European Oncology Nursing Society extravasation guidelines

  • Y. Wengström
    Corresponding author at: Department of Neurobiology, Care science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden. Tel.: +46705657980.
    University of Stirling, Department of Nursing and Midwifery, Cancer Care Research Centre and Department of Neurobiology, Care science and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden

    University of Stirling, Department of Midwifery and Nursing, Cancer Care Research Centre, Scotland
    Search for articles by this author
  • A. Margulies
    Department of Oncology, Klinik und Poliklinik für Onkologie, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
    Search for articles by this author


      An infrequent, but potential complication of chemotherapy is vesicant chemotherapy extravasation. Vesicants have the potential to cause blistering and ulceration when they extravasate from the vein or are inadvertently administered into the tissue. In 2007, the European Oncology Nursing Society published guidelines for extravasation prevention, detection, and management. Recommended management includes topical heating for plant alkaloid extravasations and topical cooling for anthracycline and other antitumor antibiotic vesicants. For treatment of antracycline extravasations topical dimethylsulfoxide (DMSO), sodium thiosulfate, and hyaluronidase have been described in the literature but due to lack of evidence to support their use as vesicant extravasation antidotes, it is recommended that these agents are studied further. Furthermore, Savene® (dexrazoxane) is the only registered drug for the treatment of antracycline extravasation. Nurses need to be aware of current evidence-based guidelines for detecting and managing vesicant extravasations and need to be prepared to administer evidence-based treatment.


      To read this article in full you will need to make a payment


      Subscribe to European Journal of Oncology Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Barlock A.L.
        • Howser D.M.
        • Hubbard S.M.
        Nursing management of adriamycin extravasation.
        American Journal of Nursing. 1979; 79: 94-96
        • Bertelli G.
        • Gozza A.
        • Forno G.B.
        • et al.
        Topical dimethylsulfoxide for the prevention of soft tissue injury after extravasation of vesicant cytotoxic drugs: a prospective clinical study.
        Journal of Clinical Oncology. 1995; 13: 2851-2855
        • Ciliska D.
        • Cullum D.
        • Marks. S.
        Evaluation of systematic reviews of treatment or prevention interventions.
        Evidence-Based Nursing. 2001; 4: 100-104
      1. European Oncology Nursing Society (EONS), 2007. Extravasation Guidelines 2007. EONS, Brussels, Belgium. Available at 〈〉.

        • Langer S.W.
        • Thougaard A.V.
        • Sehested M.
        • et al.
        Treatment of anthracycline extravasation in mice with dexrazoxane with or without DMSO and hydrocortisone.
        Cancer Chemotherapy and Pharmacology. 2006; 57: 125-128
        • Langstein H.N.
        • Duman H.
        • Seelig D.
        • et al.
        Retrospective study of the management of chemotherapeutic extravasation injury.
        Annals of Plastic Surgery. 2002; 49: 369-374
        • Mader I.
        • et al.
        Paravasation von Zytostatika—Kompendium für Prävention und Therapie. 2. Auflage.
        Springer, Wien, New York2006
        • Mouridsen H.T.
        • Langer S.W.
        • Buter J.
        • et al.
        Treatment of anthracycline extravasation with savene (dexrazoxane): results from two prospective clinical multicentre studies.
        Annals of Oncology. 2006; 18: 546-550
        • Olver I.N.
        • Schwarz M.A.
        Use of dimethyl sulfoxide in limiting tissue damage caused by extravasation of doxorubicin.
        Cancer Treatment Reports. 1983; 67: 407-408
        • Olver I.N.
        • Aisner J.
        • Hament A.
        • et al.
        A prospective study of topical dimethyl sulfoxide for treating anthracycline extravasation.
        Journal of Clinical Oncology. 1988; 6: 1732-1735
        • Sauerland C.
        • Engelking C.
        • Wickham R.etal.
        Vesicant extravasation, Part I: Mechanisms, pathogenesis, and nursing care to reduce risk.
        Oncology Nursing Forum. 2006; 33: 1134-1141
        • Schulmeister L.
        Extravasation management.
        Seminars in Oncology Nursing. 2007; 23: 184-190