extravasatio

Extravasation, from the Latin extravasare, meaning to gush out, is the unintended leakage of intravenous fluids from a vessel into surrounding tissue. While any IV fluid can extravasate, the term is most commonly used for vesicant or irritant drugs such as anthracycline chemotherapies, vinca alkaloids, platinum agents, and certain vasopressors, antibiotics, or parenteral nutrition.

Pathophysiology: leakage causes local tissue injury via chemical irritation, osmotic effects, and in some cases direct cytotoxic effects, leading to pain, edema, inflammation, blistering, necrosis.

Clinical features: sudden pain at infusion site, burning, swelling, blanching; early signs include redness, warmth; progression to blistering or skin necrosis may occur hours to days after.

Management: immediately stop the infusion and leave the cannula in place to aspirate residual drug if possible; do not remove if risk of dislodging; attempt to aspirate drug; administer antidotes for specific agents: dexrazoxane within hours for doxorubicin/epirubicin; hyaluronidase injections around the area to facilitate dispersion; apply cold compress for certain agents to limit spread; warm compress or elevation depending on agent; document and monitor; consult plastic surgery if necrosis; consider imaging.

Prevention: avoid vesicants through central venous access for high-risk drugs; ensure proper needle placement, securement, and patency; use infusion pumps; monitor infusion sites frequently; rotate sites; educate patient.