Chemotherapy Safe Handling and Extravasation

Hazardous antineoplastic drugs can injure workers even when the quantity is too small to see. There is no established occupational exposure limit that defines a harmless dose, so safe practice does not depend on staying below a permissible threshold. Exposure can occur by inhaling droplets, particles, or vapors; touching contaminated equipment or surfaces; eating or drinking in a contaminated handling area; or sustaining a needlestick or other sharps injury. The consequences range from acute skin, eye, and mucous membrane irritation to nausea, headache, and dizziness. Repeated or substantial exposure has been associated with genotoxic effects and reproductive harm, including infertility, miscarriage, low birth weight, and congenital anomalies. Extravasation is a different exposure problem: the drug escapes from the vascular space into surrounding tissue during administration. The injury is determined by the drug, concentration, volume, tissue location, and time before treatment. A vesicant may blister and destroy tissue; an irritant usually produces inflammation and pain but generally does not cause necrosis. Some agents labeled irritants, including oxaliplatin, paclitaxel, and nab-paclitaxel, require vesicant-level response if they extravasate.