Extravasation Management
Introduction
Extravasattion refers to unintentional or inadvertent leakage (or instillation) of fluid out of a blood vessel into surrounding tissue.
- A variety of symptoms, including erythema, ulceration, pain, tissue sloughing, and necrosis, are possible.
A variety of drugs have been reported to cause tissue damage if extravasated.
- Irritant - An agent that causes aching, tightness, and phlebitis with or without inflammation, but does not typically cause tissue necrosis. Irritants can cause necrosis if the extravasation is severe or left untreated.
- Vesicant - An agent that has the potential to cause blistering, severe tissue injury, or tissue necrosis when extravasated. Can be further classified into DNA binding and non-DNA binding.
Initial Management
Stop the infusion: At the first suspicion of extravasation, the drug infusion and IV fluids should be stopped.
Do NOT remove the catheter/needle: The IV tubing should be disconnected, but the catheter/needle should be left in place to facilitate aspiration of fluid from the extravasation site and, if appropriate, administration of an antidote.
Aspirate fluid: To the extent possible, the extravasated drug solution should gently be removed from the subcutaneous tissues. It is important to avoid any friction or pressure to the area. Aspiration of extravasated contrast media is not recommended.
Do not flush the line: Flooding the infiltration site with normal saline or dextrose (5%) in an attempt to dilute the drug solution is not recommended.
Remove the catheter/needle: If an antidote is not going to be administered into the extravasation site, the catheter/needle should be removed. If an antidote is to be injected into the area, it should be injected through the catheter to ensure delivery of the antidote to the extravasation site. When this has been accomplished, the catheter should then be removed.
Elevate: The affected extremity should be elevated.
Compresses: If indicated, apply dry compress to area of extravasation (either cold or warm, depending on vesicant extravasated). May refer Lexicomp - Management of Drug Extravasation, 2021 for more information.
Monitor and document: Mark the extravasation site (using a surgical felt pen, gently draw an outline on the skin of the extravasation area) and photograph if possible. Monitor and document the event and follow-up activities according to institutional policy.
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