Extravasation (Accidental leaking of drugs)

What is an extravasation?

An extravasation is when a small amount of a drug has accidentally leaked from the vein into the surrounding tissues under the skin. Extravasation is rare; however, if this leakage is left untreated it could lead to serious damage to the skin.

A photograph may be arranged to be taken of the extravasation to record in your medical notes. This will help the nurses to monitor the skin for any changes that may occur afterwards.

It is important that you follow the advice given to you by the nurse and the instructions on this page to prevent serious damage and help the area to heal.

The advice you are given depends on the type of drug and the amount of that drug that has leaked.

Your healthcare provider will advise on the following:

• Drug name
• Type of pack to be used
• Further treatment/advice

Using a heat pack

A heat pack is used to increase the blood supply to the affected skin to help disperse the drug. The heat pack has a soothing effect and can help to ease any pain. There is a risk of burns or scalds if the heat pack is too hot. The skin must be checked often for signs of redness or blistering. If you notice any of these signs, please remove the heat pack straight away.

Using a cold pack

A cold pack is used to reduce the blood supply to the affected skin which will help to prevent the leaked drug from spreading. Be careful not to burn your skin. Check your skin often; if the skin appears blotchy, white or blue remove the cold pack straight away.

General advice

Wrap the heat or cold pack in a clean cloth and apply to the affected area for 30 minutes, 4 times a day for 2 days.

Keep the affected limb raised up to 15 to 25 centimetres (5 to 10 inches) above the level of your heart for as long as possible for the first 24 hours following the extravasation.

Avoid direct sunlight to the area.

Avoid wearing tight clothing over the area.

Injections of hyaluronidase

The nurse may have given you 5 hyaluronidase injections around the extravasation area. Hyaluronidase helps some types of drugs to be re-absorbed under the skin and prevent any serious damage. The injections will sting and the skin may go red but this should ease quickly afterwards.

Application of dimethyl sulfoxide (DMSO) liquid

This liquid may be given to you, by the nurse, to take home to be used to help remove the leaked drug from under your skin.

Apply a thin layer of DMSO to your skin using a piece of gauze or cotton wool. The nurse will show you how to do this. You must do this twice a day for 14 days.

If you notice any skin irritation or blistering after applying the DMSO, stop using it and contact the 24 hour Acute Haematology Oncology Unit (AHOU) Helpline for advice. The number is at the end of this page.

Please return any unused DMSO for disposal.

Reducing pain

If the extravasation is painful, you can take paracetamol to ease this. Follow the dosage instructions in the packet. If you still have pain after taking paracetamol, please call the Acute Haematology Oncology Unit (AHOU) Helpline for further advice.

Checking the area

Before using the hot or cold pack, always check the affected skin each day for any of the following:

• Has the skin changed colour or increased in redness?
• Is the skin blistering, peeling or flaking?
• Does the area feel more painful or hot to touch?
• Is pain making it difficult for you to use your arm or hand?
• Does the skin feel numb or is it tingling?

Follow up appointment

The nurse will arrange a follow-up appointment for you so that the affected area of skin can be assessed within the next 7 days. This appointment may be in person or over the telephone.

After the appointment, a nurse may contact you regularly, by telephone, to assess the skin where the extravasation happened. This will continue until no longer necessary.

Contact information

AHOU Helpline

Tel: 0300 422 3444

This helpline is available 24 hours a day, 7 days a week, including bank holidays.