necrosis was prevented in 98% of the patients. Dexrazoxane for extravasation is the only registered antidote for extravasation of anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin, etc.). The only FDA approved treatment for vasopressor extravasation is phentolamine Pain management and other measures Pain management and local supportive care is important, as it can help to minimize the additional risk of infection and superinfection. Prevention Only qualified, chemotherapy-certified nurses who have been trained in venipuncture and administration of medications with vesicant and irritant potential should be allowed to administer vesicants. Choose a large, intact vein with good blood flow for the venipuncture and placement of the cannula. Do not choose inadvertently "dislodgeable" veins (e.g. dorsum of hand or vicinity of joints) if an alternative vein is available. The digits, hands, and wrists should be avoided as intravenous sites for vesicant administration because of the close network of tendons and nerves that would be destroyed if an extravasation occurred. Place the smallest gauge and shortest length catheter to accommodate the infusion. Monitor the venipuncture site closely for evidence of infiltration and instructing patients to report any pain, discomfort, or tightness at the site. The IV infusion should be freely flowing. The arm with the infusion should not begin to swell (oedema), "get red" (erythema), "get hot" (local temperature increase), and the patient should not notice any irritation or pain on the arm. If this occurs, extravasation management should be initiated. The infusion should consist of a suitable carrier solution with an appropriately diluted medicinal/chemotherapy drug inside. After the IV infusion has finished, flush the cannula with the appropriate fluid. Finally, depending on clinical circumstances, central line access may be most appropriate for patients who require repeated administrations of vesicants and irritants. Examples of vesicant medicinal drugs List of vesicant and irritant medications: Cytotoxic drugs Amsacrine Cisplatin Dactinomycin Daunorubicin Docetaxel Doxorubicin Epirubicin Idarubicin Mechlorethamine Mitomycin C Mitoxantrone Oxaliplatin Paclitaxel Vinblastine Vincristine Vindesine Vinorelbine Non-cytotoxic drugs Acyclovir Adrenergic agonists (e.g. dobutamine, adrenaline) Alcohol Aminophyllines Amiodarone Amphotericin Arginine Chlordiazepoxide Calcium solutions (e.g. calcium gluconate) Diazepam Digoxin Mannitol Metronidazole Nafcillin Nitroglycerine Oxacillin Phenytoin Promethazine Propylene glycol Sodium thiopental Tetracyclines Total parenteral nutrition Valproate Vancomycin Vasopressin References External links Table of chemotherapy vesicants, irritants, and treatments for extravasation Management of chemotherapy extravasation: ESMO–EONS Clinical Practice Guidelines UK National Extravasation Information Service Iv-therapy.net — links to useful websites about extravasation Savene website Intravenous fluids Medical error Medical terminology