A purple arm with a swollen elbow. Inside the arm blue blood vessels can be seen leaking a black liquid. Extravasation

Extravasation

Until very recently, I had no idea what this was, although now I understand it has happened to me during my time of living with stage IV metastatic breast cancer. When I received an email about it, I nearly deleted it - I'm sure we've all been there with tons of emails and it's hard sometimes to figure out what is spam and what is good info. Glad I opened that email!

The definition of Extravasation by the National Cancer Institute is: "The leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it. It is also used to describe the movement of cells out of a blood vessel into tissue during inflammation or metastasis (the spread of cancer)."

Surgery prep

What happened to me before one of my many surgeries in 2017 was that after an IV was placed in pre-op and then what I call "happy juice" was injected, the fluid ended up under my skin rather than in my vein. I was on the stretcher/gurney being wheeled into the operating room when my elbow felt really weird. When I looked down, instead of seeing the crook of my elbow, I saw a baseball-sized ball.

Freaked me out and I was already anxious because of my surgery.  Another line was placed in my hand (over my objections) and I was quickly out. Honestly, after I addressed the issue of lack of consent - I was literally yelling "I don't consent" as the anesthesiologist accessed a vein in my hand -- I totally forgot about it.

Until I got that email and started reading.

In my own experience, I didn't have any long-lasting issues. Yes, my elbow was super bruised (not uncommon for me), but I didn't retain any of that fluid and totally forgot about what happened.

Contrast from scans

But, what if what is being injected is nuclear material?

This is where the rubber meets the road. For many scans, we are given radioactive isotopes to provide contrast for the radiologists to see stuff --e.g., to see masses that should be there or interact with glucose to light up where metabolic activity is too high to be normal. For those of us who are forever patients, we get a lot of these scans during our lifetime, and, for most of us, the radioactive isotopes are injected straight into our veins. Also, for those of us getting IV chemo, the chemotherapy that often requires our nurses to dress up like they are going to space (even before COVID) is injected directly into our veins.

And what happens if the nuclear material or the chemotherapy doesn't go where it's supposed to?

Extravasation.

Reporting requirements for extravasation

Now I'm sure you are thinking, so what?  That's exactly what I was thinking at first, especially when considering what happened to me. I didn't have any issues or long-lasting side effects from the saline solution going into my skin rather than my vein. Well, aside from the obvious, that nuclear material or chemo is definitely different from saline, I have learned that there are no reporting requirements or treatment protocols for when this happens. Some substances can actually kill the tissues and cause necrosis. And yet, no one is held accountable and the patients are not informed.

I pulled my surgical report after speaking with Rx4Good, the organization that sent me the email, and nothing was said about what happened between pre-op and the operating room.  Definitely got me thinking!!

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