Chemotherapy drugs are administered into a vein in the hand or arm, or into a catheter located in the chest or arm. Because these drugs are toxic, they can cause regional side effects at the injection site, ranging from uncomplicated irritation to severe tissue damage, according to the Chemocare website. Chemotherapy patients should be aware of injection site side effects and alert nurses quickly to prevent tissue damage.
Non-Irritating Drugs
Patients receive chemotherapy through a peripheral vein in the hand or arm, or through a catheter. The catheter is a central venous access device that allows direct and easy access to the venous system. One type of device is a PICC line, which is placed using an X-ray, into the upper arm. Another type of device is a port-a-cath, which is placed surgically in the upper chest. Local side effects are possible with any type of injection site, but are less frequent with central venous catheters. Infiltration occurs when chemotherapy drugs leak out of the vein. According to the Ohio State University Medical Center, this may happen because the veins are weak and fragile, if there is a history of frequent intravenous treatments, peripheral vascular disease, or limited vein options. If the drugs infusing during infiltration are non-irritating, damage to the tissue is unlikely. One example of a non-irritating drug is intravenous fluids. Symptoms of infiltration include tenderness or pain, redness, warmth, swelling and itching. These symptoms usually resolve quickly, without long-term side effects.
Irritating Drugs
According to the Chemocare website, most chemotherapy drugs are considered irritating. They include carboplatin, bleomycin, cisplatin, etoposide and ifosfamide. Tissue damage is more likely if infiltration occurs while an irritating drug is infusing. If infiltration occurs, the infusion is stopped, the arm is elevated and ice can be applied to the injection site. Sometimes the site can become irritated several hours after completion of the infusion. Infiltrations of irritating drugs usually resolve without long-term damage.
Vesicant Drugs
Some chemotherapy drugs are classified as vesicants because they can cause serious, long-term damage if they leak out of the vein into the surrounding tissue. When this occurs, it is called extravasation, according the the Ohio State University Medical Center. Vesicant drugs include doxorubicin, vincristine, vinorelbine, daunorubicin, epirubicin, vinblastine and idarubicin. The symptoms of extravasation are the same as infiltration initially and present as mild irritation. If extravasation is severe, it might cause blistering of the skin and eventually severe skin and tissue damage. The extent of damage depends on the drug, amount of drug that entered the tissue and the initial steps nurses follow to contain the damage. Initial treatment of extravasation is to stop the infusion. The following steps of treatment depend on the drug that was infusing. Infiltration and extravasation are rare events, however it is important to be familiar with the symptoms of these reactions and report them immediately.
