Management of Systemic Anti-Cancer Therapy Chemotherapy Extravasation

  • Reference Number: HEY-832/2016
  • Departments: Haematology, Oncology (Cancer Services)

Introduction

Extravasation is a term used when a small amount of a drug has accidentally leaked from the veins into the surrounding tissues. This may cause pain, blistering, swelling and redness at the area where the leakage occurred.

Although extravasation is very rare, if it happens and the leakage is left untreated, it could lead to serious damage to the skin or tissue underneath.

Therefore, it is essential that you follow the advice given to you by the nurse and the instructions below, which will be specific to the drug that has leaked.

The drug which has accidentally leaked is: _____________________________________________

You will be advised on the appropriate treatment specific to you as below:

Treatment

Additional Instructions

Tick Box  Heat Pack

Tick Box  Cold Pack

Tick Box  Hydrocortisone 1% Cream

(Nurse to tick as appropriate and note additional instructions.)

Using a heat pack

In some cases, a heat pack is used where there is a need to increase the blood supply to the affected tissues in order to increase absorption of the leaked drug.  It has a direct soothing effect and helps to relieve pain.

Evidence in relation to extravasation injury suggests that absorption is increased if a heat pack is applied and kept in position for as long as is practically possible within the 24 hours following the injury.  The disposable heat pack provided is designed to sit directly on the skin; each pack lasts 8 hours.

It is advisable to aim to keep the affected limb elevated as much as possible within the first 24 hours following the injury and you will be provided with a sling, which your nurse will fit initially and advise you further.

You must be aware:

Heat packs must be used carefully as there may be a risk of burns or scalds if too hot. Whilst the pack is being used, the skin must be checked regularly for signs of redness, rashes or blistering.  If these signs are present, the pack must be removed immediately.

Using a cold pack

In some cases, a cold pack is used where there is a need to decrease the blood supply to the affected tissues, which helps to prevent the leaked drug from dispersing.

Evidence in relation to extravasation suggests that a cold pack should be applied firmly but without pressure for approximately 30 minutes every 2 hours for the first 24 hours. The pack must be wrapped in a clean cloth to prevent direct skin contact.

It is advisable to aim to keep the affected limb elevated as much as possible within the first 24 hours following the injury and you will be provided with a sling, which your nurse will fit initially and advise you further.

You must be aware:

A cold pack must be used carefully otherwise it may cause a skin burn. The skin must be checked regularly whilst the pack is being used. If the skin appears white, blue or blotchy, the pack must be removed immediately.

Application of Hydrocortisone 1% cream

If you require cream, it will be provided for you to take home. You must apply this cream sparingly, by rubbing it into the affected area for 3 times a day for at least 3 days or more, as instructed by the nursing staff.

Reducing pain

The nurse will advise you regarding pain relief medication, as you may experience pain or discomfort in the affected area. The nurse will advise you of the frequency you need to take the pain relief medication.

Important

The nurse will arrange an initial follow-up appointment for you approximately 24 hours later, so that the injury site can be reassessed. This appointment will be given to you before you go home and any additional appointments will be provided at each assessment.

Follow up appointments:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What else can you do?

  • Do not expose the area to direct sunlight.
  • Avoid wearing tight clothing.
  • Gently exercise the affected hand/arm.
  • Do not apply any lotions, creams or ointments unless instructed and provided by the nurse.
  • Protect the affected area when bathing or in the shower.

If the pain is not adequately controlled or the skin around the affected site becomes blistered, broken or inflamed, please contact the helpline.

Helpline

Monday to Friday, from 8am to 6pm: (01482) 461098.
Out of hours: Ring the hospital switchboard on (01482) 875875 and ask for Bleep 500.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

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We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

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