Extravasation injury

Myelosuppression (dose-related) mucositis (worse with continuous infusion) moderate emetogenic potential alopecia vesicant severe extravasation injury cardiac toxicities acute—not related to cumulative dose arrhythmias, pericarditis chronic— cumulative injury to myocardium (total dose greater than 550 mg/m2 lower total cumulative doses cause damage to myocardium in children (e.g., 350 mg/m2)... 

Peripheral neuropathy primary dose-limiting toxicity motor sensory, autonomic, and cranial nerves may all be affected (paresthesias, ileus, urinary retention, facial palsies) may be irreversible mild emetogen SIADH vesicant extravasation injury... 

Ac/m/n/sfraf/on. Administration only should be via the IV route using a large-bore, free flowing IV in the antecubital vein, or a central vein due to unpredictable absorption. Small IVs in the extremities are both unreliable and unsafe for vasopressor administration. Frequent monitoring of the IV sites for extravasation injury is essential when vasopressor agents are being used. 

Subcutaneous injection of hyaluronidase (150 U/mL) may decrease the morbidity associated with intravenous extravasation injuries [126],... 

Langer SW, Sehested M, Jensen PB. Protection against anthracychne induced extravasation injuries with dexrazoxane Elucidation of the possible mechanism. Proc Am Soc Clin Oncol 2000 38 492. 

Four cases of fixed plaques of erythrodysesthesia have been attributed to intravenous docetaxel (9). There had been no extravasation or previous skin injury. While this was a new presentation, the authors did not explain why the lesions were not just late presentations of small-volume extravasation injuries. 

Even in cases of accidental extravasation, the risk of skin ulceration is low. Severe cisplatin-related extravasation injury appears to be primarily restricted to the use of... 

Treat extravasation injury with warm soaks, and injection of hyaluronidase... 

Prevent ileus treat constipation aggressively doses range from 1-1.4 mg/m (max) doses are traditionally capped at 2 mg to minimize neurotoxicity, but capping is controversial Reduce dose by 50% for total bilirubin 1.5-3 mg/dL by 75% for total bilirubin >3 mg/dL treat extravasation injury with warm soaks, and injection of hyaluronidase LETHAL if administered intrathecally ... 

Myelosuppression mucositis worse with continuous infusion moderately emetogenic may cause acute and delayed (by 24 8 hours) emesis vesicant severe extravasation injury cardiotoxicity (similar to other anthracyclines) may be less cardiotoxic than doxorubicin controversy about equ ivalent doses cardiac toxicity associated with cumulative doses >900 mg/m Myelosuppression moderately emetogenic may be worse with oral and high-dose regimens alopecia mucositis hypotension infusion rate-related etoposide phosphate can be given IV push without hypotension risk hypersensitivity reactions especially common in children... 

Myelosuppression highly emetogenic rapid onset, within 1-2 hours of dose vesicant extravasation injury secondary malignancies sterility and infertility... 

Bhosale GP, Shah VR. Extravasation injury due to dopamine infusion leading to dermal necrosis and gangrene. J Anaesthesiol Clin Pharmacol 2012 28(4) 534-5. 

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