Extravasation of Chemotherapeutic Agents

There are many things that can go wrong when administering medications that have vesicant or irritant properties. Extravasation is a serious problem when chemotherapeutic agents are administered through an intravenous or intra-arterial delivery system. Extravasation occurs when medication or any other type of fluid is transmitted into the subdermal or subcutaneous tissue surrounding the administration site. This may happen because the needle administering the medication is not positioned properly in the vein, there is leakage due to structurally compromised veins (this may be more common in the elderly), or there is transmission through small holes caused by venipuncture during earlier testing or blood draws.

There are two classifications of chemotherapy drugs that can cause harm when extravasated:

• Vesicant – These drugs may lead to chemical burns and severe tissue damage, including blistering and necrosis of the tissue. The damage will be worse based upon the amount of leakage that occurred, the concentration of the drug being administered, and what actions were taken after the extravasation happened. Chemotherapy drugs that are vesicant agents are Dactinomycin, Daunorubicin, Doxorubicin (also may be classified as an irritant), Epirubicin, Idarubicin, Mechlorethamine, Mitomycin, Mitoxantrone, Paclitaxel, Streptozocin, Vinblastine, Vincristine, and Vinorelbine.
• Irritant – Temporary inflammation of the drug administration site, including redness, tenderness, or warmth. Chemotherapy drugs that are irritants include Bleomycin, Carboplatin, Carmustine, Cisplatin, Dacarbazine, Denileukin, Difotox, Doxorubicin, Etoposide, Ifosfamide, Teniposide, and Thiotepa.

The damage done by extravasation depends upon the type of drug that leaks into the area surrounding the administration site. Drugs that cause the most harm are those that are DNA-binding drugs, such as those used to target tumor growth. These drugs may lead to the necrosis of tissue, including muscles and tendons, leading to severe and permanent harm. There is no antidote for some of these drugs, leading to a recommendation to excise, or cut out, the tissue that has come in contact with the extravasated drug. When the tissue has become ulcerated or blistered, it is critical to call in a surgeon to review the case as soon as possible.

When a patient is going to receive chemotherapy, it is important for the doctor to do the following:

• Inform the patient about the policies and procedures of the facility at which the chemotherapeutic drugs are going to be administered;
• Make sure the patient understands the dangers of extravasation or infiltration of drugs and what the signs and symptoms are when this happens;
• Discuss alternatives to the intravenous or intra-arterial administration of chemotherapeutic drugs; and
• Carefully monitor the administration of the drugs.

There are steps that should be taken if an extravasation has occurred, specifically including:

• Immediate intervention after signs of extravasation appear – this may include applying pressure to the site, elevating the limb, administering any antidotes, and bringing in any necessary consultants, such as a surgeon if tissue excision is necessary; and
• Make certain that the patient knows what to do after the extravasation, including how to monitor the progression of the injury.

When a doctor fails to inform the patient of all of the risks of the intravenous administration of chemotherapeutic drugs, does not oversee the administration of the drug in the appropriate manner, or does not react to the extravasation of the drug with the right treatment, then he may be liable for medical malpractice.

Although the administration of chemotherapeutic agents is an effective way to combat some types of cancer, the manner in which the drugs are delivered may lead to more harm than good. A doctor has an obligation to ensure that the patient has all relevant information, that appropriate actions are taken during the delivery of the drug, and that all necessary measures are taken after extravasation has happened. If you were the victim of the extravasation of a chemotherapeutic agent, the skilled and hardworking medical malpractice attorneys at Peter Thompson & Associates may be able to help you get the justice you deserve. To schedule an initial consultation, please call us at 800.804.2004.