Extravasation is an emergency situation and immediate treatment should be started as soon as it recognised. Early treatment of the extravasation will decrease the likelihood of tissue damage and necrosis.
Immediate treatment for extravasation involves:
- Rapid action to prevent tissue necrosis
- Discontinuation of IV fluids, but without removing the cannula until aspiration via the cannula has been performed to remove any remaining drug
- Elevation of the limb with the extravasation site
- Application of compresses (warm or cold) in accordance with the hospital protocol and extravasated drug:
- Heat treatment increases vasodilation to enhance dispersion of the vesicant and reduce its accumulation in the tissues.
- Cooling packs helps vasoconstriction to control dispersion of the drug.
- Frequent communication with the patient and monitoring of the IV site to identify sensory changes such as tingling, burning or tightening.
- Extravasation should be reported to the medical team, as appropriate
- Administration of the following to treat inflammation:
- Dexamethasone or hydrocortisone can be given by subcutaneous injection locally, or they may be administered intravenously at a site far from the injury.
- Antihistamines and analgesics can be given for symptom relief.
Subsequent aspects of treatment will depend on the nature of the vesicant and will generally require specialist advice. There are two approaches to deal with vesicants:
- Localisation and neutralisation of the vesicant:
- Administration of an antidote (if available) following consultation with a specialist, in addition to application of cold compresses 3 to 4 times daily.
- Spreading and dilution of the vesicant:
- Flushing out the subcutaneous tissue of the affected area with physiological saline
- Administration of an enzyme to help dilute the vesicant:
- Collegenase: This enzyme has the ability to break down collagen
- Hyaluronidase: This is used to render the tissues more readily permeable to injected fluids, e.g., for introduction of fluids by subcutaneous infusion
- Dexrazoxane which is an iron chelator (bonding agent) approved for treating anthracycline extravasation
Pain relief can include:
- Counter-irritation of the skin with rubefacients to relieve superficial or deep-seated pain.
- A rubefacient is a substance that when applied topically cause redness of the skin by causing dilation of the capillaries and increasing blood circulation.
- Topical non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, ketoprofen or piroxicam for musculoskeletal conditions.
- Oral NSAIDs may also be used for pain relief.
