# Management of chemotherapy extravasation by drug class

Source: https://onco.cc/protocols/chemotherapy-extravasation-management/  
OnCo record `chemotherapy-extravasation-management` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

If a chemotherapy drug leaks out of the vein into the skin around a drip or port, the nurse stops the drip at once, draws back what they can, marks the area and then treats it according to the drug, with an antidote or a cold or warm pack. Tell the team straight away if the site stings, burns, swells or changes colour, during treatment or in the days after.

## Summary

Extravasation is leakage of an intravenous anticancer drug into the surrounding tissue. Management starts the same way for every drug: stop the infusion, leave the cannula or port needle in place, aspirate what can be withdrawn without flushing, mark and photograph the area, inform the senior nurse and doctor, then remove the device and elevate the limb.

The specific measures depend on the drug's class. Vesicants are split into DNA-binding agents (anthracyclines, mitomycin, dactinomycin, mechlorethamine), which are localised and neutralised with cold, and non-DNA-binding agents (vinca alkaloids, taxanes), which are dispersed with warmth and hyaluronidase. The ONS/ASCO 2025 guideline, the newest GRADE-based one, recommends antidotes where available: dexrazoxane for doxorubicin, daunorubicin, epirubicin and idarubicin; hyaluronidase for vinca alkaloids, and conditionally for paclitaxel and docetaxel; topical dimethyl sulfoxide for mitomycin and mitoxantrone, or for an anthracycline when dexrazoxane is unavailable or contraindicated; sodium thiosulfate for more than 20 ml of high-concentration cisplatin and for bendamustine. Thermal compresses are used three to four times daily for 48 to 72 hours: cold for most vesicants, warm for vinca alkaloids, etoposide and oxaliplatin, and for taxanes when hyaluronidase is given.

Dexrazoxane is given intravenously in the opposite limb, 1000 mg/m2 on days 1 and 2 and 500 mg/m2 on day 3, the first dose within six hours, with cooling removed 15 minutes beforehand and no dimethyl sulfoxide alongside. Extravasation from a central venous access device, and high-risk cases, are referred early for surgical review. The Japanese 2024 guideline differs on heat (it weakly recommends against warm compresses alone) and makes no recommendation on aspiration; it weakly recommends against local steroid injection and against debriding an ulcer without necrosis. Documentation, patient teaching and follow-up for weeks complete the protocol.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: Extravasation management; Vesicant extravasation; Anthracycline extravasation; Chemotherapy leak into tissue

## Connected records

- technologies: [DMSO (dimethyl sulfoxide)](https://onco.cc/technologies/dmso-dimethyl-sulfoxide/), [Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)](https://onco.cc/technologies/implanted-ports/), [Peripherally inserted central catheters (PICC lines)](https://onco.cc/technologies/picc-lines/)
- drugs: [Bendamustine](https://onco.cc/drugs/bendamustine/), [Carmustine](https://onco.cc/drugs/carmustine/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Dacarbazine](https://onco.cc/drugs/dacarbazine/), [Dactinomycin (actinomycin D)](https://onco.cc/drugs/dactinomycin/), [Daunorubicin](https://onco.cc/drugs/daunorubicin/), [Dexrazoxane](https://onco.cc/drugs/dexrazoxane/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Epirubicin](https://onco.cc/drugs/epirubicin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Idarubicin](https://onco.cc/drugs/idarubicin/), [Mechlorethamine (chlormethine)](https://onco.cc/drugs/mechlorethamine/), [Mitomycin C](https://onco.cc/drugs/mitomycin/), [Mitoxantrone](https://onco.cc/drugs/mitoxantrone/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Sodium thiosulfate (otoprotectant)](https://onco.cc/drugs/sodium-thiosulfate/), [Trabectedin](https://onco.cc/drugs/trabectedin/), [Vinblastine](https://onco.cc/drugs/vinblastine/), [Vincristine](https://onco.cc/drugs/vincristine/), [Vinorelbine](https://onco.cc/drugs/vinorelbine/)
- terms: [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/), [Infusion reactions, hypersensitivity and extravasation](https://onco.cc/terms/extravasation-infusion-reaction/)
- protocols: [Anticancer treatment administration checks at the chair: assessment, independent double checks and line tracing](https://onco.cc/protocols/sact-administration-checks-at-the-chair/), [Peripheral cannula for anticancer treatment: vein choice, siting and checks, including vesicants](https://onco.cc/protocols/peripheral-cannula-for-anticancer-therapy/)

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