Extravasation (intravenous)

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Extravasation (intravenous)
Classification and external resources
MeSHD005119
 
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Extravasation (intravenous)
Classification and external resources
MeSHD005119

Extravasation is the accidental administration of intravenously (IV) infused medications into the extravascular space/tissue around infusion sites, either by leakage (e.g., because of brittle veins in very elderly patients), previous venipuncture (such as from blood drawn for laboratory tests prior to therapy), or direct leakage from mispositioned venous access devices. Extravasation of medication during intravenous therapy is an adverse event related to therapy that, depending on the medication, amount of exposure, and location, can potentially cause serious injury and permanent harm, such as tissue necrosis. Milder consequences of extravasation include irritation, characterized by symptoms of pain and inflammation, with the clinical signs of warmth, erythema, or tenderness.

Medications[edit]

The two main categories of medications to describe the local consequences of their extravasation are:

Complications related to extravasation are possible with many medications, but it is a particular concern with cytotoxic/chemotherapeutic drugs used in the treatment of cancer, since these are often highly toxic medications that must be administered in controlled fashion to avoid adverse events.

In recent years, healthcare professionals are becoming more aware of this problem.[1][2][3][4][5]

Treatments and techniques[edit]

The best "treatment" of extravasation is prevention. Depending on the medication that has extravasated, there are potential management options and treatments that aim to minimize damage, although the effectiveness of many of these treatments has not been well studied.[6] In cases of tissue necrosis, surgical debridement and reconstruction may be necessary. The following steps are typically involved in managing extravasation:

Pain management and other measures[edit]

Prevention of extravasation in hospitals[edit]

Examples of vesicant medicinal drugs[edit]

List of vesicant and irritant medications:[6][10]

Cytotoxic drugs[edit]

Non-cytotoxic drugs[edit]

See also[edit]

References[edit]

  1. ^ Sauerland C, Engelking C, Wickham R, Corbi D. Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk. Oncol Nurs Forum. 2006 Nov 27;33(6):1134-41. Review.
  2. ^ Wickham R, Engelking C, Sauerland C, Corbi D. Vesicant extravasation part II: Evidence-based management and continuing controversies. Oncol Nurs Forum. 2006 Nov 27;33(6):1143-50. Review.
  3. ^ Goolsby TV, Lombardo FA. Extravasation of chemotherapeutic agents: prevention and treatment. Semin Oncol. 2006 Feb;33(1):139-43. Review.
  4. ^ Ener RA, Meglathery SB, Styler M. Extravasation of systemic hemato-oncological therapies. Ann Oncol. 2004 Jun;15(6):858-62. Review. Fulltext
  5. ^ Schrijvers DL. Extravasation: a dreaded complication of chemotherapy. Ann Oncol. 2003;14 Suppl 3:iii26-30. Review. Fulltext
  6. ^ a b c Chemotherapy vesicants, irritants, and treatment for extravasation
  7. ^ For more information on substance-specific measures, see, for example, the textbook "Extravasation of cytotoxic agents" (Authors: I Mader et al., Springer Publishing House)
  8. ^ Mouridsen HT, Langer SW, Buter J, Eidtmann H, Rosti G, de Wit M, Knoblauch P, Rasmussen A, Dahlstrom K, Jensen PB, Giaccone G. Treatment of anthracycline extravasation with Savene (dexrazoxane): results from two prospective clinical multicentre studies. Ann Oncol. 2007 Mar;18(3):546-50.
  9. ^ Infusion Nurses Society, Infusion Nursing 3rd ed 2010
  10. ^ www.IVACCESS.com

External links[edit]