No one ever wants to see or hear that chemotherapy has gone outside the vein it was intended for. Depending on the chemotherapy being given, this can range from being unfortunate to potentially devastating. Every person administering a chemotherapeutic is responsible for knowing what that drug does and what to do if administration goes wrong.

There are many resources out there comparing and contrasting the various antidotes and extravasation protocols. There is also not always a consensus on how a specific one is handled. In this presentation, we will look at the classifications of the common chemotherapeutics: vesicant, irritant, neutral. Vesicants have the potential to cause tissue damage, while irritants tend to simply have the potential to cause pain and inflammation. Neutrals are also called non-irritants, but this can be misleading because although there is generally no reaction, they can cause mild inflammation.

Common vesicants include doxorubicin, dactinomycin, mechlorethamine, vincristine, vinblastine, vinorelbine, and rabacfosadine. However, not all vesicants are created equal. The first 3 listed cause far more damage to surrounding tissue than the others. For those 3, the goal is to localize and neutralize. Localization is achieved by aspirating back as much of the drug as you can, then using a cold compress. Not all drugs can be neutralized, however, the antidote should be used when available. For the other 4 vesicants, the goal is to disperse and dilute. Again, aspirate back as much drug as possible, then apply warm compresses. Dilute using the appropriate antidote, usually hyaluronidase.

Common irritants include mitoxantrone, carboplatin, and dacarbazine. These should be localized, as no antidote exists for any of them. Please note that mitoxantrone can also be considered a vesicant and carboplatin can also be considered neutral. Non-irritants should be monitored for mild inflammation.