Information
Extravasation – may be linked to peripheral cannulation or a Central Venous Access Device (CVAD).
This is the accidental administration of drugs into the extra vascular tissue instead of into the vein. In patients receiving systemic anti cancer therapy (SACT) some drugs have potential to cause tissue necrosis and damage to surrounding tissue. This is dependent upon the drugs involved, the amount extravasated and the area infiltrated by the drug. In extreme cases this may require plastic surgeon review.
If this does happen GP’s will receive a letter from the treating centre advising patient has experienced an extravasation and that the Chemotherapy Unit will take responsible for the acute management of this complication. The GP should retain this information in the patients file in the event of any future intervention being required.
The majority of extravasations will occur at time of chemotherapy administration and the Oncology team will act according as per local extravasation guidelines. However occasionally patients may present with a “delayed” extravasation/phlebitis.
Most common symptoms are pain, stinging, swelling, erythema, and/or blistering or other changes in the skin at the site of or near where the drug was administered.
Who to refer:
Patients receiving IV systemic anti cancer therapy who have symptoms suggestive of extravasation.
Who not to refer:
If in doubt please do not hesitate to call the on call oncology team.
How to refer:
Contact the Acute Oncology team at the Edinburgh Cancer Centre on 07798774842 or 0131 537 1000 and ask to speak to Acute Oncology team for oncology.
If following assessment you are confident symptoms are suggestive of phlebitis check patients FBC to assess if neutropenic, consider treating with oral antibiotics and topical steroid cream (1% hydrocortisone TID for 7 days or until redness goes away) encourage patient to monitor temperature BD or if feeling unwell and to call Cancer Treatment Helpline on 08009177711.
All patients on or within 6 weeks of treatment should be encouraged to monitor symptoms and call Cancer Treatment Helpline (CTH) on 08009177711 if any treatment related concerns. Please note the CTH is a call operator service provided by NHS 24 who then refer on to acute care specialist. They are not able to give specialist advice. Note if a patient has presented to primary care for assessment the patient should not be advised to call the CTH to pass on this information or seek further advice. The primary care clinician should call the Acute Oncology team at the Edinburgh Cancer Centre to discuss if appropriate.
Link to Acute Oncology Initial Management Guidelines:
UKONS | Acute Oncology Initial Management Guidelines (sundownsolutions.co.uk)
