1) CARBOPLATIN: Necrosis associated with extravasation has been reported in patients with various tumor types who received single-agent carboplatin (n=1893) (Prod Info PARAPLATIN(R) IV injection, 2010).
2) CARMUSTINE: Pain and burning at the injection site may occur, particularly with infusions administered over a period of less than 2 hours. Following extravasation, infiltration of carmustine can cause local soft tissue toxicity, including swelling, pain, redness, burning and skin necrosis (Prod Info BiCNU(R) IV injection, 2010).
3) CISPLATIN: Moderately severe cellulitis and fibrosis following an extravasation of cisplatin has been observed (Lewis & Medina, 1980). A 20 mL solution containing 15 mg of cisplatin was extravasated in the medial part of the forearm in a 57-year-old man with inoperable gastric adenocarcinoma. An infiltrated zone, with cutaneous hyperesthesia, retraction of bicep tendon, inhibiting extension of the forearm at 120 degrees, and induration of the veins infused were noted one month after the extravasation. Full recovery was reported by 2 months after the incident (Louvet et al, 1989).
4) CONTRAST MEDIA: Local reactions after injection of iodinated contrast material occurs frequently, but actual extravasation of contrast materials is well studied, and occurs in less than 1% of cases based on a large cohort of over 22,000 patients (Cohan et al, 1997). Although most patients develop minimal localized edema and erythema following low volume contrast medium extravasation (Schaverien et al, 2008), severe injury, including skin ulceration, soft-tissue necrosis or compartment syndrome have been reported following extravasation of large volumes of contrast medium (Schaverien et al, 2008; Tsai et al, 2007).
5) DACTINOMYCIN: Dactinomycin is extremely corrosive, and extravasation during IV administration can result in cellulitis and damage to soft tissues. In one case, extravasation led to contracture of the arms. Epidermolysis, erythema and edema, with some cases being severe, have occurred with regional limb perfusion (Prod Info COSMEGEN(R) intravenous injection, 2008).
6) DANTROLENE: Injection site reactions (eg, pain, erythema, swelling) and tissue necrosis secondary to extravasation have been reported (Prod Info RYANODEX(R) intravenous injection suspension, 2014).
7) DEXTROSE 10%: Extravasation injury may occur due to the dextrose solution or the administration technique (Prod Info dextrose IV injection, 2005).
8) DOCETAXEL: Infusion site reactions (eg, hyperpigmentation, inflammation, redness or dryness of skin, phlebitis, extravasation and swelling of the vein) have been reported with docetaxel therapy in patients with various tumor types, including patients with breast cancer. Most cases were mild in severity (Prod Info TAXOTERE(R) injection concentrate IV infusion, 2010):
9) DOXORUBICIN AND VINCRISTINE: One study reported extravasation of an unknown amount of DOXOrubicin (2.1 mg/mL) and vinCRIStine (0.1 mg/mL) administered as a 96-hour infusion into the medial aspect of the right upper arm in a 56-year-old patient with multiple myeloma without producing severe acute symptomatology. Local swelling and redness were not apparent until 2 weeks after the infusion was completed. Surgical debridement was required at 2 and 3 weeks after the incident, followed by a split thickness skin graft (Dorr et al, 1989).
10) ESMOLOL: Edema, erythema, skin discoloration, burning at the injection site, thrombophlebitis and local skin necrosis from extravasation have occurred in less than 1% of patients (Prod Info BREVIBLOC IV injection, 2007; Abrams et al, 1985).
11) ETOPOSIDE: In clinical trials, extravasation/phlebitis occurred in 5% of patients who received 450 mg/m(2) or more of etoposide phosphate as a total dose over 5 days. Infiltration with etoposide phosphate may cause local swelling, pain, cellulitis and necrosis (Prod Info ETOPOPHOS(R) IV injection, 2011).
12) HEROIN: CASE REPORT: A 57-year-old man developed extravasation injury following heroin injections, and presented with a skin lesion on the posterior region of the left forearm with extensive necrosis of skin and subcutaneous layer, involving the underlying muscle planes. The lesion had a sanious, fibrinous, secreting and smelly bottom. He received ciprofloxacin for 2 weeks after the lesion culture was positive for Pseudomonas aeruginosa. He was treated with daily dressing before the chemical debridement of the lesion using a topical ointment containing a collagenase plus hyaluronic acid (Bionect Start(R)). Each dressing contained 4 phases: disinfection with sodium hypochlorite 0.05% and povidone-iodine solution 10%, cleansing with saline solution, the application of a layer of 2 mm Binect Start(R) and covering with a pre-medicated patch. His symptoms gradually improved and a complete wound healing was observed 3 months after presentation (Onesti et al, 2014).
13) IFOSFAMIDE: Ifosfamide extravasation produced a local reaction in a 54-year-old woman. The patient received combination chemotherapy including ifosfamide 1760 mg over 1 hour (scheduled for 5 days). Following extravasation of ifosfamide the patient developed an inflamed, hot area that was painful to touch. Chondroitin sulfatase 150 units (which enhances the systemic uptake of the drug from the tissue) was administered with a satisfactory decrease in inflammation and pain (Mateu et al, 1994a).
14) MECHLORETHAMINE: Extravasations of even small amounts of mechlorethamine result in painful inflammation and induration. The patient may immediately experience pain, erythema or swelling at the site of extravasation. Alternatively, the only indication may be a decrease in the flow rate of the intravenous fluid or a lack of blood return. Mechlorethamine rapidly fixes to all tissues. It ubiquitously alkylates protein and DNA. It spontaneously and rapidly degrades in vivo and is unstable in alkaline solutions (Prod Info Mustargen(R), 1999).
15) MITOMYCIN: Extravasation during injection has resulted in necrosis and sloughing of tissue with mitomycin use (Prod Info mitomycin iv powder for injection, 2000). Delayed extravasation injury (several days to weeks after therapy) was reported in 2 patients following administration of mitomycin that included erythema, ulceration and necrosis at sites where other intravenous preparations had been administered, but distant to the mitomycin injection site. The wounds healed, but significant scarring was reported in one patient (Patel & Krusa, 1999a).
16) MITOXANTRONE: Extravasation of MitoXANTRONE has occurred, producing no tissue necrosis or other toxicity except transient blue skin discoloration (Alberts et al, 1980; Vietti et al, 1981; Smith, 1983).
17) NAFCILLIN: Severe tissue necrosis secondary to extravasation has been reported following intravenous administration of nafcillin (Prod Info Nafcillin IV injection, 2007). Cutaneous necrosis has been reported in 4 pediatric patients following infiltration of intravenous sites with nafcillin (Tilden et al, 1980a).
18) N-ACETYLCYSTEINE: Compartment syndrome secondary to extravasation of IV N-acetylcysteine infusion occurred in a 26-year-old man with a history of schizophrenia who was admitted to a hospital about 12 hours after intentional ingestion of several different drugs of unknown amounts. He was asymptomatic upon admission and a toxicology screen was positive for an acetaminophen level of 16 mcg/L and an elevated aspartate aminotransferase level (41 Units; normal: 0 to 37 Units/L). N-acetylcysteine was started and during the third phase of the infusion, the patient complained of pain and swelling at the site of the infusion. A hand surgeon measured a compartment pressure of 45 mmHg with a delta pressure of 17 mmHg and the patient underwent emergent fasciotomy secondary to compartment syndrome. The odor of "rotten egg" (characteristic of N-acetylcysteine) was noted intraoperatively when the compartments were released. Postoperatively the patient's pain, paresthesia and sensory deficits had improved. Based on this case, it was difficult to determine if N-acetylcysteine acted as an irritant or vesicant or caused a space-occupying lesion that could have augmented venous outflow (Berman et al, 2015).
19) OXALIPLATIN: Injection site reaction (redness, swelling and pain) has been reported with oxaliplatin administration (Prod Info ELOXATIN(R) intravenous lyophilized powder for solution, intravenous concentrate for solution, 2011).
20) PACLITAXEL: Extravasation reactions may occur (Prod Info TAXOL(R) IV injection, 2010).
21) PHENYTOIN: Irritation and inflammation of soft tissue at the injection site with or without extravasation of intravenous phenytoin has occurred. The irritation may range from a slight tenderness to extensive necrosis, sloughing and purple glove syndrome, and may not appear for several days after administration; rare instances of amputation have been reported (Prod Info Dilantin(R) intravenous injection solution, 2011).
22) PROMETHAZINE: One case of extravasation of intravenous promethazine was reported. Symptoms included bluish discoloration of skin, marked swelling, redness, pain and reduced range of motion (Malesker et al, 1999).
23) TENIPOSIDE: Local tissue necrosis and/or thrombophlebitis may occur (Prod Info VUMON(R) injection intravenous solution, 2011).
24) TOTAL PARENTERAL NUTRITION: In one case, parenteral nutrition solution was infused through a central venous catheter which perforated the right internal mammary vein causing extravasation of the parenteral nutritional fluid and breast abscess formation (Clark & Higgs, 1991).
25) VINBLASTINE: A case of mediastinitis due to probable central venous catheter extravasation was reported with vinBLAStine (Anderson et al, 1996).
26) VINCRISTINE: Leakage of vinCRIStine into surrounding tissue during intravenous administration may cause considerable irritation (Prod Info Oncovin(R), 1999). However, no untoward sequelae, either acute or delayed, were reported in 3 pediatric patients accidentally injected with vinCRIStine (1 to 1.6 mg) into the thigh. Only 1 patient had discomfort after the injection. Each patient was treated topically with cold compresses and the area was infiltrated with 8.4% sodium bicarbonate (Clark et al, 1997).