Management of Extravasation and Infiltration of non-cytotoxic ...
Management of Extravasation and Infiltration of non-cytotoxic medications in adults
(Radiology, oncology and haematology please refer to your local extravasation protocols)
Extravasation and infiltration refers to the leakage of intravenous fluid from the vein into the surrounding tissue.
It can result in blistering and tissue necrosis and requires immediate attention to limit further injury.
Suggested management:
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At first concern of extravasation / infiltration:
Stop the injection / infusion immediately
Leave the IV cannula in-situ until further assessed
Aspirate as much back from cannula as possible (do not flush cannula)
Elevate limb to minimise swelling
Obtain extravasation kit from nearest location
Inform medical team & ward pharmacist
Initiate substance specific measures
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Further management:
Give pain relief if needed
Classify injury (see below)
Mark area with a pen
Take digital image for documentation in clinical notes
Remove cannula if not severe, place dressing over site
Arrange daily assessments and images
Complete Safety 1st report
Classification:
Mild:
Moderate:
Severe:
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Minimal volume of irritant or vesicant causing little pain / swelling, and no erythema / blistering
Small volume of extravasation causing a local inflammatory reaction, moderate tenderness, with or without erythema but no blistering
Large volumes, typically vesicant infusions, resulting in extreme pain, marked swelling, cool to touch, diminished or absent pulse, erythema and often blistering
Immediate plastic surgery consultation is required for severe injuries ¨C contact plastics via on-call service
For specific drug management see below. NB. for drugs not listed see Hospital Health Pathways regarding information on physiological properties
Thermal compressors should only be applied after determining if the extravasated drug requires a warm or cold compress. Applying a compress that is the wrong temperature can
exacerbate the injury. Wet compresses should never be used as this increases the risk of tissue maceration.
Extremes of pH
Aciclovir
Cefotaxime
Promethazine
Vancomycin
Extremes of osmolarity
Aminophylline
Diazepam
Digoxin
Mannitol
Cold compress
Cold induces vasoconstriction and limits damage to
surrounding tissue
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cold, dry (not moist) compress
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apply proximal to injury for 15-20 minutes at
least 4 x daily for 24-48 hours
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no specific antidote
*antidotes generally only considered in severe cases
Calcium chloride
Calcium gluconate
Glucose 10-50%
Parenteral nutrition (PN)
Vasopressors
Phenytoin
Potassium chloride
Sodium bicarbonate
Sodium chloride >3%
Adrenaline
Dobutamine
Dopamine
Methylene blue
Noradrenaline
Warm compress +/- hyaluronidase*
Warm compress +/- phentolamine*
Warm increases blood circulation and encourages drug
dispersal away from affected area
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warm, dry (not moist) compress
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apply proximal to injury for 15-20 minutes at
least 4 x daily for 24-48 hours
Warm increases blood circulation and encourages drug
dispersal away from affected area
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warm, dry (not moist) compress
?
apply proximal to injury for 15-20 minutes at
least 4 x daily for 24-48 hours
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