Extravasation

Extravasation General Information

As a definition to the term, Extravasation is the leakage of a fluid out of its regular container. In medical terms, it is used to describe several types of leakage – either of intravenously administered drugs, of irrigation fluids in certain types of endoscopic surgery, of urine or of infusates.

Extravasation of IV administered drugs may occur either due to a leak in the vein (especially in elder patients, whose circulatory system becomes brittle and frail) or due to a direct puncturing of the vein when injecting the substance. This is a serious problem which can lead to severe complications, and even loss of the affected limb, and most of the time, it can be avoided as in most cases it is an effect of human error. The severity of the affection directly depends on the type of drug that leaks. The so called “irritant” drugs have only a minor effect of discomfort and passing pain, however the “vesicant” drugs can cause severe damage to the tissues, possibly even destroying them completely.

The exact rate of occurrence of the affection is not possible to be calculated, due to the fact that most mild cases are overlooked and are not documented, but the rate of occurrence may be as high as 10%. This is a situation that is expected to be controlled in the near future, as health care specialists become more concerned about the risks and as medical training more effectively addresses the matter.

Extravasation Symptoms

While most cases of Extravasation are mild, characterized only by localized pain at the site of the injection, reddening of the skin or a local irritation, there are some cases in which the unattended leakage may worsen over time. The pain may come under the form of burning or stinging sensations, and the region may swell and become tender. Cases of erythema have also been noted, as well as a shortage of blood in the affected region. Some of the symptoms are not always present, and the reaction may differ from one patient to another.

More severe cases of Extravasation may also present some symptoms affecting the skin covering the area, such as local blistering, or an unusual coloring of the skin – typically the skin will darken, and also the pain may grow in intensity. Firm induration may be a sign of eventual ulcerations at the spot of the injection. In cases where the thickness of the skin is severely damaged, the region may become very white and cold to touch, with no apparent traces of capillaries, and later on the area may develop a dry scar that is black in appearance. In severe cases, 10 to 14 days after the Extravasation a necrotic ulceration of the affected tissue occurs. Typically, the ulceration has a yellowish color, and is surrounded by a rim of erythema. Such cases are severe enough to require surgery. Extreme cases have been documented, where the patient had to undergo the affected limb’s amputation.

There may be more symptoms associated with this affection, and are not listed here. For more detailed information concerning the symptoms, it is advised that you consult a health care specialist qualified in this particular area of expertise.

Extravasation Treatment

As it is mostly caused by human error, it is highly advised that first and foremost Extravasation cases are reduced through prevention. Health care specialists are trained to avoid such situations however stress, haste or lack of attention are all factors that may lead to vein puncturing, and professionals should refrain from any medical activity under such conditions, if possible. While there is no dedicated treatment for cases of Extravasation, there are some techniques that may be applied in certain cases, and which may help depending on case. If the leaking substance is an “irritant” class drug, the main concern should be pain prevention and management until the leaked substance is absorbed by the body. Also, infection prevention should be employed if necessary, in the case of vaccine injections. Also, if there is any risk of super-infection, it is advised that the matter is brought to the attention of a specialist in infectious diseases for further testing and observation, and treatment as necessary.

In some cases the drug manufacturers have recommended antidotes that may be administered. For example, in cases of vasopressor Extravasation there have been obtained positive results by using Phentolamine or similar medication which has a relaxing effect of the smooth vascular muscles. Parenteral nutrition has been alleviated by administration of a vasodilator such as glyceryl trinitrate. Dimethyl sulphoxyde has proven to have good results in case of doxorubicin, daunorubicin and mitomycin leakage, and Sodium thiosulphate has been used as an antidote for mustine leaks. Dexrazoxane (Savene) has been largely used as an effective cure in cases of anthracycline drugs leaks.

Severe cases of Extravasation will require surgical procedures, involving removal of the affected tissues and / or skin grafts, depending on the particularities of the case. Ideally, only superficial tissues are affected and need to be removed, however sometimes the leakage is severe enough to affect nerves or tendons and may result in permanent damage. Extreme cases have been documented where amputation of the affected limb had to be employed in order to prevent further worsening of the condition and eventually the death of the patient.

While it is clear that this situation can only be prevented by proper training of the health care specialists, if you suspect to be affected by Extravasation you should immediately consult your physician in order to further research and prevent a possible worsening of the condition. It is highly advised that you present the medical authorities a list of the intravenous drugs that you have been recently administered, in order to check whether they are irritants or vesicants. The doctor may prescribe certain medications or procedures to relieve the symptoms. It is recommended that you closely follow the prescribed treatment, and additional testing and observation may be required to monitor the further evolution of the condition.