Protection against the extravasation of anticancer drugs by standardization of the management system

The extravasation of anticancer drugs is a serious complication. On the basis of data regarding extravasation prevention and treatment obtained primarily by pharmacists, the management system for extravasation of anticancer drugs was standardized at an outpatient chemotherapy center. A kit was prepared so that physicians could promptly and safely perform venipuncture; the kit included a classification list of anticancer drugs. Prior to administration of vesicant or irritant drugs, pharmacists and nurses educated the patients. When anticancer drugs were administered via peripheral vein without using an implanted venous access device, extravasation occurred in 10 out of 7,059 courses (0.14%) during the 2-year study period postintroduction of the present management system. This incidence is remarkably low as compared with those previously reported. The extravasated drugs were epirubicin (n = 3), paclitaxel (n = 3), vinorelbine (n = 1), 5-fluorouracil (n = 1), carboplatin (n = 1), and cyclophosphamide (n = 1). Cold packs were applied around the injection site except in the cases involving vinorelbine, in which warm packs were used. In all cases of extravasation of vesicant drugs, glucocorticoid was injected locally. There were no cases involving continuous pain or skin ulcers. The standardization of the management system for extravasation of anticancer drugs was very effective in decreasing the occurrence, as well as decreasing skin damage if it occurred.