Overview of extravasation management and possibilities for risk reduction based on literature data

Background: The escape of cytostatic drugs from the blood vessels (paravasation, extravasation) during peripheral intravenous administration is a relatively frequent complication; in the United States of America it is reported in seven percent of cases with different severity and consequences. Although methods to completely avoid this complication are still unavailable, we are able to decrease its risk by identifying the patient and procedure-related factors. Methods: In this article the risk factors of extravasation, its prevention possibilities and in case of its development the available treatment choices will be reviewed based on the relevant literature data. Conclusion: The patient - if he/she was adequately informed - is a good indicator of extravasation therefore in case of patient’s cooperation was not reliable due to any reason a closer nursing surveillance is required. The severity of tissue injury depends mainly on the chemical structure of the substance escaping from the blood vessels into the surrounding tissues (vesicant, irritant or non-vesicant) which may be modified by other factors as well. There are no high-level evidences available for the management of this complication, immediate discontinuation of the infusion and making an attempt to draw back the escaped drug through the cannula, elevation and immobilization of the affected extremity are required. Literature is contradictory about cooling or warming of the affected area and similarly there are still open questions regarding the value of using antidotes (dexrazoxane, dimethylsulfoxide, thiosulfate and hyaluronidase). If extravasation occurs early referral to dermatologist and surgeon is inevitable for definitive diagnosis and choosing the optimal management.