An extravasation is the accidental leakage of vesicant drugs outside of the vein and into the surrounding tissue. You may have reported pain, swelling, stinging or burning to your healthcare provider during your drug administration. This may last for a couple of days and, dependent on the drug involved and the volume of drug which has extravasated, could result in local tissue damage. 

For the majority of patients there will be no long lasting damage but for some there may be further complications. The quicker your healthcare provider is alerted to a problem, the sooner treatment can be started. Therefore it is important that you are aware of the signs and symptoms to look out for and that they are reported immediately to your healthcare provider.

What causes an extravasation?

An extravasation can occur for a variety of reasons which can include:

  • The cannula has moved out of the vein, going to the toilet, the IV line being pulled accidentally etc
  • The PICC or PORT has an obstruction that was not detected
  • Damage to veins from previous treatment

Sometimes the extravasation injury will not be noticed until a few days after it has happened. This is known as a delayed extravasation and will follow the same treatment plan as those realised at the time.

Urgent alert

Please contact the Hotline on 0800 169 5555 should you notice any of the previously mentioned signs and symptoms in the days following your drug administration.

What treatment will I require?

Your nursing team, radiotherapy team and/or doctor has commenced the extravasation treatment in line with national guidelines. While the purpose of the treatment is to minimise the chance of developing further problems you will need to continue to monitor the injury site while at home. You will be followed up by a healthcare professional by telephone and you should contact the hotline if you need to escalate any concerns.

If you complain of any symptoms or we suspect that there is a problem with the infusion site, we will act quickly. The infusion will be stopped and the infusion site assessed.

If an extravasation has occurred we will try to draw out the medicine running through the line. The drug will be drawn back as much as possible and the affected area will have been marked.

A compress should have been given to place over the site and depending on the drug, the compress will have been either hot or cold.

A medical photograph will be taken for monitoring purposes. Please ensure that you signed a consent form if you were happy for us to take that photograph. The photograph will be stored in your electronic patient records. 

Warning alert

What to look out for

Check the area four times a day and report any of the following:

  • Has the area changed colour or has the redness increased?
  • Is there any blistering, peeling or flakiness?
  • Is there any increasing or new bouts of pain or discomfort?
  • Is the pain making it difficult to move the affected limb?
  • Are you experiencing any tingling or unusual sensations in the affected limb? Particularly if the sensations are felt lower down that the site of the injury.

When should you contact The Clatterbridge Cancer Centre?

If you have answered yes to any of the questions above or if you are concerned or worried about your extravasation injury please contact the Hotline0800 169 5555, 24 hours a day, 7 days per week.

The nurses who answer the phone will ask you some questions about your symptoms and progress and if necessary they will want to review the injury site face to face at our Liverpool site.

You should have had a follow up scheduled prior to leaving the hospital so please ensure that you attend the appointments as arranged. This may include an appointment at Whiston burns unit. It is important that you attend this appointment. The Clatterbridge Cancer Centre staff will be in touch with you for the outcome of this appointment and to plan your follow-up. 

What else do I need to do?

  • Gently exercise the affected arm or hand
  • Raise the hand or arm on a pillow to reduce any swelling
  • Take mild painkillers as required
  • Do not apply any other lotions, creams or ointments unless you have been instructed to do so by the doctor or nurse
  • Do not expose the area to strong sunlight
  • Avoid wearing tight clothing around the affected area
  • Protect the affected area when bathing (or having a shower) so that it does not get wet

The area may be sore and uncomfortable for a while but if the extravasation injury is recognised and treated early then there should not be any lasting effects. However, in cases where tissue damage is more extensive, further specialist treatment may be required and healing times may be longer.

In these cases the plastic surgery team will be involved on a regular basis. If the injury has been extensive, there may be a delay in your treatment if the injury has required any surgical interventions. Your oncologist will discuss the plan with you and answer any questions or concerns you may have.

Moving forward the decision for IV access will depend on the severity of the extravasation injury and medical history. It may be that a Central Venous Access Device is inserted for future treatment if you agree. You will be given information needed to allow you to make a decision. 

At The Clatterbridge Cancer Centre we treat extravasation injuries very seriously and are committed to preventing extravasations in the future. We ensure the infusion site is clearly visible and we regularly check the site to ensure there are no signs of extravasation. We also have a good awareness of the types of drugs which can increase the risk of extravasation. We record, monitor and investigate all extravasation injuries that occur. This is so that we can put measures in place to try to prevent them from happening in the future.