EXTRAVASATION EXPLAINED

Medical Malpractice and Extravasation

Introduction

Extravasation is defined as the accidental leakage from the vein into the surrounding tissue. Medical professionals have a duty to safeguard their patients while administering intravenous medication. Depending on the substance that extravasates into the tissue, the degree of injury can range from a very mild skin reaction to severe necrosis.

Types of Extravasation

There are various types of extravasation that are classified according to the reaction that is caused by the substance that enters into the tissue. These drugs are normally grouped into 3 categories: non-vesicants, irritants, and vesicants. Each of these groups produces known reactions when extravasated.

Non-vesicants do not cause ulceration when extravasated.  Instead, the may cause some inflammation associated with an extravasation but there will be no tissue damage.

Irritants have the potential to cause tissue damage only when large amounts are extravasated. In most cases, irritants will cause an inflammatory response without necrosis.

Vesicants will cause blistering and tissue damage when left untreated. These drugs can cause serious tissue damage and when extravasated that can lead to severe nerve injury and loss of limb or body part.

Preventing Extravasation

As Benjamin Franklin once said: “An ounce of prevention is worth a pound of cure.” There are a number of steps that must be taken to reduce the risk of extravasation. These steps include the following: educating the patient, assessing the patient, IV device selection and insertion, dressing, and obtaining a blood return.

Healthcare professionals have a duty to educate their patients prior to IV administration. This education should include a detailed discussion of the risks of extravasation and the signs and symptoms associated with extravasation.

Healthcare professionals also have a duty to assess the patient to determine the proper IV site for that particular patient.  This assessment will include a detailed inspection of the patient’s veins and ports. Specifically, small, fragile or damaged veins should be avoided.

Healthcare professionals have a duty to correctly select and insert the proper IV device. The physician will normally determine whether a peripheral or central IV device will be used.

Healthcare professionals have a duty to obtain a blood return before administering a vesicant. The purpose of the blood return is to insure that the IV device is correctly placed and that the vesicant will enter the vein and not the surrounding tissue. The healthcare professional has a duty to follow institutional policies and to not proceed with administration of a vesicant until patency is confirmed.

When the above duties are followed, extravasation will not normally occur. However, when one or more of these duties are breached, there exists a large risk that extravasation will occur.

Management of Extravasation

Once extravasation is recognized, a quick response by the nurses and doctors is necessary to prevent further damage.  The response should include the following:

  1. Stop the infusion immediately.
  2. Disconnect the infusion.
  3. Leave the cannula/needle in place and attempt to aspirate as much of the drug as possible.
  4. Mark the affected areas and take digital images of the site.
  5. Remove the cannula or needle.
  6. If the extravasated material is a non-vesicant apply ice and elevate the limb to limit swelling. If the drug is a vesicant, use cold compresses and if feasible use an antidote to help prevent further tissue damage and consider admitting the patient and consulting a surgeon.
  7. In case of a vesicant, surgery and debridement may be necessary and follow-up with a surgeon is recommended.

Conclusion

Extravasation injuries, especially chemotherapy, can have dire consequences. If one of the required steps is not followed, we have the experience necessary to effectively protect your interests when dealing with an extravasation injury caused by medical negligence.

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