Infusion safety · Point-of-care reference
Extravasation Intervention Chart
Search common vesicants and irritants for compress selection, antidote or required intervention, and the caveat that changes the response.
Evidence recordRestricted clinical scopeVersion 0.1 · Updated July 17, 2026
28 of 28 grouped entries shown
| Drug(s) | Compress | Antidote / intervention | Critical note | Evidence anchor |
|---|---|---|---|---|
| Dobutamine · dopamine · epinephrine · norepinephrine · phenylephrineVasopressor | Warm | Phentolamine preferred; topical nitroglycerin or terbutaline alternatives when protocol permits. | Use vasodilator promptly and follow local antidote dosing protocol. | UIC/Ong 2020–2021 |
| VasopressinVasopressor | Warm | Topical nitroglycerin preferred; phentolamine or terbutaline alternatives. | Agent-specific hierarchy differs from catecholamine vasopressors. | UIC/Ong 2020–2021 |
| Methylene blueVasopressor | Warm | Topical nitroglycerin; specialist review. | Included with vasoconstrictive noncytotoxic vesicants in the cited review. | UIC/Ong 2020–2021 |
| Calcium chloride · calcium gluconateNoncytotoxic | Warm | Hyaluronidase; sodium thiosulfate is an alternative described for calcium. | Calcium chloride carries substantial tissue-necrosis risk; urgent escalation for evolving injury. | UIC/Ong 2020–2021 |
| Dextrose 10%–50% · parenteral nutrition · mannitol ≥20%Noncytotoxic | Warm | Hyaluronidase. | Hyperosmolar injury; institutional procedure determines preparation and injection pattern. | UIC/Ong 2020–2021 |
| Potassium ≥60 mEq/L · phosphate salts · sodium bicarbonate 8.4% · sodium chloride ≥3%Noncytotoxic | Warm | Hyaluronidase. | High-osmolality/pH injury; concentration and volume affect risk. | UIC/Ong 2020–2021 |
| Acyclovir · amiodarone · conivaptan · dantrolene · doxycycline · esmololNoncytotoxic | Warm | Hyaluronidase. | Acidic or alkaline agents; verify the local noncytotoxic-vesicant policy. | UIC/Ong 2020–2021 |
| Gentamicin · pentamidine · pentobarbital · phenobarbital · phenytoin · promethazine · vancomycinNoncytotoxic | Warm | Hyaluronidase. | pH, vehicle, and tissue absorption contribute to injury; promethazine and phenytoin warrant urgent attention. | UIC/Ong 2020–2021 |
| Diazepam · digoxin · etomidate · lorazepam · nitroglycerinNoncytotoxic | Warm | Hyaluronidase. | Propylene-glycol-containing or hyperosmolar formulations may drive injury. | UIC/Ong 2020–2021 |
| Propofol · IV lipid emulsionNoncytotoxic | Warm | Hyaluronidase. | Used for agents described as refractory to absorption. | UIC/Ong 2020–2021 |
| MetronidazoleNoncytotoxic | Warm | Hyaluronidase considered. | Evidence is limited and largely consensus-based. | UIC/Ong 2020–2021 |
| ValproateNoncytotoxic | Cold | Hyaluronidase considered. | Agent-specific compress differs from many other noncytotoxic entries. | UIC/Ong 2020–2021 |
| Amphotericin B · penicillinNoncytotoxic | Warm or cold | Hyaluronidase considered. | Published recommendations vary; use local policy and patient findings. | UIC/Ong 2020–2021 |
| Iodinated or gadolinium contrast mediaContrast | Warm or cold | No routine antidote; elevate and monitor. Surgical evaluation for severe or progressive signs. | Routine hyaluronidase or aspiration is not supported by ACR guidance. | ACR 2025 |
| Doxorubicin · daunorubicin · epirubicin · idarubicinAntineoplastic | Cold | Dexrazoxane preferred; DMSO only when dexrazoxane unavailable or contraindicated. | Remove cold compress before dexrazoxane per product/institutional procedure; do not combine DMSO with dexrazoxane. | ONS/ASCO 2025 |
| Vincristine · vinblastine · vinorelbine · vindesine · vinflunineAntineoplastic | Warm | Hyaluronidase. | Dispersive strategy for non–DNA-binding vesicants. | ONS/ASCO 2025 |
| Paclitaxel · docetaxelAntineoplastic | Warm | Hyaluronidase suggested. | With hyaluronidase, use warm compress; without hyaluronidase, ONS/ASCO describes cold compress for taxanes. | ONS/ASCO 2025 |
| Cabazitaxel · nab-paclitaxelAntineoplastic | Cold | No standard antidote; follow oncology extravasation protocol. | Do not automatically extrapolate the paclitaxel/docetaxel hyaluronidase recommendation. | eviQ 2025 |
| Etoposide · etoposide phosphate · teniposideAntineoplastic | Warm | Hyaluronidase is described for etoposide in noncytotoxic/cytotoxic reviews; follow local oncology protocol. | Warm compress is consistent across current oncology guidance. | ONS/ASCO 2025 |
| OxaliplatinAntineoplastic | Warm | No established antidote. | Avoid cold because it may exacerbate cold-induced neuropathy. | ONS/ASCO 2025 |
| Cisplatin >0.5 mg/mL and >20 mL extravasatedAntineoplastic | Cold | Sodium thiosulfate. | Both concentration and estimated volume matter in the 2025 recommendation. | ONS/ASCO 2025 |
| BendamustineAntineoplastic | Cold | Sodium thiosulfate. | Treat under the antineoplastic extravasation protocol. | ONS/ASCO 2025 |
| MechlorethamineAntineoplastic | Cold | Sodium thiosulfate. | Urgent antidote administration according to institutional preparation/dosing procedure. | eviQ 2025 |
| Mitomycin C · mitoxantroneAntineoplastic | Cold | Topical DMSO. | Do not substitute an antidote without checking the oncology protocol. | ONS/ASCO 2025 |
| DactinomycinAntineoplastic | Cold | Topical DMSO used in oncology protocols. | DNA-binding vesicant; specialist oncology management. | eviQ 2025 |
| CyclophosphamideAntineoplastic | Cold | Sodium thiosulfate has been described; confirm local oncology protocol. | Evidence and protocol recommendations are less uniform than for mechlorethamine. | UIC/Ong 2020–2021 |
| Gemcitabine · carboplatin · fluorouracil · irinotecan · topotecanAntineoplastic | Cold | No recommended antidote. | Primarily irritants; assess severity and follow oncology protocol. | eviQ 2025 |
| Melphalan · liposomal doxorubicin · lurbinectedin · trabectedinAntineoplastic | Cold | No recommended antidote in the cited eviQ table. | Irritant with vesicant properties or vesicant management category varies by agent. | eviQ 2025 |
This chart does not contain antidote preparation or dosing instructions. Those details depend on product concentration, estimated extravasated volume, timing, patient age, and institutional kit/procedure. Use the linked evidence and your current protocol at the bedside.
Evidence packet
What this tool is based on
This versioned record keeps the citations, equation or decision rule, units, test coverage, intended population, and exclusions attached to the tool.
How evidence review works →Current antineoplastic guideline · GuidanceONS/ASCO Guideline on the Management of Antineoplastic Extravasation.JCO Oncol Pract. 2025. doi:10.1200/OP-25-00579 ↗Noncytotoxic consensus review · Evidence reviewOng et al. Recommendations for Management of Noncytotoxic Vesicant Extravasations.J Infus Nurs. 2020;43(6):319–343. PMID: 33141794 ↗Clinical drug-information synthesis · Evidence reviewUniversity of Illinois Chicago Drug Information Group: Current recommendations for treatment of drug extravasation.UIC Drug Information Group. February 2021. ↗Anticancer quick-reference table · GuidanceeviQ: Treatments for extravasation of intravenous anti-cancer therapies.Cancer Institute NSW. Updated December 2025. ↗Contrast-specific guidance · GuidanceACR Manual on Contrast Media: Extravasation of Contrast Media.American College of Radiology. 2025. ↗
Intended population
Clinicians responding to a suspected peripheral or central IV extravasation while activating the institution's current extravasation procedure.
Equation record
Searchable evidence synthesis mapping grouped drugs to warm, cold, either, or unspecified compresses and to agent-specific antidotes or interventions. No antidote preparation or dosing is generated.
Unit handling
Reference table only; no patient-specific units or calculations. Concentration/volume thresholds are shown when they materially change an intervention.
Test coverage
Search terms and synonyms, compress and category filters, warm/cold exceptions, current antineoplastic antidote mappings, empty results, and source labels.
Do not skip
Limitations and exclusions
- The chart is not exhaustive; absence does not mean an agent is non-vesicant or requires no intervention.
- Antidote dose, preparation, injection pattern, timing, and compatibility must come from the current institutional procedure and product information.
- Recommendations differ across antineoplastic and noncytotoxic guidance and may depend on concentration, extravasated volume, formulation, and whether an antidote is administered.
- Progressive pain, swelling, neurovascular compromise, blistering, ulceration, large-volume injury, or central-device extravasation requires urgent specialty escalation.
- Pediatric and neonatal management may require different doses and procedures.
One clearly labeled, contextually relevant sponsor may support this reference area. Sponsorship will never interrupt inputs, obscure results, influence formulas, or imply clinical endorsement.
About this tool
IV Extravasation Treatment and Antidote Chart
Use this extravasation treatment chart to rapidly review compress selection, antidotes, and critical immediate actions for commonly encountered agents.
Extravasation response is time-sensitive and agent-specific. Follow the current product information, institutional policy, and escalation pathway; the chart is a reference aid, not a substitute for them.