Background: Chemotherapy-induced extravasation (CIE) arises when chemotherapy drugs escape from an intravenous (IV) site into surrounding tissues, leading to complications such as necrosis, infection, and functional impairment. Vesicant drugs, including anthracyclines and alkylating agents, pose a significant risk of severe tissue damage. Despite preventive measures, extravasation remains a major concern in oncology, particularly in patients with poor venous access and those receiving high-risk chemotherapy agents. Identifying incidence rates and associated risk factors is essential for improving patient safety and treatment outcomes.
Methodology: This cross-sectional study was conducted at Sinor Hospital Swat, to assess the incidence and risk factors of CIE in adult cancer patients. A total of 150 patients undergoing chemotherapy were included using a convenience sampling method. Data were collected from patient records, chemotherapy logs, and clinical observations. Variables analyzed included patient demographics, chemotherapy agents, IV access type, and extravasation severity. Statistical analysis was performed using the statistical package for the social sciences (SPSS) version 22.
Results: The study found a 13.3% incidence of chemotherapy-induced extravasation. Peripheral IV access and obesity (Body mass index (BMI) ≥30) were significantly associated with higher extravasation rates (p = 0.01, p = 0.03). Most cases were mild (60%), occurring mainly in the arm/hand (50%). No significant associations were found with age, gender, or chemotherapy dosage.
Conclusion: Peripheral IV access and obesity were key risk factors for chemotherapy-induced extravasation. Implementing standardized monitoring, proper IV selection, and healthcare provider training can help reduce extravasation rates and improve patient safety.

Chemotherapy-induced extravasation, Oncology nursing, Intravenous access, Obesity, Risk factors, Patient safety.

The accidental release of chemotherapy drugs through an intravenous line during treatment processes leads to tissue damage in the surrounding areas. This phenomenon is called CIE.[1] Drugs used in chemotherapy treatment that are classified as vesicants or irritants lead to severe damage to skin and underlying tissues when they leak from the infusion point. The vesicant substances among anthracyclines and alkylating agents trigger major tissue necrosis and tissue sloughing when no prompt medical treatment occurs. Medical experts must treat extravasation because it creates an urgent situation that demands immediate response to stop tissue fibrosis alongside potential infections and enduring functional disability.[2] Chemotherapy extravasations occur more frequently when patients have poor venous access and are exposed to specific medication classes following inappropriate treatment procedures, and according to their age and demographics.[3]

Appropriate treatment of extravasation stands as a severe and avoidable condition affecting chemotherapy delivery, yet continues to represent a critical point in clinical oncology work and nursing practice.[4] The potential for tissue damage and long-term consequences necessitates careful monitoring during chemotherapy administration. Specific risk factors for extravasation depend on the chemotherapy drugs being used because some medications show a greater potential to harm tissues during an extravasation incident.[5] The prevention of extravasation requires that nurses properly insert and maintain intravenous access, along with using central venous catheters and practicing appropriate drug handling to minimize these incidents.[6]

The frequency of CIE depends on what medical facility administers the treatment, the particular chemotherapy drugs used, and the patient’s characteristics.[7] The occurrence of extravasation events during chemotherapy administration stands between 0.1% and 6% of all therapy sessions according to available research. Many extravasation incidents remain unidentified since patients with minor symptoms often do not report them, and healthcare providers misclassify these events.[8] Many chemotherapies drug-related extravasation incidents result from vesicant medications that cause permanent tissue damage if medical staff fail to detect them early. The impact of extravasation encounters in cancer patients becomes less severe when healthcare professionals detect and address this complication early enough.[9]

The severity of vascular conditions, along with prior extravasation experiences and multiple medical health issues, all affect the probability of extravasation occurrences during drug administration.[10] Patients who identify as elderly, together with those who have challenging peripheral venous access, and those undergoing serial chemotherapy treatments, face elevated risks of extravasation. Strong chemotherapy agents, such as those classified as high-risk, raise the risk for extravasation to occur.[11] The risk profile of extravasation is anticipated to grow because of evolving treatment strategies that combine newer potent drugs with complex delivery methods, so health professionals must continuously monitor this situation and educate each other.[12]

The knowledge of CIE incidence risks helps healthcare providers deliver better patient results. The workforce of healthcare providers needs proper training for the quick detection and efficient management of extravasation incidents.[13,14] This research focuses on determining how common CIE occurs among adult patients, along with the critical factors that lead to this condition. The research investigates multiple factors that seek to generate evidence-based guidance regarding extravasation prevention and better-quality care delivery for oncology patients receiving chemotherapy.

Sinor Hospital Swat served as the study location because it provides chemotherapy services to adult patients with cancer. This research investigated the frequency, together with potential risk components, of CIE occurrences in adult treatment patients (ages 18 and above). The study participants were patients who underwent chemotherapy treatment during the research period after receiving at least one cycle and subsequent diagnoses of extravasation or experiencing symptoms of extravasation. The study included adult patients who also received chemotherapy unless they did not give permission. The study excluded clinical participants who were under 18 years old, outside the treatment period, or whose medical records had an unsatisfactory completion status. Data collection for identifying CIE cases contained a convenient sampling methodology that extracted information from patient records, chemotherapy logs, and clinical reports.

Data collection: Data collection was carried out by reviewing patient medical records, chemotherapy administration logs, and clinical observation reports.
A structured data collection form was used to gather the following variables:

• Demographics: Age, sex, BMI, comorbidities, and smoking history.
• Chemotherapy-related factors: Type of chemotherapy agents administered, IV access used, and chemotherapy dosage.
• Clinical factors: Location of extravasation, clinical symptoms, and severity of extravasation.
• Risk factors: Type of venous access (peripheral vs. central), vein characteristics, duration of infusion, and chemotherapy administration technique (e.g., rate of infusion).

Data analysis: Data were analyzed using SPSS software version 22. Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to summarize patient characteristics and the incidence of extravasation. To determine the association between risk factors and extravasation.

Demographic finding: The study included 150 participants, with a fairly balanced distribution across age groups. Most participants were male (53.3%), with a significant proportion of patients being either normal weight (40%) or obese (33.3%). Most patients had no comorbidities (70%) and did not have a smoking history (76.7%) (Table 1).

Table 1: Demographic characteristics of study participants

The chemotherapy-related variables showed that the most used chemotherapy agents were Doxorubicin (33.3%) and Cyclophosphamide (30%). A majority of patients received chemotherapy through peripheral IV lines (66.7%), while 33.3% had central venous catheters. In terms of dosage, most patients received moderate doses (40%), followed by high doses (33.3%) and low doses (26.7%) (Table 2).

Table 2: Chemotherapy-related factors

Incidence of extravasation: Out of 150 patients, 13.3% experienced CIE. The majority of extravasation cases occurred in the arm/hand (50%), followed by the neck (30%) and upper leg (20%). Most extravasation cases were mild (60%), with fewer cases classified as moderate (30%) or severe (10%) (Figure 1).

Figure 1: Clinical characteristics and incidence of extravasation

Obesity (BMI ≥30) and the use of peripheral IV lines were significantly associated with higher rates of CIE (p = 0.03, p = 0.01). Age and gender did not significantly influence the occurrence of extravasation (p = 0.32, p = 0.62). Chemotherapy dosage was not found to be a significant risk factor for extravasation (p = 0.45).

Table 3: Risk factors associated with CIE

The objective of this research was to evaluate the frequency and determine the factors of CIE within the adult cancer population being treated at Senior Hospital Swat. The research established that extravasation affected 13.3% of patients, while other studies report similar occurrence rates between 10% and 14%. The reported data incorporates unique patient case profiles and different chemotherapy treatments alongside medical facility characteristics that potentially influence the incidence results.[15]

Risk factors: The age variable did not create a statistical connection between patient age and extravasation development (p = 0.32). Additional research articles have demonstrated a lack of statistical relationship between patient age and extravasation development. Age-related vein deterioration might increase the difficulty of venous access for older patients, according to certain research studies. The age group of patients between 41–60 years experienced the majority of extravasation incidents. Therefore, other variables like chemotherapy drugs and intravenous access seem more
influential.[16]

This study shows no meaningful connection between gender and extravasation rate (p = 0.62). Gender distribution of extravasation cases in the current study showed little relationship to patient gender correspondence. The research team did not find evidence to support past suggestions that linked female anatomical differences to vein size or accessibility with extravasation occurrences.

The study established a meaningful link where obesity led to CIE based on the calculated p-value of 0.03. Research findings alongside other investigations demonstrate that obese patients face a higher risk of extravasation incidents. Obese patients experience greater difficulty when obtaining venous access because excess body fat accumulated near veins interferes with the nine-injection process for chemotherapy drugs.[17] The findings demonstrate why health professionals must evaluate patients’ BMI before selecting the most suitable approach for chemotherapy delivery methods.

Venous access proved to be a strong factor for predicting occurrence (p = 0.01). The placement of peripheral IV lines created a higher probability of extravasation in patients than central venous catheters. Similar to previous research, central venous catheters demonstrate better stability during chemotherapy delivery while simultaneously lowering the chances of extravasation. The location of peripheral IV lines in small and fragile veins leads to increased extravasation risks since they are frequently used for access. Medical practice favors central venous access routes when administering chemotherapy medications whose extravasation potential is high.[18]

Research did not show a connection between chemotherapy dosage amounts and extravasation development (p = 0.45). Research findings differ from other studies, which demonstrate that higher chemotherapy doses tend to result in additional extravasation risks. Current study results indicate that existing vein traits, along with selected types of intravenous access, influence extravasation risks more strongly than chemotherapy dosage levels alone. Further research investigating selected chemotherapy drugs alongside their particular dosages would generate additional information regarding this field.[19]

Severity of extravasation: Research observations indicate that extravasation episodes in our environment were mostly light because they affected 60% of patients, but severe cases represented just 10% of patients. Available research backs these findings by showing that most extravasation cases were classified as moderate or mild, while severe extravasation incidents were extremely rare.[20] The documented study demonstrates that medical staff prevented severe outcomes after detecting infusion problems through prompt citizenship and executing cold/warm compresses following infusion endpoint procedures. The factors determining extravasation severity consist of both drug agent selection, combined with the infusion protocol, and professional medical response speed.[21]

Limitations and implications: The results of this study are restricted by various factors. There are several restrictions to outcome generalization because convenience sampling was used as the data collection methodology. The research used 150 patient participants, but a sufficiently bigger sample would have strengthened the study findings. The study’s cross-sectional nature prevents researchers from establishing causal relations, which makes them able to identify relationships between variables only.

Research results verify that extravasation happens frequently among adult cancer patients receiving chemotherapy treatment, and both obesity and peripheral IV access methods serve as common risk factors. The study findings indicate healthcare organizations must develop customized care plans that address BMI values and venous access types to decrease extravasation events. Future studies should conduct research with extensive participant numbers and prospective investigation approaches to enhance the understanding of the CIE consequences of developing enhanced treatment methods.

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Corresponding Author:
Muhammad Farooq
Department of Nursing
Saidu group of teaching hospital swat, Pakistan
Email: mfarooqswat6@gmail.com

Co-Authors:
Sabir Rehman
Department of Nursing
DHQ hospital Karak, Pakistan

Adeeb shah
Department of Nursing
THQ Barikot swat, Pakistan

Shah Hussain
Department of Nursing
Zalan College of Nursing Swat, Pakistan

Muhammad Farooq was responsible for data collection and data analysis. Sabir Rehman contributed to data analysis. Adeeb Shah handled data collection, while Shah Hussain was involved in data analysis.

Ethical approval for this study was obtained from the Senor Hospital’s ethics committee (Ref No SH-IRB-2025-07). All participants provided written informed consent before being included in the study. Patient confidentiality was ensured by de-identifying the data and using coded identifiers. The study adhered to the ethical guidelines for research involving human subjects.

The authors declare no conflicts of interest.

None

https://doi.org/10.63096/medtigo3062312

Farooq M, Sabir R, Adeeb S, Shah H. Incidence and Risk Factors of Chemotherapy-Induced Extravasation in Adult Patients. medtigo J Med. 2025;3(1):e3062312. doi:10.63096/medtigo3062312 Crossref