Highlights
- Extravasation is the inadvertent administration or leakage of blood, lymph or other fluid (including medication) into the subcutaneous or subdermal tissues, instead of the intended vascular or lymphatic pathways (View Highlight)
(View Highlight)- A high risk of ensuing tissue injury exists in the following scenarios:
(1) Vesicant drug extravasation (any volume)
(2) Moderate (or greater) volume of irritant drug extravasation (≥5 ml)
(3) Grade 3 to 4 severity (any agent)
(4) High volume (>50 ml; smaller volume in young children) and suspicion of compartment syndrome (any agent) (View Highlight)
- The cool compress is used to ‘localise and neutralise’ (limiting drug dispersion and damage of adjacent tissue), whilst the warm compress is used to ‘dilute and disperse’ (aiding dispersion and decreasing drug accumulation in the local tissue) (View Highlight)
- Subcutaneous hyaluronidase is a suitable antidote for all non-vasoactive agents, where a ‘dilute and disperse’ approach is indicated. It enzymatically increases tissue permeability, which facilitates diffusion and systemic absorption (View Highlight)
- specific antidotes for vasoconstrictor agents include topical nitroglycerine 2% ointment, subcutaneous phentolamine and subcutaneous terbutaline. Each of these vasodilator agents may reduce tissue ischaemia and necrotic injury (View Highlight)