Paclitaxel Extravasation Treatment
Immediately stop the infusion, leave the cannula in place, and attempt to aspirate as much extravasated drug as possible through the existing line—paclitaxel is a vesicant capable of causing severe tissue necrosis requiring surgical debridement. 1, 2
Immediate Management Steps
Step 1: Stop and Aspirate
- Stop the infusion immediately upon suspicion of extravasation 3, 1
- Leave the cannula in place—do not remove it 3, 4
- Gently aspirate through the existing cannula to withdraw as much extravasated solution as possible 3, 4
- Avoid applying pressure or massaging the surrounding area, as this spreads the drug further into tissues 4, 5
Step 2: Supportive Care
- Elevate the affected extremity to reduce swelling 4
- Apply dry cold compresses for 15-20 minutes, four times daily for 24-48 hours to promote vasoconstriction and limit drug dispersion 5
- Provide appropriate analgesia for pain control, as paclitaxel extravasation can cause severe pain 4
Step 3: What NOT to Do (Critical Pitfalls)
- Do not use subcutaneous corticosteroids—retrospective data demonstrates that intralesional corticoids increased the need for surgical debridement 5
- Do not remove the cannula before attempting aspiration 3, 4
- Do not apply manual pressure to the extravasation site 4, 5
Documentation Requirements
Document the following mandatory items for patient safety and legal purposes: 3, 5
- Patient name and identification number
- Date and time of extravasation
- Name of drug extravasated and diluent used
- Signs and symptoms (including those reported by patient)
- Description of the IV access site and location
- Estimated extravasation area and approximate volume of drug
- Management steps taken with corresponding times
- Consider photographic documentation for follow-up purposes and decision-making 3, 5
Follow-Up Protocol
Review the patient daily or every 2 days during the first week, then weekly until complete resolution of symptoms 3, 4
What to Monitor For:
- Early signs may be subtle and not immediately evident 3
- In the following days, initial inflammation increases with more redness, edema, and pain 3
- After several days or weeks, blisters may appear and inflammation can evolve to necrosis 3, 2
- One case report documented no acute symptoms at the time of extravasation, but severe progressive pain developed on day 11 with erythema and central necrosis requiring surgical intervention 2
Surgical Management
Surgical debridement is reserved for unresolved tissue necrosis or pain lasting more than 10 days 3, 4, 5
Surgical Procedure:
- Wide, three-dimensional excision of all involved tissue 3, 5
- Temporary coverage with biologic dressing 3, 5
- Simultaneous harvesting and storage of split-thickness skin graft 3
- Delayed graft application at 2-3 days once the wound is clean 3, 5
Note that only one-third of extravasations progress to ulceration, so surgical intervention is relegated to severe cases or when conservative therapy was not appropriately initiated 3
Special Considerations for Central Line Extravasation
Suspect central line extravasation if acute thoracic pain develops during infusion 3, 4
Management:
- Confirm diagnosis with thoracic CT scan showing accumulation in mediastinum, pleura, or subcutaneous chest/neck tissue 3, 4
- Stop the infusion and aspirate through the central venous catheter as much solution as possible 3
- Consider IV corticosteroids, antibiotics, and analgesia for mediastinitis or pleuritis symptoms 3, 4
- Surgical drainage procedures may be considered in severe cases 3
Important Clinical Context
Paclitaxel's vesicant potential has been historically underestimated—older literature classified it as merely a local irritant, but multiple case reports demonstrate it can cause severe delayed necrosis requiring surgical debridement 2, 6. The FDA label specifically warns about the possibility of extravasation and advises close monitoring of the infusion site during administration 1. Prolonged peripheral infusions should be avoided or administered with extreme caution 2.