Table 1. Overview of the management procedure after extravasation of cytotoxics

General measures after extravasation / Application to
Stop injection/infusion immediately / All cytotoxics
Get extravasation kit / All cytotoxics
Put on (sterile) gloves / All cytotoxics
Replace infusion lead or syringe with 5 ml disposable syringe and aspirate slowly as much as possible of the extravasated drug; Cave! do not exert pressure on extravasation area / All cytotoxics
Remove i.v. access while aspirating / All cytotoxics
Only if blisters occur: aspirate with 1 ml syringe and s.c. canula, use new equipment for every new attempt at aspiration / All cytotoxics
Elevate limb and immobilize / All cytotoxics
Start substance specific measures / antidote administration / Amsacrine, anthracyclines, cisplatin, dactinomycin, mitomycin C, paclitaxel, vinca alkaloids
Ensure adequate analgesia / All cytotoxics
Complete extravasation documentation sheet including extent of extravasation / All cytotoxics
Inform and instruct the patient and relatives / All cytotoxics
Regular control (aftercare) / All cytotoxics
In case of vesicants: always consult a (plastic) surgeon within 24 hours / Vesicants

For a detailed discussion of these interventions refer to [10]

Antidote / specific measures / Application to
Dry, topical cooling in combination with topical dimethylsulfoxide (DMSO, 99% purity) over a period of at least seven days (to be administered three times daily) [6] / Amsacrine, anthracyclines, cisplatin, dactinomycin, mitomycin C
Dry, topical cooling alone over a period of at least seven days (to be administered three times daily)[7,10] / Encapsulated anthracyclines
Injection of 1500 IU hyaluronidase s.c. around the affected area followed by application of dry heat over a period of seven days (three times daily)[8] / Vinca alkaloids
Injection of 1500 IU hyaluronidase s.c. around the affected area[9,10] / Paclitaxel

For a detailed discussion of these interventions refer to[10]

Topical care / Clinical Symptoms / Application
Chlorhexidine acetate tulle gras / Blister, epithelial defect, small necrotic area, pain /
Application until full resolution of symptoms, change b.i.d
Sulfadiazine silver ointment / Erythema, edema /
Local application b.i.d up to two weeks
Heparin ointment / Phlebitis, hematoma, thrombosis /
Local application b.i.d over one week
Dexpanthenol ointment / Local symptoms subside /
Local application b.i.d until full resolution of symptoms
Skin moistening ointments / Local symptoms subside /
Local application b.i.d until full resolution of symptoms
NSAID peroral or intravenous
diclofenac or lornoxicam / Pain /
Application twice daily over three days
Antibiotics / Antimicrobial prophylaxis in case of impaired skin integrity /
Clindamycin: 300 mg p.o.,t.i.d over seven days or Amoxicillin: 1 g p.o., t.i.d over seven days

Legend: NSAID = non-steroidal anti-inflammatory compounds; b.i.d. = twice daily (bis in die); t.i.d. = thrice daily (ter in die)