title: Management of the extravasation of anti-neoplastic agents.
abstract: BACKGROUND
  Extravasation is a potentially severe complication that can occur during the administration of chemotherapy. The scarcity of evidence available makes it difficult to develop an optimal management scheme. The purpose of this guideline is to review the relevant scientific literature on the prevention, management, and treatment of extravasation occurring during the administration of chemotherapy to cancer patients.
  
  
  METHODS
  A scientific literature review was conducted using the PubMed search tool. The period covered was from database inception to April 2014, inclusively. Since the literature on extravasation treatment is often empirical, anecdotal, and controversial, the review also identified clinical practice guidelines and expert consensuses published by relevant international organizations and cancer agencies.
  
  
  RESULTS
  Identification of potential risk factors and preventive measures can reduce the risk of extravasation. Recognition and management of symptoms are crucial in patients with this complication. Provision of adequate instruction to personnel responsible for administering chemotherapy and to patients on recognizing symptoms, preventing, and managing extravasation is essential. Extravasation can be treated with dry warm or cold compresses and various antidotes such as dimethyl sulfoxide, dexrazoxane, hyaluronidase, or sodium thiosulfate, depending on the agent that has caused extravasation. Patient monitoring to assess the progression or regression of symptoms and to thus take the appropriate measures is necessary.
  
  
  CONCLUSIONS
  Several strategies must be established to ensure that extravasation is recognized and properly managed. Given the evidence available at this time, the Comité de l'évolution des pratiques en oncologie (CEPO) has made recommendations for clinical practice in Quebec.
authors.affiliation: Institut national d'excellence en santé et en services sociaux, 2535 Laurier Boulevard, 5th floor, Quebec City, Quebec, G1V 4 M3, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Boulanger
authors.forename: A
authors.initials: A
authors.lastname: Ducharme
authors.forename: A
authors.initials: A
authors.lastname: Dufour
authors.forename: S
authors.initials: S
authors.lastname: Fortier
authors.forename: K
authors.initials: K
authors.lastname: Almanric
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D064730:Dexrazoxane / Q000627:therapeutic use; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use; D009369:Neoplasms / Q000188:drug therapy*; D011792:Quebec; D012307:Risk Factors; D013885:Thiosulfates / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D013885:Thiosulfates; D064730:Dexrazoxane; D006821:Hyaluronoglucosaminidase; C017717:sodium thiosulfate; D004121:Dimethyl Sulfoxide