| Patient factors | Administration factors | Drug factors |
| Elderly (fragile skin/veins) | Automated syringe driver | Vasoactive drugs |
| Neonates/infants/ex-premature | Pressure bags | Hyper-osmotic agents |
| Anaesthetised or sedated | Cannula in periarticular area | Highly acidic or alkalotic drugs |
| Obese or oedematous | Into limb with prior LN clearance | Large drug volume |
| Use of scalp veins | Cannula dressed/bandaged | |
| Reduced peripheral sensation | Untrained/inexperienced personnel | |
| Impaired communication |
Extravasation Injuries
Extravasation Injuries
- Exravasation describes the inadvertent administration or leakage of fluid (medication, lymph or blood) into the subcutaneous or subdermal tissues
- It is a risk of peripheral IV drug administration, with an incidence as high as 6.5%
- There are multiple methods through which extravasated drug may cause tissue injury, and they aren't mutually exclusive:
- Vasoconstriction, leading to ischaemic necrosis
- Direct drug toxicity
- Osmotic damage
- Extrinsic mechanical compression (from large solute volumes)
- Superimposed infection
- Pain: tenderness, discomfort, paraesthesiae, burning, pain during injection
- Change to skin apperance: blanching, erythema, staining, weeping, necrosis
- Change to tissue architecture: swelling, taut skin, induration
- Leakage of fluid
- Increased resistance to injection (either manually or via infusion pump)
Immediate measures
- Stop the injection / stop and disconnect the infusion
- Aspirate as much drug as possible from the cannula
- Remove the cannula
- Mark area of extravasation ± medical photography
- Explain events to, and reassure, the patient
Subsequent measures
- Elevate limb
- Analgesia, which may include use of regional sympathetic block
- Consider non-constrictive dressings
- Cool or warm compress, depending on the drug
- Observation of the affected limb
- Inpatient - 4hrly limb observations for 72hrs
- Outpatient/day-case - 4hrs of observation, then discharge with safety netting if no worsening/changing features
- Consider plastics referral
Specific or surgical interventions
- Hyaluronidase; for all non-vasoactive agents
- For vasoconstrictors which have extravasated:
- Phentolamine subcutaneously
- Terbutaline subcutaneously
- 2% nitroglycerine applied topically
- Surgical intervention (required in 11 - 21% of cases)
- Liposuction
- Saline washout (modified Gault flush-out technique)
- Squeeze technique
- Fasciotomy if high volume extravasation and evidence of compartment syndrome
- Excision and wound debridement
- Rarely, reconstruction or amputation