Another issue of chemotherapy safety is extravasation. Antineoplastic agents that cause severe tissue damage when they escape from the vasculature are called vesicants. Some examples of vesicants are the anthracyclines and the vinca alkaloids. The tissue damage may be severe, with tissue sloughing and loss of mobility, depending on the area of extravasation. Patients need to be educated to notify the nurse immediately if there is any pain on administration. If extravasation of a vesicant occurs, the injection should be stopped, and any fluid aspirated out of the injection site. If an antidote should be administered, such as with nitrogen mustard extravasation, the pharmacy should be notified immediately so that the sodium thiosulfate can be prepared and delivered quickly. Cold compresses should be applied (heat should be used for vincas) to the affected area. The area of extravasation should be recorded and inked and followed closely to detect early signs of infection and to treat pain. Obviously, prevention of extravasation is very important. Good IV access is key, which may include the placement of a central venous catheter, along with free-flowing IV fluids. During administration of a vesicant, blood return should be checked to be sure that the drug is going into the vein. Central venous catheters can be placed for patients needing infusions of vesicants or for patients with small, friable veins to prevent extravasation.

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