About the Extravasation Guide

What it is

Fast lookup, per parenteral antineoplastic drug, of the tissue injury risk class in extravasation (vesicant, irritant with vesicant properties, irritant, nonvesicant) and of the antidotes and compresses named by the guidelines. The three guidelines appear side by side, each with table and page, and the site does not choose between them when they differ. There is no step-by-step management: follow your institution’s protocol.

Where the data comes from

Classifications, antidotes and compresses: ONS/ASCO 2025 (Clin J Oncol Nurs 2025;29(5):384-399), ESMO-EONS 2012 (Ann Oncol 2012;23 Suppl 7:vii167-73, with the 2013 corrigendum) and JSCN/JSMO/JASPO 2024 (ESMO Open 2024;9(10):103932). Portuguese names: Brazilian Common Names list (DCB, ANVISA IN 473/2026). Brand names: active ANVISA registrations with an injectable presentation in the CMED price list (Brazil). When a guideline names a class (e.g. "anthracyclines"), the measure is shown for the drugs the guideline itself lists in that class.

How to read the classes

Vesicant: may cause blistering and necrosis. Irritant with vesicant properties (ONS/ASCO only): an irritant that may cause injury like a vesicant. Irritant: pain, inflammation or phlebitis at the site, usually without necrosis. Nonvesicant: low risk of injury. Each card shows the class assigned by each guideline.

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Guidelines

• Thomas T et al. ONS/ASCO Guideline on the Management of Antineoplastic Extravasation. Clin J Oncol Nurs 2025;29(5):384-399.
• Pérez Fidalgo JA et al. Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Ann Oncol 2012;23 Suppl 7:vii167-73.
• Matsumoto K et al. Extravasation associated with cancer drug therapy: multidisciplinary guideline of JSCN, JSMO and JASPO. ESMO Open 2024;9(10):103932.

General recommendations of the guidelines

• ONS/ASCO 2025Recommendation 1 · Strong; very low

  Use antidotes, when one exists, for vesicants and irritants with vesicant properties, rather than no antidote.

  Table 3, p. 388
• ONS/ASCO 2025Recommendation 3 · Conditional; very low

  Thermal compress (cold or warm depending on the agent) rather than no compress.

  Table 3, p. 388
• ONS/ASCO 2025Recommendation 4 · Conditional; very low

  Compress for more than 24 hours rather than 24 hours or less.

  Table 3, p. 388
• ONS/ASCO 2025Recommendation 5 · Conditional; very low

  Central line extravasation: surgical referral or escalation of care in addition to conservative management.

  Table 3, p. 388
• JSCN/JSMO/JASPO 2024CQ10a · Recommend (weak)

  Cold compression (weak recommendation).

  Table 1, CQ10a
• JSCN/JSMO/JASPO 2024CQ10b · Not recommend (weak); D

  Non-use of warm compresses (weak recommendation).

  Table 1, CQ10b

Who makes it

Gabriel Chácara, medical oncologist (CRM MG 63539). [email protected]