Side Effect: Infusion Site Pain

What is Infusion Site Pain?

Infusion site pain can be a side effect of certain intravenous (IV) chemotherapy therapy treatments and refers to discomfort, soreness, or pain at the site where the needle is inserted into a vein to administer medications. It can be caused by local irritation of the blood vessels by the medication being infused. In more serious cases called extravasation, the medication can leak out of the blood vessels, enter the surrounding tissues, and cause severe tissue damage.

What does Infusion Site Pain look like?

Infusion site pain can present in different ways depending on the severity. In most cases, it may be described as a sharp or dull ache, burning sensation, or throbbing pain that is localized to the site of the IV. Other symptoms such as redness, swelling, or warmth around the site may also be present.

Who gets Infusion Site Pain?

Chemotherapy agents that are known to have a risk of causing infusion site pain can be classified as either irritants or vesicants. Irritants are medications that can cause pain, inflammation, and burning at the infusion site but don’t typically cause any tissue damage. Vesicants are medications that can cause severe tissue damage if exposed to tissues that surround the blood vessels.

Irritants

• Alkylating agents – carboplatin (Paraplatin®), cisplatin (Platinol®), oxaliplatin (Eloxatin®), cyclophosphamide (Cytoxan®), bendamustine (Bendeka®), carmustine (BCNU®), dacarbazine (DTIC®), busulfan (Busulfex®), ifosphamide (Ifex®), melphalan (Alkeran®, Evomela®)
• Topoisomerase inhibitors – liposomal doxorubicin (Doxil®) mitoxantrone (Novantrone®), etoposide (Toposar®), irinotecan (Camptosar®), topotecan (Hycamptin®)
• Taxanes – paclitaxel (Taxol®), docetaxel (Taxotere®), ixabepilone (Ixempra®)
• Arsenic trioxide (Trisenox®)
• Trastuzumab emtansine (Kadcyla®)

Vesicants

• Anthracyclines – doxorubicin (Adriamycin®), daunorubicin (Daunomycin®), epirubicin (Ellence®), idarubicin (Idamycin®)
• Vinca alkaloids – vincristine (Oncovin®), vinblastine (Velban®), vinorelbine (Navelbine®)
• Trabectidin (Yondelis®)
• Oxaliplatin (Eloxatin®)
• Mitomycin (Mutamycin®)
• Dactinomycin (Cosmegan®)

How to prevent Infusion Site Pain

It is very important that an appropriate site for IV insertion is selected, one where a vein is easily accessible and has good blood flow. It is also important that an appropriate gauge needle and cannula be utilized for IV insertion.

When receiving an agent that is considered a vesicant, a central venous access device (CVAD) is typically placed and used for administration. Commonly used CVADs are implanted ports, tunneled catheters (Hickman, Groshong, Broviac), and peripherally inserted central catheters (PICC). By using a central line, the medication is delivered into a large vein instead of a small one and decreases the risk of the medication leaking out into the surrounding tissues. Vesicants may be given through a peripheral IV, but added measures are taken to ensure that the blood vessel is working properly throughout the infusion.

How to treat Infusion Site Pain

If significant infusion site pain occurs, the infusion is stopped and any remaining medication in the IV line is removed along with some blood from the vein. Localized therapy such as warm or cold compresses can be utilized to help decrease the amount of irritation at the site.
In some cases of extravasation, medications may be indicated to help the body absorb the medication away from the tissues. These medications include dimethyl sulfoxide (DMSO), sodium thiosulfate, dexrazoxane, or hyaluronidase. Typically, multiple injections of one or more of these medications are given under the skin that surrounds the IV site.