Reducing the morbidity from extravasation injuries

Extravasation is defined as the leakage of solutions from the vein. This may cause damage to surrounding tissue during intravenous fluid administration. Extravasation has an incidence of 5% of all cytotoxic drug administrations. In the authors' hospital, a protocol has been set up using the dilution flush-out technique. Extravasation packs containing cannulae, normal saline, hyaluronidase, and instructions on how to manage extravasation injuries, accompanied by an audit sheet to assist follow-up, have been introduced to allow the treatment of extravasation at the ward level in an attempt to reduce morbidity from the injury. Between December 1997 and December 1999, 18 adult patients were identified with extravasation injuries after the administration of cytotoxic medication. Seventeen were treated immediately according to the protocol. One, however, was not. Patients were followed-up for 6 months after injury. The 17 patients treated immediately needed no further surgical intervention, whereas the 1 patient not treated needed a split skin graft to cover the defect. The authors recommend the placement of "extravasation packs" on all wards where cytotoxic drugs are prescribed and that all staff members are familiar with this regime. These steps help to reduce the morbidity of a potentially damaging injury.