to aspirate residual fluid, and elevating the limb. Depending on the medication, cold or warm compresses are applied. Specific antidotes may be administered, such as dexrazoxane for anthracycline extravasations or hyaluronidase for vinca alkaloids, before safely re-siting vascular access elsewhere.