![]() ![]() Do not insert the cannula in the antecubital fossa area, where it is extremely difficult to detect extravasation. Do not insert the cannula in the joints because it is difficult to secure, and neural damage and tendon injury can be caused if extravasation occurs due to vesicant drugs. Preventive strategies: peripheral venous access device extravasation Assess patient’s sensory changes, tingling or burning, and always pay attention to the words of patients. Extravasation kit includes the following: 25G needle, 10-cc syringe, and 1-mL syringe disinfection swabs, sterile gauze, and adhesive bandage saline solution (1 ampule) sterile distilled water (1 ampule) dimethyl sulfoxide 99% solution hyaluronidase 1,500 U/mL (refrigerated) hydrocortisone cream 1% sodium thiosulfate 25% solution and warm pack and an ice pack (frozen). Regularly check the extravasation kit and refill any used medications. Be familiar with the extravasation management standard guidelines and prepare the extravasation kit. It is important to remember that the degree of damage is dependent on the type of the drug, the drug concentration, the localization of the extravasation, and the length of time for which the drug develops its potential for damage. ![]() The staff involved in the infusion and management of cytotoxic drugs must be trained to implement several preventive protocols for the minimization of the risk of extravasation. Most extravasations can be prevented with the systematic implementation of careful, standardized, and evidence-based administration techniques. It is anticipated that these guidelines would help health professionals to prevent extravasation during IV and central vein injection and to promote patient safety should extravasation occur in any case. These contents are derived from authors’ experiences and the references. Antidotes, special drug management, drugs with high osmolarity, and drugs with pH are provided as supplement files ( Supplements 1– 4). These guidelines consist of following topics: basic knowledge about extravasation, extravasation management, and extravasation prevention. ![]() The second purpose is to raise the medical team’s awareness of extravasation in order to prevent extravasation with careful injection, recover patient trust, and increase patient satisfaction. The primary purpose of these guidelines is to minimize the side-effects of IV injection, by suggesting proper and prompt emergency measures for extravasation and the appropriate treatments corresponding to the properties of the injected drug. To prevent extravasation, a clinical specialist should perform the venipuncture or injection, who with relevant skills and management ability understands the properties of the injected drug. In severe cases, extravasation may cause tissue dysfunction or physical defects, resulting in a delay of attempted treatment, patients’ distrust, and numerous other issues. Common symptoms and signs of extravasation include pain, stinging or burning sensations, and edema around the intravenous (IV) injection site. With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement.Įxtravasation refers to the leakage of injected drugs from blood vessels causing damage to the surrounding tissues. The medical team’s continuous education on extravasation is essential. ![]() They should regularly check the extravasation kit, assess patients’ sensory changes, tingling or burning, and always pay attention to patients’ words. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Management of extravasation includes nursing intervention and thermal application. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. The purpose of these practice guidelines is to offer and share strategies for preventing extravasation and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled experts at intravenous (IV) injection. ![]()
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