extravasations

Extravasation refers to the leakage of intravenously administered fluids or drugs into surrounding tissue. When the leaked material is a vesicant or irritant capable of causing tissue injury, the event is called a vesicant extravasation or simply extravasation. Infiltration, by contrast, generally refers to leakage of nonvesicant IV fluids without significant tissue damage.

Causes and setting: Extravasation most commonly occurs with peripheral venous access during chemotherapy, vasopressor infusions, or administration of hyperosmolar or irritant solutions. Vesicant chemotherapy drugs such as anthracyclines (for example doxorubicin), vinca alkaloids (vincristine), and platinum agents, as well as certain biologic agents and iron preparations, carry higher risk. Central venous lines reduce risk but do not eliminate it. Prevention relies on correct catheter placement, patency checks, securement, and careful monitoring.

Clinical features and diagnosis: Early signs include sudden pain, burning, swelling, redness, and tenderness near the infusion site, sometimes with blanching or tight sensation. If the infusate is highly damaging, blistering or necrosis may develop over hours to days. Diagnosis is clinical, supported by observation of infusion resistance or extravasation on imaging if indicated.

Management: Stop the infusion promptly, leave the cannula in place if it can be safely aspirated, and attempt to remove residual drug by gentle aspiration. Elevate the limb and apply appropriate topical measures (cold or warm compress depending on agent). Follow institution-specific guidelines; antidotes may be used for certain drugs (for example dexrazoxane for anthracyclines, and hyaluronidase injections to facilitate dispersion for some extravasations). Severe injury requires burn service or surgical evaluation.

Prevention and prognosis: Ongoing staff training, vigilant monitoring, and appropriate IV access reduce risk. Most mild extravasations heal with local wound care, but significant injuries can cause lasting necrosis, scarring, or functional impairment and may require surgical management.