Evaluation and treatment of chemotherapy extravasation injuries

Extravasation of chemotherapeutic vesicant agents can result in significant tissue damage, alteration in limb function, and pain. Quality of life for long-term survivors can be severely impacted by negative sequelae from vesicant extravasation. Currently, there is no known preventive therapy. Early detection and intervention are paramount to halt tissue damage and reduce the chance of permanent disability or disfigurement. This article provides an overview of known chemotherapeutic vesicants (mechlorethamine, mitomycin-C, doxorubicin, daunomycin, vincristine and vinblastine), associated theories of tissue destruction, assessment techniques for peripheral intravenous sites, vascular access devices and central venous lines, current treatment strategies, and investigational therapies. A brief discussion of the legal implications of extravasation injuries and recommended key points for medical record documentation are included.