Treatment for Extravasation of Non-Chemo Drugs

• Non-chemotherapy drugs are not generally considered to be vesicants. However, extravasation or infiltration of non-chemotherapy drugs can still cause harm to skin and soft tissue. 
• Some general advice in the case of extravasation includes immediately stopping the
  drug infusion and elevating the affected limb to minimize swelling.
• Cold compresses (dry not moist) may also reduce swelling and are generally preferred for most vesicant or irritant drugs.
• Warm compresses (dry not moist) can cause vasodilation and help distribute the drug, reducing local drug concentrations.
• Other treatments can depend on the drug. Hyaluronidase given subcutaneously around the affected site can help distribute the drug away from the site. 
• Phentolamine can counteract local vasoconstriction caused by extravasation of vasoconstrictors. Quicker treatment may result in better outcomes for patients, but surgical intervention may be required for severe cases of extravasation.
• Treatments for extravasation are generally based on case reports in the literature,
  as opposed to more solid evidence. 

 

1. Cold or warm compresses should generally be applied for 20 minutes, every six to eight hours, for up to three days.
2. The dose of hyaluronidase (U.S. only) for adults for extravasations is generally 150 units/mL, 0.2 mL intradermally or subcutaneously at each of five sites of the edges surrounding the affected area. A concentration of 15 units/mL (same instructions as above) has also been used for non-chemo agents. Hyaluronidase should be used within about one hour of extravasation.
3. The dose of phentolamine for adults is generally 5 to 10 mg diluted in 10 to 15 mL of normal saline injected subcutaneously into the area of extravasation as ten 1 mL injections. It should be used within 12 hours of extravasation.
4. Different formulations of topical nitroglycerin have been used (per case reports) for extravasation including 2% topical nitroglycerin ointment

References:
Treatment for Extravasation of Non-Chemo Drugs, 2011. www.pharmacistsletter.com