TREATMENT OF EXTRAVASATION OF BOTH DOXORUBICIN AND VINCRISTINE ADMINISTRATION IN A Y-SITE INFUSION

OBJECTIVE: To describe a patient treated with vincristine, doxorubicin , and dexamethasone who experienced extravasation of both doxorubicin and vincristine during a Y-site infusion. CASE SUMMARY: A 74-year-old white woman was diagnosed with multiple myeloma IgA kappa in stage ITA . One year after a complete remission she relapsed. Her treatment incl uded daily doxorubicin 16 mg in 500 mt of dextrose 5% and vincristine 0.4 mg in 500 mt of dextrose 5% administered in a Y-site continuous in fusion into a peripheral vein of her left forearm. Extravasation occur red during administration of these drugs. Immediately, chondroitinsulf atase, a mucopolysaccharidase similar to hyaluronidase, was administer ed subcutaneously around the extravasation area and repeated 24 hours later. Furthermore, dimethyl sulfoxide 90% v/v was applied topically o n the area four times daily for 2 weeks. All inflammatory signs resolv ed and no necrosis developed. DISCUSSION: This is the first report of an extravasation of two cytotoxic drugs. Doxorubicin and vincristine h ave different antidotes and opposite physical treatments for their ext ravasation. The antidotes dimethyl sulfoxide and chondroitinsulfatase have different mechanisms of action, but both cause uptake of the cyto toxic agent from the tissue and are likely to be administered together . No warming or cooling was performed. CONCLUSIONS: Topical dimethyl s ulfoxide four times daily for 14 days plus subcutaneous chondroitinsul fatase in one or two applications effectively treated an extravasation of both doxorubicin and vincristine in our patient.