Extravasation of Noncytotoxic Drugs
- 8 April 2014
- journal article
- review article
- Published by SAGE Publications in Annals of Pharmacotherapy
- Vol. 48 (7), 870-886
- https://doi.org/10.1177/1060028014527820
Abstract
Objective: Extravasation is a potential complication associated with intravenous therapy administration. Inadvertent leakage of medications with vesicant properties can cause severe tissue necrosis, which can lead to devastating long-term consequences. Recognizing potential agents is an essential step in mitigating the risk of extravasation. Data Source: A literature search was carried out using PubMed with the following key words: extravasation, soft tissue injury, phlebitis, and infiltration, from January 1961 through January 2014. Study Selection and Data Extraction: The publications were screened manually and reviewed to identify reports for medications that included synonyms of the International Nonproprietary Name, while excluding antineoplastic agents, radiographic contrast material, investigational or nonmarketed drugs, and animal data, to yield 70 articles. Furthermore, reference citations from publications were also reviewed for relevance and yielded 4 articles. Data Synthesis: We discovered 232 cases of extravasation involving 37 agents (in order of frequency): phenytoin, parenteral nutrition, calcium gluconate, potassium chloride, calcium chloride, dopamine, dextrose solutions, epinephrine, sodium bicarbonate, nafcillin, propofol, norepinephrine, mannitol, arginine, promethazine, vancomycin, tetracycline, dobutamine, vasopressin, sodium thiopental, acyclovir, amphotericin, ampicillin, cloxacillin, gentamicin, metronidazole, oxacillin, penicillin, amiodarone, albumin, furosemide, lipids, lorazepam, immunoglobulin, morphine, and sodium valproate. Potential properties contributing to extravasation include the following: pH, osmolarity, diluent, vasoactive properties, and inactive ingredients. Antidotes and supportive care agents used in the management of these cases of extravasation include hyaluronidase, phentolamine, terbutaline, topical anesthetics (such as lidocaine and prilocaine cream), topical antimicrobials (such as silver sulfadiazine and chlorhexidine), topical debridement agents (collagenase ointment), topical steroids, and topical vasodilators (nitroglycerin). Conclusion: Data on the management of noncytotoxic extravasations is sparse, consisting primarily of case reports and anecdotal evidence. Fortunately, this adverse outcome is preventable and identification of vesicant agents plays a pivotal role. The intent of this review is to provide a reference identifying noncytotoxic vesicants and the management of extravasations associated with specific agents.Keywords
This publication has 84 references indexed in Scilit:
- Chemical Burn Secondary to Propofol ExtravasationWestern Journal of Emergency Medicine, 2012
- Extravasation injury due to dopamine infusion leading to dermal necrosis and gangreneJournal of Anaesthesiology Clinical Pharmacology, 2012
- Propofol extravasation and tissue necrosisIndian Journal of Dermatology, 2012
- Arginine extravasation leading to skin necrosisJournal of Paediatrics and Child Health, 2011
- Severe local vancomycin induced skin necrosisBritish Journal of Clinical Pharmacology, 2007
- Images in emergency medicineAnnals of Emergency Medicine, 2006
- Amiodarone induced skin necrosisHeart, 2006
- Necrosis of the hand after extravasation of intravenously administered phenytoinJournal of the American Academy of Dermatology, 1993
- Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neonatesThe Journal of Pediatrics, 1992
- Clinical and pharmacokinetic evaluation of nafcillin in infants and childrenThe Journal of Pediatrics, 1978