Extravasation (intravenous) - Treatments and Techniques

Treatments and Techniques

The best "treatment" of extravasation is prevention. Depending on the medication that has extravasated, there are potential management options and treatments that aim to minimize damage, although the effectiveness of many of these treatments has not been well studied. In cases of tissue necrosis, surgical debridement and reconstruction may be necessary. The following steps are typically involved in managing extravasation:

• Stop infusion immediately. Put on sterile gloves.
• Replace infusion lead with a disposable syringe. While doing this, do not exert pressure on the extravasation area.
• Slowly aspirate back blood back from the arm, preferably with as much of the infusion solution as possible.
• Remove the original cannula or other IV access carefully from the arm (removal of the original cannula is not advised by all healthcare institutions, as access to the original cannula by surgeons can be used to help clean extravasated tissue).
• Elevate arm and rest in elevated position. If there are blisters on the arm, aspirate content of blisters with a new thin needle.
• If, for the extravasated medication, substance-specific measures apply, carry them out (e.g. topical cooling, DMSO, hyaluronidase or dexrazoxane may be appropriate).
• Recent clinical trials have shown that Totect (USA) or Savene (Europe) (dexrazoxane for extravasation) is effective in preventing the progression of anthracycline extravasation into progressive tissue necrosis. In two open-label, single arm, phase II multicenter clinical trials, necrosis was prevented in 98% of the patients. Dexrazoxane for extravasation is the only registered antidote for extravasation of anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin, etc.).