Extravasation (intravenous)

Extravasation means in medicine that either a physical fluid ( eg blood, urine) or cells that are normally found in these bodily fluid leaked from the physical vessel predicted for this liquid into the surrounding tissue. In the context of an inflammatory extravasation means that leukocytes have leaked out of the capillaries, see Leukodiapedese. In the context of cancer extravasation means that cancer cells have leaked from the capillaries, which may lead to metastasis.

Much more common but does extravasation in medicine that a medical infusion that gets the patient is mistakenly not run in the time allotted for this infusion vein, but into the surrounding Armgewebe.

The leaked or misplaced liquid is called extravasation. In most languages ​​, eg in English or Italian, is called extravasation extravasation. The German medical language thus forms an exception.

  • 2.1 Treatment of pain and other follow-up actions
  • 2.2 Measures in case the paravasierte drug " vesicant " is ( vesicant )
  • 4.1 cytostatics
  • 4.2 Other drugs

Overview of extravasation during infusion

Extravasation can be a dangerous side effect of intravenous infusions. Extravasation is the accidental administration of an intravenous ( IV) infusion into the surrounding Armgewebe instead of the appropriate vein. This accidental transfer can happen through leakage, eg in elderly patients with very permeable veins, or because the infusion needle has pierced the vein. The outlet is then in actual Armgewebe and the infusion goes directly into the Armgewebe. This can happen, for example, in children, move her arm too much, or because the infusion needle from the beginning was not very well placed, or if the patient falls asleep lying on his arm, etc.

Extravasation during infusion is a side effect that can be avoided and must.

In average cases causes extravasation pain, redness, irritation and swelling of the arm with the infusion needle. In severe cases occurs necrosis of Armgewebes. In very rare, extremely severe cases, it can even mean the loss of the arm.

Extent of the damage

The damage after extravasation can be easy, medium or hard fail. If only the pure carrier solution (usually either saline = 0.9 % NaCl solution or sugar solution = 5% glucose solution) was infused, the damage will be slightly.

Some medicines cause to the arm with the infusion needle after extravasation only an average loss; they are referred to as " irritant ". Other drugs cause to the arm with the infusion needle serious damage; they are referred to as " a vesicant ."

Damage is especially after extravasation of cytotoxics, ie during chemotherapy, feared. However, damage can also occur after extravasation from all other drugs, not only after extravasation of cytotoxics.

Frequency

The proportion of patients who have had an extravasation is not exactly known as an extravasation, in particular a slight extravasation, often not recognized and / or is not documented, but overall is probably 10%.

In recent years, health professionals much more to the problem of extravasation were attentive.

Treatment of extravasation

The best "treatment" of extravasation is prevention, since there is no specific treatment for extravasation. Although the effectiveness of different measures is not very high, they should be always performed after extravasation.

Recent clinical studies show that dexrazoxane effective upon extravasation of anthracyclines is that is can prevent the occurrence of tissue necrosis. Developed in two multicenter, open-label, non-controlled, small phase II clinical trials following administration of dexrazoxane 98 % of patients after extravasation of an anthracycline no tissue necrosis. ( The anthracyclines include daunorubicin, doxorubicin, epirubicin, idarubicin, etc. )

Pain treatment and other follow-up actions

Effective pain management is very important for the patient, just as a complete documentation and prevention of infection and superinfection. If such a situation occurs, request a antibiogram and consult the specialist in infectious diseases. Regular inspections and follow-up are necessary.

Measures if the paravasierte drug " vesicant " is ( vesicant )

  • The i.v. access not flush.
  • No moist compresses, no alcoholic compresses, no dressing.
  • Early on a senior physician who has experience in the treatment of extravasation has, and the services of a reconstructive surgeon.
  • Such cases sometimes require skin grafts and intense physiotherapy.

Prevention of an extravasation

  • IV access place only by experienced personnel, if possible, at least for particularly vulnerable patients, such as patients very thick, very young patients, very old patients and patients with no visible veins.
  • When IV access - not lay multiple Einstechversuche in the same area.
  • Using thin cannulas. Before infusion, the position of the needle by aspiration of blood and flushing should be controlled by carrier solution.
  • Frequent observation of the infusion.
  • The intravenous infusion should be the appropriate carrier solution with the correctly resolved cytostatic / products covered.
  • After intravenous infusion, the vein flush with the carrier solution.
  • Placed a central line (central venous catheter, central venous catheter ) is advantageous during infusion of vesicant drugs if the patient is suitable for a single access.

Examples of vesicant drugs

Cytostatics

  • Amsacrine
  • Dactinomycin
  • Daunorubicin
  • Docetaxel
  • Doxorubicin
  • Epirubicin
  • Idarubicin
  • Mechlorethamine
  • Mitomycin C
  • Mitoxantrone
  • Oxaliplatin
  • Paclitaxel
  • Vinblastine
  • Vincristine
  • Vindesine
  • Vinorelbine

Other drugs

  • Alcohol
  • Aminophylline
  • Chlordiazepoxide
  • Diazepam
  • Digoxin
  • Nafzillin
  • Sodium bicarbonate
  • Nitroglycerin
  • Phenytoin
  • Propylene glycol
  • Sodium thiopental
  • Tetracycline
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