Extravasation BY TAIQUITA ARDAN, RAÚL CARDONA, CLARA DALTON, AND JULIE TEEGARDEN

Introduction

Extravasation:

The inadvertent administration of a vesicant solution or medication into surrounding tissue.

Learner Goals:

Identification, treatment, and prevention of extravasation of medications.

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Objectives

Identify medications that can cause extravasation.

Identify predisposing factors to extravasation.

Identify signs and symptoms of extravasation.

Understand the treatment and management of extravasation.

Recognize ways to prevention extravasation.

Significance of Topic to Critical Care

Patients in critical care units are extremely unstable and any complication can have major consequences.

Critical care patients have many of the risk factors associated with extravasation.

Many of the medications used in critical care can cause extravasation injuries.

Critical care patients typically have many IV lines.

Medications Implicated in Extravasation

Cytotoxic medications

Electrolyte solutions

Calcium chloride, Calcium gluconate, Parenteral nutrition, Potassium chloride, Sodium bicarbonate, Sodium chloride > 0.9%.

Vasopressors

Dobutamine, Dopamine, Epinephrine, Norepinephrine.

Anti-infectives

Vancomycin.

Miscellaneous

Contrast media, Diazepam, Digoxin, Mannitol, Phenytoin.

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Factors Associated with Extravasation

Catheter-Specific Factors.

Physiologic Factors.

Pharmacologic Factors.

Patient-Specific Risk Factors.

Nurse-Specific Factors.

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Signs and Symptoms of Extravasation

Pain.

Redness.

Swelling.

Blood Return.

Ulceration.

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asation-injury-26.jpg

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Treatment of Extravasation

Stop the injection or infusion

Remove the IV

Notify the medical staff

Elevate the extremity for 48 hours

Depending on medication

Apply warm or cold pack

Administer hyaluronidase or phentolamine

Document

Monitor

Nursing Research

Errors in high-risk intravenous injections administered by nurses: The causes according to healthcare professionals (Kim & Seomun, 2014).

Aim:

To identify the causes and problems of errors in the administration of IV meds.

Methods:

Qualitative study involving 13 participants divided into three focus groups.

Interviews were transcribed, analyzed, and organized in topics and subtopics.

Nursing Research

Results:

3 categories emerged from the data concerning causes of IV administration errors:

human-related factors

injection procedure-related

environmental factors

One of the main things needed to avoid extravasation is simple awareness.

This is even more important in the critical care setting where serious complications are more likely to result.

Nursing Research

Increasing nurse competence in peripheral intravenous therapy (Woody & Davis, 2013).

Aim:

To identify complications associated with extravasation and evaluate the impact of incidents on a medical/surgical unit.

Methods:

Determine methods of documentation.

Reviewing how nursing competency is assessed.

Creation of a pretest and post-test, and educational module

Collecting info from pretest and post-test

Nursing Research

Number of reported cases before education were compared with number of cases after.

35 participants.

Results:

Pretest scores had a mean of 12.77, post-test had a mean of 13.29 (no significant difference).

The number of incidents over a three month period pre-intervention was compared with three-month period post-intervention, and indicated a 50% decrease in rates of extravasation.

Significance is that it shows the importance of reeducation of core competencies.

Conclusion

Discussed medications that can cause extravasation.

Identified factors that predispose patients to extravasation.

Discussed how to identify signs and symptoms of extravasation.

Described the treatment and management extravasation.

Discussed how to prevent extravasation.

Evaluation of Objectives: Post Test

Which one of these medications does not cause extravasation?

A. Potassium chloride

B. Calcium gluconate

C. Epinephrine

D. Vancomycin

E. Lasix

Evaluation of Objectives: Post Test

True or False

Patient’s risk factors include…

Age

Obesity

Underlying chronic disease (diabetes)

Condition of veins

Impairment in communication

History of multiple venipunctures

Evaluation of Objectives: Post Test

Which sign or symptoms are not classified as delayed manifestations of extravasation? Select all that apply.

A. Swelling

B. Inability to obtain blood return

C. Ulceration

D. Severe stinging or burning pain

E. Local tingling and sensory deficits

Evaluation of Objectives: Post Test

You suspect your patient has extravasation, which action do you perform first.

A. Call the physician

B. Administer 1,500 units hyaluronidase

C. Stop intravenous infusion

D. Apply hot or cold pack

References

Coyle, C. E., Griffie, J., & Czaplewski, L. M. (2014). Eliminating Extravasation Events: A Multidisciplinary Approach. Journal of Infusion Nursing, 37(3), 157-164.

Doellman, D., Hadaway, L., Bowe-Geddes, L. A., Franklin, M., LeDonne, J., Papke-O'Donnell, L. ... & Stranz, M. (2009). Infiltration and extravasation: update on prevention and management. Journal of Infusion Nursing, 32(4), 203-211.

Dougherty, L. (2010). Extravasation: prevention, recognition and management. Nursing Standard, 24(52), 48-55.

Dychter, S. S., Gold, D. A., Carson, D., & Haller, M. (2012). Intravenous therapy: A review of complications and economic considerations of peripheral access. Journal of Infusion Nursing, 35(2), 84-91.

References

Groll, D., Davies, B., Mac Donald, J., Nelson, S., & Virani, T. (2010). Evaluation of the psychometric properties of the phlebitis and infiltration scales for the assessment of complications of peripheral vascular access devices. Journal of Infusion Nursing, 33(6), 385-390.

Kim, M., & Seomun, G. (2014). Errors in high-risk intravenous injections administered by nurses: The causes according to healthcare professionals. Health Science Journal, 8(2), 249-261.

Martin, S. M. (2013). Extravasation Management of Non-chemotherapeutic Medications. Journal Of Infusion Nursing, 36(6), 392-396. doi:10.1097/NAN.0000000000000010

Woody, G., & Davis, B. A. (2013). Increasing Nurse Competence in Peripheral Intravenous Therapy. Journal Of Infusion Nursing, 36(6), 413-419. doi:10.1097/NAN.0000000000000013