Extravasation remains one of the most serious complications associated with intravenous therapy, particularly in oncology where vesicant and irritant medications can cause significant tissue injury when they leak outside the vein.
When extravasation occurs, the goal is clear: minimize tissue exposure, reduce injury, and provide timely intervention. The approach to management can vary significantly across institutions and regions.
Treatment strategies may include observation, thermal therapies, pharmacologic antidotes, surgical consultation, and in some healthcare systems, saline washout. While these approaches differ, they share a common objective — reducing the impact of extravasation after it has occurred.
However, the opportunity to improve outcomes begins even earlier: recognizing the event as soon as possible.
Why Extravasation Remains a Clinical Challenge
Patients receiving intravenous therapy, especially systemic anti-cancer therapy (SACT) are at increased risk for extravasation due to a variety of factors, including:
- Repeated treatment cycles and cumulative vascular damage
- Fragile or compromised peripheral veins
- Vesicant and irritant medications
- Medication properties such as extremes of pH or osmolarity
- Patient-specific factors that may delay recognition of symptoms
When a medication leaks into surrounding tissue, the consequences can range from localized pain and inflammation to ulceration, tissue necrosis, treatment delays, and surgical intervention.
Even with strong prevention strategies — including appropriate device selection, careful insertion technique, staff education, and routine site assessment — extravasation can still occur.
This is why early recognition and rapid response remain critical components of patient safety.
What Is Saline Washout?
Saline washout is an extravasation management technique used in some healthcare systems, particularly in parts of the United Kingdom, to reduce tissue exposure after certain vesicant or irritant medications have leaked outside the vein.
The concept behind saline washout is based on a simple principle: once a medication has entered surrounding tissue, reducing the amount of drug remaining in the tissue may help limit ongoing exposure and potential injury.
Rather than relying only on passive dilution or dispersion, the technique aims to physically remove or dilute the extravasated agent through controlled irrigation.
The technique was originally described in the UK in the early 1990s by plastic surgeon David Gault and has since been incorporated into some institutional extravasation pathways, particularly within oncology settings.¹
What Does the Evidence Show?
Published case reports, audits, and clinical reviews have described favorable outcomes associated with saline washout. However, similar to many areas of extravasation management, the evidence base remains limited.
Because randomized controlled trials are challenging to conduct in this area, much of the available evidence comes from clinical experience, case series, expert guidance, and institutional outcomes.
Currently, there is no definitive evidence demonstrating that saline washout is superior to other management approaches, including pharmacologic antidotes.²
As a result, decisions regarding treatment are influenced by factors such as:
- The medication involved
- Timing of recognition
- Extent of tissue exposure
- Institutional protocols
- Available expertise
- Patient-specific considerations
Saline washout is not universally adopted yet, but remains one option within a broader extravasation management framework.
How Is Saline Washout Performed?
In healthcare settings where saline washout is part of the extravasation pathway, the procedure is typically performed using a structured protocol and under strict aseptic conditions. 2-4
While techniques may vary, the process commonly includes:
- Identifying and marking the affected area
- Providing local anesthesia for patient comfort
- Creating small exit points around the affected tissue
- Irrigating the area using saline or other solutions based on institutional protocols
- Monitoring the patient and reassessing the affected site
Historically, saline washout was often performed by plastic surgery teams. In some settings, this created delays while waiting for specialist availability. To address this, some hospitals have developed multidisciplinary extravasation teams that include trained nurses, physicians, and specialists supported by formal education, competency assessment, and standardized pathways.⁴
Published experiences from these programs have reported timely intervention, positive patient experiences, and favorable clinical outcomes.²
The Role of Early Detection in Extravasation Management
Regardless of the treatment approach selected, one factor consistently influences outcomes: time.
The longer an extravasated medication remains in surrounding tissue, the greater the potential for injury. Earlier recognition provides clinicians with more opportunity to intervene before damage progresses.
Saline washout, antidotes, and other interventions are designed to manage extravasation after it has occurred. Early detection focuses on identifying the event sooner — reducing the delay between the first signs of a problem and clinical action.
This shift from reactive response to proactive recognition represents an important evolution in IV safety. 1,4
Building a Comprehensive Extravasation Safety Strategy
Reducing extravasation harm requires a coordinated approach that includes:
- Prevention through evidence-based IV practices
- Consistent assessment and monitoring
- Clear escalation pathways
- Staff education and competency development
- Rapid recognition and intervention when complications occur
Continuous IV therapy surveillance can provide another layer of proactive protection by helping clinicians identify changes in the tissue earlier and support timely intervention.
The future of extravasation management is not defined by a single treatment approach. It is built through earlier recognition, informed decision-making, and systems that give clinicians the time needed to protect patients.
Learn how continuous IV therapy surveillance can complement existing IV safety practices by providing an additional layer of proactive prevention and earlier detection.
- Gault DT. Extravasation injuries. British Journal of Plastic Surgery, 1993.
https://www.jprasurg.com/article/0007-1226(93)90137-Z/fulltext - Harrold K, Gould D, Drey N. The efficacy of saline washout technique in the management of exfoliant and vesicant chemotherapy extravasation. European Journal of Cancer Care, 2013.
https://openaccess.city.ac.uk/id/eprint/3378/ - St George’s University Hospitals NHS Foundation Trust. Extravasation patient information leaflet, 2024.
https://www.stgeorges.nhs.uk/wp-content/uploads/2024/07/PLS_EXV.pdf - SORT NHS. Extravasation injury management guideline, 2024.
https://www.sort.nhs.uk/Media/Guidelines/Extravasation-injury-management.pdf - 5. Mas V et al. Upper limb extravasation of cytotoxic drugs: results of the saline washout technique in children. Journal of Child Orthopaedics, 2020.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7302410/