What is the immediate management for suspected vesicant extravasation of a chemotherapy drug?

• A. Stop the infusion; do not remove the cannula if possible; aspirate residual drug; follow antidotes per protocol and local care.
• B. Stop the infusion; remove the cannula immediately; apply cold compress.
• C. Stop the infusion; do not aspirate residual drug; continue to push saline.
• D. Elevate the limb and apply heat.

Answer: (C)

Vesicant extravasation management centers on rapidly limiting tissue exposure to the drug and starting the appropriate antidote as soon as possible. The immediate step is to stop the infusion right away. If possible, leave the cannula in place and attempt to aspirate any residual vesicant from the tissue through the cannula; this helps reduce further spread. Do not push more fluid through the cannula to flush the drug, as that can drive it deeper into tissue. After aspiration, remove the cannula when no additional drug can be retrieved or per local protocol. Apply the antidote specified for the drug involved (drug-specific antidotes may include dexrazoxane for anthracyclines, hyaluronidase for certain agents), and provide local care accordingly. Elevate the limb and use the appropriate temperature therapy (cold or warm compress) as directed by the agent’s guidelines, since different vesicants respond to different treatments. Continuous monitoring for evolving pain, swelling, or necrosis is essential, with escalation of care as needed.