Extravasation injuries

Learning objectives

The unintentional injection or leakage of fluid in the perivascular or subcutaneous space
Resulting from solution cytotoxicity, osmolality, vasoconstrictor properties, infusion pressure, and regional anatomical peculiarities
May cause significant tissue necrosis resulting in the amputation of an extremity

Propofol, ondansetron, rocuronium, and cyclizine can all cause discomfort or pain on injection
Venous spasms may occur and can lead to localized skin blanching

Avoid IVs in the hand/wrist as the most appropriate site is considered to be the forearm
Careful insertion of peripheral venous catheters
Flush catheter with sterile saline
Apply a suitable dressing to prevent movement of the catheter and avoid unreassuring IVs
Inspect the catheterization site regularly
Regulated delivery of intravenous fluids from continuous infusion pumps
Hyperosmolar fluids, acidic or alkaline solutions, or infusates with irritant or vesicant properties should be given through central venous lines, if possible, or should be diluted or neutralized
For slow infusion of high-risk drugs, a central line or peripherally inserted central catheter (PICC) line should be used
Keep antidotes and the worksheet in the room with the patient
10 mg of phentolamine mesylate can be added to each liter of solution containing norepinephrine (the vasopressor effect of norepinephrine is not affected)