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Practice Guideline
. 2025 Sep 17;29(5):384-399.
doi: 10.1188/25.CJON.384-399.

ONS/ASCO Guideline on the Management of Antineoplastic Extravasation

Tanya Thomas  1 , Caroline Clark  2 , Chelsea Backler  3 , Kari Bohlke  4 , Deena Centofanti  5 , Aparna C Jotwani  6 , Diane G Cope  7 , Kerri A Dalton  8 , Celestine G Gochett  9 , Victoria Henney  10 , Gwen King  11 , Donald C Moore  12 , Hannah Dzimitrowicz McManus  13 , Holly M Anderson  14 , Kerri A Moriarty  15 , Karen DiValerio Gibbs  16 , Rebecca L Morgan  17
Affiliations
Practice Guideline

ONS/ASCO Guideline on the Management of Antineoplastic Extravasation

Tanya Thomas et al. Clin J Oncol Nurs. .

Abstract

Purpose: Extravasation is an uncommon but high-risk adverse event that occurs when an agent with the potential to cause tissue damage leaks out of the intended administration space into the surrounding area. This guideline presents evidence-based side effect management recommendations to support interprofessional teams in decision-making to minimize severity or progression of extravasation injury from antineoplastic treatment in individuals with cancer.

Methodologic approach: The Oncology Nursing Society and the American Society of Clinical Oncology appointed healthcare professional and patient representative members to a panel for guideline development focused on antineoplastic vesicants and irritants with vesicant properties. The panel applied GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology and followed the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines. A systematic review of studies examining outcomes of antineoplastic agent extravasation in adults informed the guideline. The panel assessed the certainty of the evidence using the GRADE approach.

Findings: The panel agreed on recommendations related to the use of antidotes for antineoplastic vesicants and irritants with vesicant properties, thermal compress application and duration, and early surgical referral or escalation to specialty care for central venous access device extravasation.

Implications for nursing: This guideline summarizes evidence-based interventions for the management of extravasation of antineoplastic vesicants or irritants with vesicant properties to guide clinical care.

Keywords: adverse event; antineoplastic extravasation; extravasation; side effect management.

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