Evidenced-based

Presented by: Adeline Tapia

Extravasation
- leakage of a drug or solution from a vein into the extravascular space. Early signs and symptoms suggesting extravasation are persistent pain, burning, stinging, and erythema at the injection site or along the .course of the vein

Non-pharmacologic interventions
Stop the intravenous push or infusion immediately if the patient admits to a .burning sensation or complains of pain The catheter or needles should not be removed immediately, but should be left in place to attempt aspiration of fluid from the extravasated area. Aspiration of the drug and surrounding fluid should be attempted with three to five milliliters (mL) of .blood .Remove the needle .Elevate the affected limb to minimize swelling Apply warm or cold compresses as indicated. This decision is usually based on .physician preference and the type of drug extravasated
In general, cold compression is recommended for extravasation of all vesicant or irritant drugs, EXCEPT the vinca alkaloids (vincristine, vinblastine, vinorelbine) and epipodophyllotoxins (etoposide), as cold worsens tissue ulceration caused by these .drugs Cold compresses should be applied for 20 minutes three or four times daily for the first 48 to 72 hours after extravasation occurs. Cold compresses cause vasoconstriction resulting .in diminished spread of the extravasate. It also reduces local inflammation and pain Hot compresses are sometimes preferred for specific drug extravasation (i.e. vinca .alkaloids) to increase local blood flow and enhance drug removal

Debridement and excision of necrotic tissue should be considered if pain .continues for 1-2 weeks

Antidote administration for extravasations

the goal of antidote administration is to reverse the action of the extravasated agent, interfere with process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage. The efficacy of antidotes has been evaluated primarily from animal studies or reported ;anecdotally based on human experience

Sodium thiosulfate. This is an accepted antidote for mechlorethamine (nitrogen mustard) extravasation. Sodium thiosulfate 1/6 molar (0.16 M) solution, injected subcutaneously, is the only antidote currently recommended by the Oncology Nursing Society for extravasation of mechlorethamine. The recommendations are based largely on in-vitro data demonstrating a chemically neutralizing interaction of thiosulfate with mechlorethamine, and in animal data demonstrating the ability of thiosulfate to .inactivate mechlorethamine

Hyaluronidase. This agent is an enzyme that degrades hyaluronic acid. It modifies connective tissue permeability and enhances drug resorption from subcutaneous tissues. Animal and human studies supported the efficacy of hyaluronidase as an antidote of .extravasation from vinca alkaloids

Dimethyl sulfoxide (DMSO) is believed to exert its antioxidant action via free radical scavenging, causing potent vasodilation, pain reduction, anti-inflammatory action, and stabilization of the cell membrane. Topical application of DMSO may be effective against anthracycline-induced tissue damage because of its ability to scavenge anthracycline-generated free radicals. Various applications have been used with DMSO concentrations of 50% to 99% solutions applied topically every 3, 4, 6, or 8 hours for 7 to 14 days. The side effects of topical DMSO are mild, including mild burning .and skin scaling, and unpleasant garlic-like odor

Carboplatin

Cold

Sodium thiosulfate 0.16 M :Primary solution; Inject 5 mL into the extravasation sitea Dimethylsulfoxide : Alternative (DMSO) 99% solution. Apply 4 drops/10 square centimeter of skin surface. Apply topically over area twice the size of that affected, every 8

.hours for 7 days. Allow to air dry Cisplatin Cold

. :Primary