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INTRODUCTION

Extravasation and infiltration events are common occurrences with intravenous (IV) therapy and diagnostics (Figure 141-1). Some sources cite an incidence of 10% to 30%.1 The incidence of extravasation of specific agents (e.g., intravenous contrast or vasopressors) is low.2,3 Carefully placed IV catheters for chemotherapy have an incidence of extravasation as low as 0.01%.4 Acute chemotherapeutic medication extravasations are infrequently encountered in the Emergency Department. Understanding extravasations and their treatment is important due to the high degree of morbidity, the limited application of antidotes, and the increasing presence of standalone Emergency Departments and infusion centers.5 An understanding of the early recognition and treatment of chemotherapeutic extravasations is increasingly important.6

FIGURE 141-1.

Subcutaneous infiltration of radiologic contrast. (Courtesy of Eric Heffernan, MD, and www.svohradiology.ie.)

Most extravasations cause some degree of discomfort for the patient but display limited associated toxicity.3,7,8 There is swelling distal or proximal to the IV site with the extravasate. The dependent portion of the limb swells. There is skin tightness at the IV site. This can be increased over an area depending on the amount of extravasation. The skin can be blanched and cool to the touch. Extravasation can stop the infusion and set off alarms on the IV pump. Extravasation may seep onto the skin and wet dressings. The Infusion Nurses Society has developed an infiltration and extravasation scale (Table 141-1).9

TABLE 141-1The Infusion Nurses Society Infiltration and Extravasation Scale

Prevention of extravasation of medications with known toxicity is a key focus to prevent morbidity. Anything administered in an IV may infiltrate and extravasate into the extremity. Certain medications cause tissue damage when extravasated (Table 141-2). It is recommended that medications with known extravasation toxicity be administered via a central venous catheter in nonemergent situations.10 This can limit but does not eliminate extravasation.10 Sometimes central venous access is impractical for the administration of potentially toxic ...

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