Guidelines for the management of extravasation

Abstract

The purpose of these practice guidelines is to offer and share strategies for preventing extravasation from occurring and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled intravenous injection experts. At first, the general knowledge of extravasation was described for its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. Management of extravasation includes nursing intervention and thermal application. At the first sign of extravasation, the following steps are recommended during the nursing intervention: stop administration of IV fluids immediately, disconnect the IV tubing from the cannula, attempt aspiration of the residual drug from the cannular, and administer the drug-specific antidote, and notify the physician. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Local cooling (ice packs) aids in vasoconstriction, thus theoretically limiting drug dispersion. Although clear benefit has not been demonstrated with thermal applications, it remains standard supportive care. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. For the prevention of extravasation, health professions should be familiar with the extravasation management standard guidelines. They should regularly check the extravasation kit, assess patients' sensory changes, tingling or burning, and always pay attention to patients' words. The medical team’s continuous education regarding extravasation is essential. With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation within the hospital and contribute to patient care improvement.

Elaboration and validation of an algorithm for treating peripheral intravenous infiltration and extravasation in children

“…Regarding the content category, the experts stated that it was scientifically correct: the information was clear, concise and presented a logical organization. As described in the Method, the initial approach when detecting infiltration or extravasation is to stop the infusion (2,5,17,(25)(26)(27)(28)(29) , aiming to decrease the amount of fluids in the region adjacent to the insertion area of the peripheral intravenous catheter, thus reducing potential harms. In addition, the clinical signs and symptoms of these two complications must be assessed (2,5,17,(25)(26)(27)(28) .…”

“…One of the first procedures to be performed with the in situ catheter is its aspiration through the connector or hub of the catheter to remove the largest volume of the liquid (2,5,17,(25)(26)(27)(28)(29)(32)(33) being infiltrated or extravasated.…”

Novel Conformal Skin Patch with Embedded Thin-Film Electrodes for Early Detection of Extravasation

“…Another factor is the movement of patients during IV infusion. This movement can lead to accidental displacement of the cannula from the vein [ 1 ]. The incidence of extravasation in patients undergoing chemotherapy and newborns is approximately 0.1–0.6% [ 2 ] and 11% [ 3 ], respectively.…”

Tissue distribution of epirubicin after severe extravasation in humans

“…Although anthracyclines are potent vesicants, it is not known if there is a subcutaneous tissue dose-response relation with a threshold level to initiate irreversible cellular damage resulting in tissue necrosis [2]. Despite efforts to refine and to detail management guidelines by cancer organizations [3], educational efforts [4] and deep literature search with emphasis on clinical evidence for prevention and management in cancer nursing [5], this topic was not addressed so far due to its experimental character. Moreover, little is known about the distribution within the affected lesion and the tissue clearance to reduce the toxic pressure and enable wound healing [6].…”