Management of Paclitaxel Extravasation

Immediate Management

The American Society of Clinical Oncology recommends stopping the infusion immediately upon suspicion of extravasation, leaving the cannula in place, and attempting to aspirate as much extravasated drug as possible through the existing line 1
The European Society for Medical Oncology suggests gently aspirating through the existing cannula to withdraw as much extravasated solution as possible, and avoiding applying pressure or massaging the surrounding area, as this spreads the drug further into tissues 1, 2
Elevating the affected extremity to reduce swelling is recommended 2
Applying dry cold compresses for 15-20 minutes, four times daily for 24-48 hours, to promote vasoconstriction and limit drug dispersion is advised 3

The National Comprehensive Cancer Network recommends documenting the patient's name and identification number, date and time of extravasation, name of drug extravasated and diluent used, signs and symptoms, description of the IV access site and location, estimated extravasation area and approximate volume of drug, and management steps taken with corresponding times 1, 3, 4
Reviewing the patient daily or every 2 days during the first week, then weekly until complete resolution of symptoms, is recommended 1, 2

The Society of Surgical Oncology recommends reserving surgical debridement for unresolved tissue necrosis or pain lasting more than 10 days 2, 3, 4
Wide, three-dimensional excision of all involved tissue, temporary coverage with biologic dressing, simultaneous harvesting and storage of split-thickness skin graft, and delayed graft application at 2-3 days once the wound is clean, are recommended surgical procedures 3, 4

The American College of Chest Physicians suggests suspecting central line extravasation if acute thoracic pain develops during infusion, and confirming diagnosis with thoracic CT scan showing accumulation in mediastinum, pleura, or subcutaneous chest/neck tissue 1, 2
Stopping the infusion and aspirating through the central venous catheter as much solution as possible, considering IV corticosteroids, antibiotics, and analgesia for mediastinitis or pleuritis symptoms, and considering surgical drainage procedures in severe cases, are recommended management steps for central line extravasation 1, 2