Extravasation of medicines and their treatment and care
A1 Facts
B1 Definitions
C1 Extravasation: medicines/fluids entering the perivascular or
subcutaneous space unintentionally
C2 Vesicant: Drugs that cause tissue injury
B2 May or may not cause tissue injury: assume the worse and act on it
B3 Main sources of tissue damage from extravasation
C1 Cytotoxic drugs
C2 Hyper/hypo osmolarity drugs
C3 Vasoconstrictor drugs: cause damage from ischemia
C4 Concentrated electrolyte solutions: cause damage from ischemia
B4 Damage
C1 Local without necrosis
C2 Large/local with necrosis
C3 Based on
D1 Length of time the drug is in contact in tissue outside a vein
D2 Type of drug
C4 Induration, swelling, and pain are not reliable indicators of damage
B5 Risk Factors
C1 Preexisting pathophysiology of skin, blood vessels, lymphatic vessels
C2 Poor nutrition
C3 Poor base line health condition
C4 Site of extravasation
C5 Toxicity of drug
C6 Amount of drug
C7 Length of time
C8 Pt/medical/nursng staff not vigilant in checking
B6 Images
C1
C2
A2 Assessment
B1 Symptoms
C1 Pain
C2 Burning
C3 Stinging
B2 Signs
C1 Induration
C2 Swelling
C3 Discoloration
C4 Leaking fluid
C5 Change in skin temperature in and around the cannulation site
A3 Treatment
B1 Stop infusion immediately
B2 Note
C1 The drug
C2 The amount (take the readings off the pump and make best estimate)
C3 The area (not only the site area but the area of extravasation)
C4 Time drug has been extravascular
B3 Things that do not work well
C1 Elevating the extremity
C2 Applying heat
C3 Applying cold (may work than heat, though, as it constricts and
prevents the dispersion of the vesicant into new areas)
C4 Aspiration of the extravasated liquid
B4 Things that do work
C1 Treat within 24 hours (before necrosis has started)
C2 Saline flush-out
C3 May use aspiration with liposuction cannula as it may help, too, after
flush-out
C4 Link: http://www.extravasation.org.uk/Flushout.htm
C5 May consider phentolamine (Regitine) for vasopressors as epinephrine,
norepinephrine, vasopressin, and dopamine. Use within 10 minutes. Though some say it
can wait for up to 12 hours ( ). Use 5 to 10 mg of phentolamine mesylate in 10-15 mL of
saline is injected into the area of extravasation within 12 hours with a fine hypodermic
needle.
A4 Prevention
B1 Directly observe site of IV
C1 Central lines: pay attention to the fact that the distance between distal
and proximal ports are approximately 4 cm to 5.5 cm, so the distal port may be in the
vein, but the proximal port is not.
C2 No vesicants in any IV not directly and easily seen by staff
B2 Avoid IV peripheral starts in places
C1 Many other starts in same vein
C2 If high infusion pressures will be used
C3 Tourniquet effects as blood pressure cuffs above IV site
C4 Where tendons, nerves, or arterial vessels are located
C5 Places where there was radiation
C6 Small vein
C7 Dorsal area of hand
B3 When using central lines, use the distal port only for vesicants
B4 Educated patients/families are need to report swelling, redness, or other
abnormalities.
B5 Give the most tissue irritating drug first.
A7 Sources:
http://www.anesthesia-analgesia.org/content/100/3/722.full
http://www.extravasation.org.uk/Flushout.htm
http://en.wikipedia.org/wiki/Hyaluronidase
http://www.merckmanuals.com/professional/print/lexicomp/norepinephrine.html
http://www.extravasation.org.uk/home.html
