Extravasation Injury
What is an Extravasation Injury ?
The term “Extravasation Injury” refers to the damage caused by the efflux of solutions from a vessel or a port-A-Cath system into surrounding tissue spaces during intravenous infusion.
From a clinical point of view, the following divisions have proven themselves:
- Type of substance
- Type of injection reservoir
- Time of occurrence
What Forms of Extravasation Injuries are there?
From a clinical point of view, the following divisions have proven themselves:
- Type of substance
- Type of injection reservoir
- Acute vs. chronic Extravasation injuries
Type of Substance
Tissue damage after extravasation are primarily due to the following substances:
– Chemotherapeutics (vesicant, irritant, non-vesicant)
– vasoactive substances
– hyperosmolar solutions
Type of injection reservoir
Efflux of solutions can occur from:
- a blood vessel
- artificial reservoir system (port-A-Cath system)
Acute vs. chronic Extravasation injuries
With regard to the therapy and the prognosis of possible long-term damage, a distinction is made between:
– Acute extravasation < 24 hours
– chronic extravasations > 24 hours
What are the consequences of Extravasation Injuries?
Volume expansion of the subcutaneous tissue leads to pain. Depending on the type of substance, the volume and the time of treatment, the damage can extend to involve nerves, tendons, and joints and can continue for months after the initial insult. If treatment is delayed, surgical debridement, skin grafting, and even amputation may be the unfortunate consequences of such an injury.
When skin tear wounds are not well identified, their treatment by an inexperienced treatment team results in:
- Prolonged treatment duration with significant impairment of the patient
- Poor treatment outcome
- Increased complication rate, including permanent damage
How can you treat an Extravasation injury ?
Prevention
The best way to treat extravasation injuries is to ensure they never happen in the first place. Preventative measures to practice include:
- Do not insert the cannula in the joints because it is difficult to secure, and neural damage and tendon injury can be caused if extravasation occurs due to vesicant drugs.
- Do not insert the cannula in the antecubital fossa area, where it isextremely difficult to detect extravasation.
- Veins on the back of the hand can be used, and in some cases,observation is easier. But it must be done carefully because this area can suffer a more severe injury due to extravasation.
- For observation, do not cover the cannula area with opaque gauze.
- Secure the cannula during the administration of the drug.
- Even if there is an existing IV route, secure a new route when administering vesicant drugs.
- If in doubt, re-insert the cannula and administer the drug.
- Watch for edema, inflammation, and pain around the cannula during administration.
- Check for blood backflow before/during administration, and always rinse the catheter with a saline solution in between administrations.
- Dilute stimulant drugs as much as possible and inject them at a proper rate.
- Once the needle is removed, apply pressure to the puncture site for about five minutes and elevate the limb
Emergency Treatment
Emergency treatment measures include:
- stop administration of IV fluids immediately
- disconnect the IV tube from the cannula
- aspirate any residual drug from the cannula
- notify the physician
- administer a drug-specific antidote
- elevate the limb with the extravasation site
- administer pain medication if necessary
- close follow-up
Specific Treatment
Specific treatment depends on type of solution, volume of solution and time elapsed between extravasation and onset of treatment.
Most extravasation injuries can be treated conservatively. The more aggressive the substance, the higher the need of fast treatment, and the more often surgical treatment in necessary.
