Any time a drug is infused through an intravascular catheter there is some risk of extravasation of the infusate. For many drugs this may cause minor symptoms, but chemotherapeutic agents can cause significant morbidity. Recognition of risk factors for significant extravasation injury can help identify those patients who require closer monitoring and more aggressive therapy.
Early signs of extravasation:
(1) pain
(2) swelling
Late signs of extravasation injury:
(1) tissue necrosis
(2) skin ulceration
(3) damage to adjacent joints and tendons
Risk factors associated with increased drug extravasation:
(1) multiple venipunctures
(2) difficulty with the venipuncture, with more than 1 attempt
(3) infusion distal to the site of a recent venipuncture
(4) limited number of phlebotomy sites requiring repeat use of sites
(5) lymphedema
(6) generalized debility
(7) laxity of soft tissue around vessels or venous fragility
(8) use of rigid, large bore needles
(9) delivery of fluid under pressure
Risk factors associated with significant extravasation injury:
(1) drugs with significant vesicant activity (blistering agents) or vasoconstrictive activity
(2) hyperosmolar solution
(3) higher drug concentrations
(4) large volume of extravasated fluid
(5) failure to recognize early and treat promptly
(6) patient unable to report symptoms (small child, coma, sedation, general anesthesia)
(7) infusion into dorsum of hand, over the flexor surface of the wrist and the antecubital fossa
