Management of Oxaliplatin Extravasation

Immediate Management

The European Society for Medical Oncology (ESMO) recommends stopping the infusion immediately upon suspicion of extravasation and leaving the cannula in place for aspiration attempts 1, 2
The American Society of Clinical Oncology (ASCO) suggests avoiding applying pressure to the surrounding area, as this may spread the drug further into tissues 1, 3, 4
Elevate the affected extremity to reduce swelling 2
Provide appropriate analgesia for pain control, as oxaliplatin extravasation can cause severe pain 1, 6

Document the patient's name, date and time of extravasation, signs and symptoms, and management steps taken 1, 3, 4, 5
Consider photographic documentation for follow-up purposes 1, 6
Review the patient daily or every 2 days during the first week to monitor for progression of symptoms 1, 6
Continue weekly follow-up until complete resolution of symptoms 1, 6

Surgical debridement is reserved for severe cases with unresolved tissue necrosis or pain lasting more than 10 days 4, 5
Wide, three-dimensional excision of all involved tissue, temporary coverage with biologic dressing, and harvesting and storage of split-thickness skin graft may be necessary 4, 5

Never remove the cannula immediately upon suspecting extravasation—leave it in place for aspiration attempts 1, 2
Do not apply pressure or massage the extravasation site, as this spreads the drug 1, 3, 4
Do not underestimate oxaliplatin's vesicant potential based on older literature classifying it as non-vesicant 1, 2

Suspect central line extravasation if acute thoracic pain develops during infusion 1, 3, 4, 5
Confirm diagnosis with thoracic CT scan showing accumulation in mediastinum, pleura, or subcutaneous chest/neck tissue 1, 6
Consider IV corticosteroids, antibiotics, and analgesia for mediastinitis or pleuritis symptoms 1, 3, 5