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POGO Satellite Manual

3.2 Accidental Exposure/Spills

3.3 Extravasation Management

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The information provided in the following sections is intended to guide safe practice in the POGO Satellite Program. It is not intended to replace your institutional policies and procedures. Please ensure all staff are aware of their own institutional policies and procedures and refer to them as their primary source.

Extravasation can occur with either peripheral intravenous (PIV) or central line intravenous administrations. The following procedures outline recommendations for the prevention and treatment of extravasation of chemotherapy agents. Chemotherapy should only be administered by Association of Pediatric Hematology/Oncology Nurses (APHON)-certified personnel with demonstrated knowledge of and clinical skills in the administration of chemotherapy. Maintain provider status as per APHON standards and skill competency as per institutional policy.

Definitions

  • Extravasation is the inadvertent leakage of vesicant drug or solution into the tissues surrounding an intravenous (IV) site.
  • Vesicant is an agent that can cause blistering or tissue necrosis when extravasated.
  • Irritant is an agent that can cause a local inflammatory reaction but does not cause tissue necrosis when extravasated.
  • None refers to an agent that is considered not to be a vesicant or an irritant.

Signs of Vesicant Extravasation

  • Pain and/or burning in the infiltrated area or around the needle infusion site
  • Swelling near the IV injection site or along venous tract
  • Erythema in the infiltrated area
  • Poor or absent blood return from the IV catheter
  • Increase in IV pump pressures

Signs of Irritant Extravasation

  • Aching and tightness along vein
  • Full length of vein may become erythematous and/or discoloured
  • Swelling unlikely
  • Usually able to get blood return

Signs of Flare Reaction

  • No pain
  • Immediate blotches or streaks along vein which usually subside within 30 minutes with or without treatment
  • Swelling unlikely, wheals may appear along vein line
  • Usually able to get blood return

Signs and Symptoms Associated with Vesicant Extravasation, Venous Irritation and Flare Reaction

SIGN/SYMPTOMVESICANTIRRITANTFLARE
Pain++–
Swelling+––
Erythema++–
Pump pressure increase+––
Poor or absent blood return++/––
Ulceration+ (delayed)––

Below is a list of antineoplastic vesicants and irritant drugs administered at the POGO Satellite Clinics and classified into the following categories. If you encounter a drug that is not on this list, expert sources should be consulted.

VesicantNonvesicant
IrritantNone
Dactinomycin
DAUNOrubicin (DAUNOmycin)
DOXOrubicin (Adriamycin)
VinBLAStine
VinCRIStine
Vinorelbine		Dacarbazin
Etoposide (VP-16)
Mesna (undiluted)
Mitoxantrone		Arsenic trioxide
Asparaginase
Bleomycin
CARBOplatin
Cyclophosphamide
Cytarabine
Irinotecan
Methotrexate
Nelarabine
Topotecan

Adapted from London Health Sciences Centre Formulary, Chemotherapy Extravasation Management Protocol. London, ON, Canada, Revised June 2015.

This guidance document was developed by Ms. Julie Dowler, Ms. Denise Reniers and Ms. Anne Chambers, Children’s Hospital, London Health Sciences Centre, London, in consultation with Ms. Lisa Honeyford, The Hospital for Sick Children, Ms. Kirsty Morelli, Scarborough Health Network and Ms. Mary Jo Decourcy, London Health Sciences Centre, based on the sources in Sub-Section 3.3.4.

Disclaimer: Source Accuracy

You are welcome to download and save a local copy of this document in the Word and/or PDF formats provided. As the POGO Satellite Manual is subject to ongoing revisions and updates by POGO, we recommend you regularly check the online version posted at https://www.pogo.ca/satellite-manual/ to ensure you have the most up-to-date content. In the event of any inconsistency between the content of a local copy and the online version of the POGO Satellite Manual, the content of the online version shall be considered correct. Please see also the POGO Satellite Manual Disclaimer.

Record of Updates
Version NumberDate of EffectSummary of Revisions
11/27/2022Original version posted.
3.3.1 Prevention and Management of Extravasations
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In this Section

  • 1.1 History and Overview
  • 1.2 Acknowledgements
  • 1.3 Committees and Working Groups
  • 1.4 POGO Satellite Manual Disclaimer
  • 2.1 Principles of POGO Satellite Clinic Care
  • 2.2 Eligible Patients
    • 2.2.1 Children Eligible for Chemotherapy Administration in a POGO Satellite Clinic
    • 2.2.2 Children Eligible for the Management of Complications in a POGO Satellite Clinic
    • 2.2.3 Children Eligible for Supportive Care in a POGO Satellite Clinic
  • 2.3 Scope of POGO Satellite Clinic Practice
  • 2.4 Expanded POGO Satellite Clinic Practice
  • 3.1 Safe Handling, Administration and Disposal of Chemotherapy Agents
    • 3.1.1 Personal Protective Equipment
    • 3.1.2 Preparation, Transport and Storage
    • 3.1.3 Administration of IV Hazardous Drugs
    • 3.1.4 Administration of Oral Hazardous Drugs
    • 3.1.5 Disposal of Equipment/Personal Protective Equipment used to Administer Hazardous Drugs
    • 3.1.6 Safe Handling for Pharmacy
    • 3.1.7 References
  • 3.2 Accidental Exposure/Spills
  • 3.3 Extravasation Management
    • 3.3.1 Prevention and Management of Extravasations
    • 3.3.2 Antidotes and Treatments for Extravasation
    • 3.3.3 Sample Extravasation Documenting Tool
    • 3.3.4 References
  • 3.4 Injecting SC Medication Via an Insuflon
  • 3.5 Chemotherapy Administration Reference List
  • 3.6 Central Venous Catheter Care
  • 3.7 Chemotherapy Quick Reference
    • 3.7.1 Rapid Hydration
    • 3.7.2 Provider Guide: Prevention and Management of Irinotecan-Induced Diarrhea
    • 3.7.3 Capizzi Methotrexate
    • 3.7.4 Erwinia Asparaginase
  • 4.1 Management of Fever and Neutropenia
    • 4.1.1 Routine Order Sample Sheet
    • 4.1.2 Sample Fever Cards
    • 4.1.3 Criteria for low-risk designation. Risk categorization refers to risk of bacteremia and serious complications, including mortality.
  • 4.2 Pentamidine Administration
    • 4.2.1 Inhaled Pentamidine
    • 4.2.2 Intravenous Pentamidine
  • 4.3 Antiemetics
  • 4.4 Treatment of Varicella-Zoster Infections
  • 4.5 Immunization of Children with Cancer
  • 4.6 Transfusion
  • 4.7 Clinical Circumstances that Warrant Consultation with the Specialized Childhood Cancer Program
  • 5.1 Palliative Care Overview
  • 5.2 Communication
  • 5.3 Settings of Care
  • 5.4 Symptom Management
  • 5.5 End of Life
  • 5.6 When a Child Dies at the POGO Satellite Clinic
  • 5.7 Appendix: Sample Bereavement Materials
    • 5.7.1 Reconciling Your Grief
    • 5.7.2 Funeral Arrangement Checklist
    • 5.7.3 Helping Children Who Grieve
    • 5.7.4 Coping with the Holidays
    • 5.7.5 The Grief Experience
  • 5.8 References
  • 6.1 Goals and Objectives
  • 6.2 Participant Site Selection
    • 6.2.1 Tertiary Hospital Site Selection
    • 6.2.2 Community Hospital Site Selection
  • 6.3 POGO’s Roles
    • 6.3.1 PHIPA, Privacy and Research
  • 6.4 Funding
    • 6.4.1 Funding Support for Tertiary Hospital Activity
    • 6.4.2 Funding Support for Community Hospital Activity
  • 6.5 Infrastructure and Formal Requirements
    • 6.5.1 Specialized Childhood Cancer Program Partners’ Role in the POGO Satellite Program
    • 6.5.2 POGO Satellite Clinic Partners’ Role in the POGO Satellite Program
  • 7.1 Preamble
  • 7.2 Investigator Responsibilities
  • 7.3 Training Requirements
    • 7.3.1 General Training for Conduct of Research
    • 7.3.2 Protocol-Specific Training
  • 7.4 Research Activities That May Be Completed in POGO Satellite Clinics Under Supervision of DSI
  • 7.5 Research Activities to be Completed in Specialized Childhood Cancer Programs Only
  • 7.6 Recognition and Reporting of Adverse Events (AEs)
  • 7.7 Data Transfer
  • 7.8 Pharmacy Drug Accountability
  • 7.9 Site Inspections and Quality Assurance
  • 8.1 Pediatric Oncology Shared Care Initial Data Transfer Sheet
  • 9.1 POGO Satellite Clinic Preparedness Checklist
  • 9.2 POGO Satellite Clinic Quality Assurance Checklist
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