MANAGEMENT
OF EXTRAVASATION Extravasation injury usually refers to the damage caused by
leakage of solutions from the vein to the surrounding tissue spaces during
intravenous administration. It
can cause skin necrosis, which may lead to functional impairment and
cosmetic defects. Surgical
debridement and skin grafting may be required.
Prevention of extravasation is preferable to treatment. Extravasation should be suspected if the following are
observed at the injection site: ·
the patient complains of burning, stinging or discomfort ·
swelling or leakage is observed ·
resistance when giving a bolus injection ·
an absence of free flow of fluid if infusion route is being
used
Measures
to prevent necrosis include: ·
appropriate dilution and rate of administration of drug ·
correct location of intravenous sites ie. avoid extremities
with poor venous circulation ·
careful and frequent monitoring of solutions administered by
infusion pumps ·
use of transparent dressings to allow inspection of
intravenous site
General
Procedure ·
Stop injection/infusion immediately, do
not remove cannula. ·
Disconnect giving set and attempt to aspirate as much
residual fluid as possible. This
may be facilitated by subcutaneous injection of sodium chloride 0.9% to
dilute the drug. ·
Instill antidote if appropriate. See section “Specific Drug Treatments”. ·
Remove needle/cannula and apply pressure to stop bleeding. ·
Elevate the arm and apply ice packs to site immediately for
15 minutes 4 times a day for 24 – 48 hours. If
extravasation has been caused by vinca alkaloids (ie Vinblastine,
Vincristine, Vindsine + Vinorelbine), do NOT apply ice packs. ·
Review within 24 hours for further evaluation.
If there is deterioration despite initial treatment, then refer for
surgical management. ·
All incidents and treatment must be documented. Treatment
of extravasation in infants Hyaluronidase 1500units added to 500ml sodium chloride 0.9%.
Make 4 – 8 small exit stab incisions around the affected area.
Insert a “Verres” needle through one of the exit holes into the
subcutaneous tissue. Inject
20-30ml of Hyaluronidase solution. Apply
heat to help disperse the drug. Move
the “Verres” needle along the same plane in various directions to
ensure adequate flushing. Repeat
up to a volume of 500ml. Check
the flushout fluid does not collect in the surrounding tissues.
After flushout, remove needle and apply a dressing. Specific
Drug Treatments:
Hyaluronidase should NEVER be used with vesicant drugs, unless as a specific antidote.
Some information on extravasation is included in section 10.3 of
the BNF. Recommended
treatment for common agents
Goodman,
M. & Riley, M.B. 1997 Chemotherapy administration. In: Cancer Nursing
(eds S.L., Groenwald, M.H., Frogge, M., Goodman & C. Henke Yarbro),
4th edn, pp. 317–404. Jones & Bartlett, Boston Dougherty,
L. 1999 Safe administration of intravenous cytotoxic drugs. In:
Intravenous Therapy in Nursing Practice (eds L., Dougherty & J. Lamb).
Churchill Livingstone, Edinburgh. |
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