Avoid Issues With Treatments for Extravasations

You can help reduce patient harm from “extravasation” of certain IV meds.

IV meds can sometimes leak into the tissue around an IV catheter. In most cases, this is called infiltration.

But it’s an extravasation if the med leaking out can cause blistering or tissue death. These meds are called vesicants.

Familiarize yourself with common vesicants. For example, many chemo agents are vesicants. But you may also see non-chemo vesicants...such as norepinephrine and other vasopressors, calcium chloride, or amiodarone.

Route phone calls about extravasations to your pharmacist. The treatment plan will depend on the med...and will likely involve stopping the infusion, elevating the limb, applying a warm or cold compress, and possibly drug treatment.

For instance, expect to dispense hyaluronidase for extravasations due to meds such as calcium chloride or parenteral nutrition. Hyaluronidase helps these vesicants spread through the tissue to become more dilute.

Don’t be surprised to dispense phentolamine for extravasations caused by vasopressors. Phentolamine helps open blood vessels closed off by pressors...to help prevent tissue death.

If phentolamine isn’t available, anticipate sending subcutaneous terbutaline or topical nitroglycerin for pressor extravasations.

Help ensure your pharmacy has prevention plans in place.

For example, if IV promethazine is allowed at your hospital, ensure there’s a policy to dilute it first and infuse slowly.

Use auxiliary labels so nurses know which meds can cause severe damage. For example, place “Vesicant” labels on certain chemo preps, such as doxorubicin, vincristine, and vinorelbine.

And use “Central line only” stickers when preps must be infused into large veins...such as for most parenteral nutrition bags.

For more on handling extravasations, see our resource, Management of Non-Chemo Drug Extravasation.

Key References

  • Stefanos SS, Kiser TH, MacLaren R, et al. Management of noncytotoxic extravasation injuries: A focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline. Pharmacotherapy. 2023 Apr;43(4):321-337.
  • David V, Christou N, Etienne P, et al. Extravasation of Noncytotoxic Drugs. Ann Pharmacother. 2020 Aug;54(8):804-814.
  • Ong J, Van Gerpen R. Recommendations for Management of Noncytotoxic Vesicant Extravasations. J Infus Nurs. 2020 Nov/Dec;43(6):319-343.
Hospital Pharmacy Technician's Letter. July 2024, No. 400718

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