¹ Pérez Fidalgo JA, et al. Management of Chemotherapy Extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol. 2012. Oct;23 Suppl 7:vii167-73. Free full-text article PDF

² Ice has historically been applied to constrict blood vessels and help prevent the DNA-binding vesicants from spreading to adjacent tissues, and cold compress relieves pain by blocking nerve conduction. Local warming (dry heat) is indicated for non-DNA binding vesicants to increase blood flow to the area, which helps distribute the extravasated vesicant and promotes its absorption.

³ Schulmeister L. Extravasation Management: Clinical Update. Semin Oncol Nurs. 2011. Feb;27(1);82-90. PubMed® abstract

⁴ Dexrazoxane binds to iron and prevents the formation of free radicals, which are thought to play a major role in the development of extravasation-induced tissue necrosis.

⁵ Sodium thiosulfate is believed to chemically neutralize the reactive alkylating species of mechlorethamine (and its derivative, incl bendamustine) therefore reduce the production of hydroxyl radicals that cause tissue injury.

⁶ Ener RA, et al. Extravasation of Systemic Hemato-oncological Therapies. Ann Oncol. 2004. June;15(6):858-62. Free full-text article PDF

⁷ Dorr RT. Antidotes to Vesicant Chemotherapy Extravasations. Blood Rev. 1990. Mar;4(1):41-60. PubMed® abstract

⁸ de Lemos ML and Walisser S. Management of Extravasation of Oxaliplatin. J Oncol Pharm Pract. 2005. Dec;11(4):159-62. PubMed® abstract

⁹ Kretzschmar A , et al. Extravasations of Oxaliplatin. J Clin Oncol. 2003. Nov 1;21(21):4068-9. PubMed® abstract

¹⁰ Dorr RT, et al. Experimental Dacarbazine Antitumor Activity and Skin Toxicity in Relation to Light Exposure and Pharmacologic Antidotes. Cancer Treat Rep. 1987. Mar;71(3):267-72. PubMed® abstract