title: Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment.
abstract: BACKGROUND
  Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel.
  
  
  METHODS
  A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined.
  
  
  RESULTS
  Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended.
  
  
  CONCLUSIONS
  We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.
authors.affiliation: Klinik für Innere Medizin - Hämatologie und Onkologie, Vivantes Klinikum Neukölln, Berlin, Germany. maike.dewit@vivantes.de
authors.forename: Maike
authors.initials: M
authors.lastname: de Wit
authors.forename: Petra
authors.initials: P
authors.lastname: Ortner
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Lipp
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
authors.forename: Michael
authors.initials: M
authors.lastname: Untch
authors.forename: Markus
authors.initials: M
authors.lastname: Ruhnke
authors.forename: Regine
authors.initials: R
authors.lastname: Mayer-Steinacker
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
authors.forename: Karin
authors.initials: K
authors.lastname: Jordan
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D005858:Germany; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D009369:Neoplasms / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents