An extravasation occurs when a vesicant solution is inadvertently administered into surrounding tissue instead of the vein. Signs and symptoms include pain, swelling, skin tightness, and discoloration at the IV site. Initial signs may be subtle but can progress to skin necrosis, blistering, and permanent damage if not properly managed. To manage an extravasation, the infusion must be stopped immediately, the drug withdrawn from the cannula, and the limb elevated. Further treatment depends on the drug involved and extent of damage. Proper training, assessment of competence, and documentation are important for preventing extravasation complications.

1. Management of Extravasation

2. Extravasation
• Inadvertent administration of a vesicant
solution into surrounding tissue
– Vesicant is a fluid or medication that causes the
formation of blisters, with subsequent sloughing
of tissues occurring from the tissue necrosis
• Extravasations related to:
– Puncture of the distal wall
– Mechanical friction
– Dislodgement of the catheter

4. Extravasations
• Signs and Symptoms
– Complaints of pain or burning
– Swelling proximal to or distal to the IV site
– Puffiness of the dependent part of the limb
– Skin tightness at the venipuncture site
– Blanching and coolness of the skin
– Slow or stopped infusion
– Damp or wet dressing

5. First signs are often subtle.

6. May be mild, blotchy redness, subtle swelling
or change in infusion rate.

7. Within days brawny discoloration,
indurations, dry desquamation, blistering
with discomfort and/or pain.

8. Full thickness skin necrosis that involves
underlying tendons and neurovascular
structures that leads to permanent damage.

9. Myelosuppression Infection

10. Managing Extravasation
• Stop infusion at once
• Withdraw drug
• Leave cannula insitu
• Elevate limb to reduce oedema
• Apply hot/cold pack
• Subsequent management depends upon drug
involved and degree of damage. Maybe local
extravasation policy i.e. use of antidote.

11. Preventing Complications
• Ensure staff are trained and supervised
• Supervised practice and competence assessed
• Practice continually updated
• Ensure correct preparation of patient,
equipment and environment
• Aseptic non touch technique
• Managed aftercare
• Documentation

12. Documentation
Documentation should be done at the time
of extravasation and every 4hrs until
resolution of extravasation has occurred.
• Date and time
• Type and gauge of venous access device
• Number and location of venepuncture
attempts
• Name of the drug administered
• Drug sequence

13. • Drug administration technique
• Amount of drug given. Estimate amount of
drug extravasated
• Patient complaints or statements
• Nursing management of site
• Physician notification
• Implementation of physician’s orders
• Patient education

14. • Date of return visit
• Notify pharmacy if sterility of remaining
cytotoxic drug was compromised.
• Assess patient for pain and medicate as
ordered
• Monitor site for 24-48 hrs following
extravasation and then at least weekly until
resolution
• Complete an Adverse Occurrence Report
( AORS )

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