Magnesium antidote2/1/2024 Non-pharmacologic interventions for extravasationįor most medications, the treatment of extravasation is nonpharmacologic in nature however, the efficacy of any specific approach has not been demonstrated in controlled studies. 3-6 Preventive measures include appropriate dilution of medication, infusion of medication via the appropriate rate of administration, ensuring patency of the vascular access device, careful monitoring of infusions during administration, use of clear tape or dressings to allow for visual inspection of the infusion site, and immobilization of the extremity with the IV cannula. The best approach to extravasation injury is prevention. Additionally, administration factors, including the experience of personnel administering the injection, the injection technique, and the number of venipuncture attempts to establish a line, contribute to the risk of extravasation, as does the fragility of the patient’s veins. Cytotoxic agents can be further subdivided into DNA-binding and non–DNA-binding agents. Some drugs, including anti-cancer agents, are directly cytotoxic to cells. Certain drugs cause vasospasms, which result in back pressure at the intravenous (IV) site and may expand the puncture site in the vein, allowing leakage to occur drugs that act as vasoconstrictors can also cause tissue ischemia. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. 1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015.Ī variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate). For vesicant drugs and chemotherapeutic agents, the incidence has been reported to range from 0.01% to 6%. 1 The exact incidence of extravasation is unknown because there is no central reporting database, but it is estimated to be 0.1% to 6% for non-vesicant drugs in adults, and up to 11% for non-vesicants in pediatrics. Damage from extravasation can progress to a significant degree, causing permanent disability and disfigurement, and necessitating surgical debridement or skin grafting. However, vesicants are differentiated from non-vesicants in that they can cause tissue necrosis, blistering, and ulceration. 2,3 Initial symptoms of extravasation are similar to infiltration and include persistent pain, burning, stinging, swelling, and either blanching or erythema at the site of injection or along the course of the vein. 1 Infiltration, often used in reference to extravasation, refers to leakage of a non-vesicant drug or solution. Extravasation is defined as the leakage or inadvertent administration of a vesicant drug or solution from a vein into the extravascular space.
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