PS-025 Guidelines for extravasation of non-cytotoxic vesicant intravenous drugs

Abstract

Background Extravasation of non-cytotoxic intravenous drugs (NCID) is a complication of intravenous administration through central and peripheral venous catheters. Although rare, it can result in serious consequences, both physical and psychological; it may impair the quality of life and patient survival as well as prolonging hospitalisation and increasing costs. The hospital pharmacist should contribute to the prevention and resolution of adverse effects associated with extravasation of NCID. Purpose To undertake a survey of NCID available in Portugal and analyse four key elements related to extravasation: prevention, recognition, management and documentation. Materials and methods A literature review was performed, researching guidelines related to extravasation of NCID and articles obtained from PubMed from 2003 to September 2013, intersecting the terms ‘drug extravasation’ and ‘extravasation treatment’. The summaries of product characteristics of all of intravenous cytotoxics available in Portugal were also reviewed. Some holders of market authorisation were also contacted whenever additional information was considered necessary. Results A total of 32 NCID available in Portugal were identified, some of them widely used in hospitals (e.g., calcium gluconate 10%, potassium chloride 7.45%, epinephrine, dopamine, phenytoin, cefotaxime and vancomycin). The lack of information and documentation about extravasation of NCID are barriers for the proper extravasation management, which requires detailed information about the drug’s properties, what measures need to be taken if it occurs and which antidotes should be administered (e.g., hyaluronidase, phentolamine, topical nitroglycerin, terbutaline). Most of the available information refers to cytotoxic drugs. The procedures to decrease morbidity resulting from extravasation of NCID are not clearly defined and they are not applied uniformly. However, whenever extravasation occurs or it is suspected, administration of NCID should be stopped immediately and the proper non-pharmacologic and pharmacologic measures must be taken speedily. We also designed an extravasation kit and a model document for the appropriate recording of extravasation and clinical monitoring of the patient. Conclusions The lack of standardised information about the procedures to be undertaken if NCID extravasation occurs, justifies the need to develop a manual which includes guidelines for what to do and which antidote to use. A kit should also be assembled to use in these situations. No conflict of interest.