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Extravasation of Drug from Central Intravascular Catheter | Risk for Chemical Mediastinitis

Purpose: To determine if a patient receiving a drug infusion by a central intravascular catheter is at risk for chemical mediastinitis.

Description

Some drugs are administered by a central vascular catheter to reduce local irritation and toxic reactions. If the drugs should leak from the central catheter then injuries such as chemical mediastinitis may occur. Certain factors can help identify a patient at risk for this infrequent but potentially serious complication.


Risk factors associated with the central line that can increase the risk of extravasation:

(1) thrombosis about the catheter or a fibrin sheath about the tip (manifested by difficulty in withdrawing blood from the catheter)

(2) difficulty in catheter placement, especially by an inexperienced operator

(3) migration of the catheter tip

(4) difficulty infusing through the line

 

Risk factors associated with an extravasated drug causing adjacent tissue damage:

(1) vesicant (blistering, irritating) nature of the drug

(2) concentration of the drug in the infusate

(3) volume extravasated

 

If there is any doubt about the placement or patency of a central catheter then a radiologic contrast study should be performed to visualize the catheter location and to determine if there is leakage into adjacent soft tissue.


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Specialty

Objective

ICD-10