Extravasation injury is common, yet it is always underestimated and underreported. Extravasation is defined as unintentional leakage of vesicant fluid or drug out of the blood vessels, which damages the surrounding tissue.
The extent of tissue injury depends on extravasation volume, site of the cannula, patient factor, and agent osmolarity & toxicity. The severity varies from thrombophlebitis up to disability. Unrecognized extravasation is a potential medicolegal case in healthcare.
The initiative started as the Nursing Department at Fakeeh University Hospital wanted to shed light on unexpected extravasation, and the importance of being proactive in the prevention and management of extravasation injury for avoiding any risk of disability and dysfunction.
During critical care admissions, extravasation is mostly overlooked. Therefore, it is better to prevent extravasation by standardizing practice, educating, and training healthcare staff on preventive measures and proper management of extravasation.
Extravasation injury patients initially face symptoms like thrombophlebitis, edema, pain, and erythema. If symptoms persist for over 24 hours, it is considered severe, which can potentially develop ulceration or even necrosis. The worst complications are disabilities, like contracture, nerve damage, joint stiffness, and tendon damage. Further damage can be prevented if extravasation is detected earlier.
Whereas, in complicated extravasation injuries, early aggressive wound debridement is suggested because chronicity of the wound will increase morbidity and cause more functional damage. Since most of the literature focuses on chemotherapy drugs and pediatric extravasation injuries, the severity of many cases may have been underestimated and thus underreported.
To prevent extravasation, nurses at FUH formed a multidisciplinary team to tackle all aspects that contribute to extravasation and developed Guidelines for Handling and Managing PIVC, which includes extravasation management protocol. The team included Physicians and members from the Critical Care Department, Pharmacy, and Risk Management. In addition to establishing IV cannulation standards, and management of extravasation and IV complications, they also developed a list of vesicant medications lists, for both adult and pediatric patients.
Healthcare workers must always practice prevention during cannulation and drug administration, especially regarding vesicant or irritant drugs.
Early detection produces favorable outcomes in managing IV complications, especially extravasation. Measures include stopping the infusion immediately, drug aspiration, followed by reversal agents/antidote, if indicated. Other measures can be taken, like the elevation of the limb, and applying local thermal treatments to decrease the site reaction and absorption of the infiltrate.
In summation, extravasation can lead to significant morbidity and disability in the long term. Awareness, prevention, and regular monitoring are vital for cannulation care.
For the next FUH Medical Review
©2021 Fakeeh University Hospital. All Rights Reserved
To FUH Medical Review
