Vancomycin extravasation: Evaluation, treatment, and avoidance of this adverse drug event

Abstract

Purpose: To report the presentation, management, and potential future avoidance of vancomycin extravasation. Summary: An 84-year-old woman was admitted to the emergency department due to observed seizures that progressed to status epilepticus. Status epilepticus was controlled, but the patient developed hospital-acquired pneumonia, requiring treatment with vancomycin and cefepime. During treatment with vancomycin, extravasation occurred during peripheral administration. Cold packs were immediately applied to the lesion for the next 24 hours with common gauze open dressings with frequent changes, and silver sulfadiazine 1% topical application once daily were started on the day after extravasation. While skin necrosis developed, it did not require surgical intervention and common gauze open dressings with frequent changes and silver sulfadiazine 1% topically were continued until the wound was healed. Conclusion: Although the package insert warns of extravasation with potential necrosis during vancomycin administration, this case highlights a potentially under-reported adverse event. Vancomycin extravasation was successfully managed by utilizing cold compress for the first 24 hours post-extravasation with common gauze open dressings and silver sulfadiazine 1% until the wound was healed. With a potential for vancomycin extravasation when administered peripherally, we would recommend central venous administration.

Efficacy of Vancomycin-based Continuous Triple Antibiotic Irrigation in Immediate, Implant-based Breast Reconstruction

“…We acknowledge that there are some anecdotal concerns regarding using vancomycin in breasts. First, there have been case reports of tissue necrosis resulting from extravasation of intravenously administered vancomycin, 19 , 20 which raises the concern for tissue toxicity with vancomycin exposure. It should be noted that intravenous vancomycin is administered at a concentration of 1 g/250 mL of normal saline, whereas the vancomycin-based solution in this study was used at a 4-fold lower concentration (1 g in 1 L of normal saline).…”

Extravasation of vancomycin away from the peripheral vein of administration

“…3 Skin necrosis due to vancomycin extravasation is a serious complication. 3 Although we have referred to data where chemotherapy was used in adults, 4 preventive measures against extravasation in pediatric critical care medicine remain to be elucidated.…”

“…2 Vancomycin solution is acidic (pH, 2.5-4.0) and hyperosmolar (328 mOsm/L) and may act as a vesicant when administered through a peripheral line. 3 Skin necrosis due to vancomycin extravasation is a serious complication. 3 Although we have referred to data where chemotherapy was used in adults, 4 preventive measures against extravasation in pediatric critical care medicine remain to be elucidated.…”

“…Therefore, distal superficial femoral vein (DSFV) cannulation for peripherally inserted central catheters (PICCs) is preferred when maintaining venous access devices is challenging 2 . Vancomycin solution is acidic (pH, 2.5–4.0) and hyperosmolar (328 mOsm/L) and may act as a vesicant when administered through a peripheral line 3 . Skin necrosis due to vancomycin extravasation is a serious complication 3 .…”