ABSTRACT
Extravasation—the infiltration of a vesicant drug from an I.V. line into surrounding tissue—can occur with either a peripheral or central venous catheter. This article describes prevention and management of extravasation from a peripheral catheter.Extravasation occurs when a peripheral catheter erodes through the vessel wall at a second point, when increased venous pressure causes leakage around the original venipuncture site, or when a needle pulls out of the vein. Signs and symptoms of extravasation include edema and changes in the site's appearance and temperature, such as blanching and coolness. The patient may complain of pain or a feeling of tightness around the site.Vesicant drugs or solutions (such as certain antineoplastic drugs, antibiotics, electrolytes, antiemetics such as promethazine, and vasopressors) cause severe tissue injury or destruction when they extravasate. Possible consequences include necrotic ulcers requiring surgical debridement and skin grafting, infection, disfigurement, complex regional pain syndrome, and loss of function.Although short and midline peripheral catheters aren't recommended for continuous infusion of vesicants, they may be appropriate for a medication dose given by slow injection. Adhere strictly to proper administration techniques and follow these guidelines: * Know your hospital's policy on the use of antidotes for vesicants. For example, is a kit packaged with all needed supplies available or will you need to collect items individually? * Make sure you know the antidote and other recommended treatment for the vesicant drug you're giving. * Ensure that the drug has been properly diluted before injection or infusion. Dilution reduces the amount of vesicant that will reach subcutaneous tissue if extravasation occurs. It also helps you detect edema or complaints of pain before the entire dose is administered. * Select a small-gauge catheter to minimize trauma to the vein and let enough blood flow around
