Two basic types of reactions can occur: an irritation (or local allergic reaction called a flare reaction), and an extravasation (leakage of medication), or in normal language, minor and major. A minor reaction causes redness, itching, tenderness, and perhaps swelling, and is usually the result of an allergic reaction to the injection. Certain chemo drugs known as irritants are more likely to cause this type of reaction, like bleomycin, carboplatin, etoposide, and others. Usually the reaction goes away fairly quickly. In the meantime, you can apply ice or cold compresses to the area.
A major reaction starts out looking like a minor one, then becomes blistered and painful, even potentially causing severe skin damage in a matter of days. This is usually the result of chemotherapy medicine leaking from the blood vessel to the area under the skin near the injection site. You may not notice any effects for 6–12 hours after treatment, and the severity of your reaction will depend on the type of drug used, the dosage, and how quickly the problem is treated. Drugs more likely to cause this type of reaction are called “vesicants” and include doxorubicin, mitomycin, vinblastine, and others.
As far as preventing such a reaction, it’s kind of up to your nurse! He/she needs to be well trained in injections, so you may want to strike up a conversation before treatment to try to determine his/her expertise. However, it can also depend on the drug and the condition of your blood vessels. Some drugs more likely to cause extravasation will be administered in larger blood vessels in the torso rather than the smaller ones in the arms to help prevent reactions.
Other options to reduce your risk of injection-site traumas include the following:
1. PICC Line: This is where a long plastic catheter is placed into one of the larger veins of the arm, and then used for multiple short infusions. It is temporary.
2. Tunneled catheter: These are placed through the skin in the middle of the chest and are “tunneled” through the tissue between the skin and muscle into the vessel at the entrance of the right atrium of the heart. They can be left in place for months or years to reduce incidence of infection, but they require dressing changes.
3. Port-a-cath: This is similar to the tunneled catheter, but is a more permanent option and involves no “tunneling,” but rather the device is positioned under the skin on the chest and the catheter inserted into the vessel at the entrance of the right atrium of the heart. It can last 3–5 years and requires less maintenance.
Any of these options can decrease your risk of injection-site irritation or infection. If you do experience pain or discomfort at the injection site, be sure to tell your doctor immediately. If you were the victim of extravasation, physicians will try to remove as much of the leaked medication as possible, apply ice or heat, and administer an antidote.
Some chemo drugs are more likely to cause extravasation than others, so ask your doctor about your risk before starting treatment, so you can be more aware.
Have you experienced an injection site reaction to chemo? Please share your story.
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