[OCN] Infiltration vs Extravasation

Infiltration and extravasation are complications of intravenous (IV) therapy. 

Aspect	Infiltration	Extravasation
Definition	Leakage of non-vesicant fluid or medication into surrounding tissue.	Leakage of vesicant fluid or medication that can cause irritation or tissue damage.
Severity	Generally mild and resolves quickly.	Can lead to severe complications, including necrosis, blistering, or even amputation.
Examples of Fluids	Saline, glucose solutions (non-irritating fluids).	Chemotherapy agents, vasopressors, antibiotics like vancomycin (irritating fluids).
Symptoms	Redness, swelling, cool skin, pain, and blanching around the site.	Similar symptoms but may also include blistering, eschar formation, or necrosis.

★ infiltration vs Extravasation의 정의와 차이점, 징후 및 식별

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Signs 

Infiltration Signs

• Swelling: Puffiness around the IV site as fluid accumulates in the tissue
• Coolness: The skin around the IV site may feel cooler than surrounding areas due to fluid leakage
• Pain or Discomfort: Mild pain or tenderness near the IV site, which may worsen during infusion
• Blanching: Pale or lighter skin tone around the IV site due to pressure from swelling
• Decreased or Stopped Flow: The IV infusion may slow down or stop entirely
• Tightness: Skin around the site may feel stretched due to swelling

Extravasation Signs

• Severe Pain: Intense pain at the IV site caused by vesicant drugs irritating tissues
• Burning or Stinging Sensation: A burning or stinging feeling at the injection site
• Redness and Swelling: Rapidly spreading redness and swelling near the IV site
• Blistering or Ulceration: In severe cases, blistering or skin ulceration due to tissue damage caused by vesicants
• Change in Skin Color: Bruising, darkening, or discoloration of the skin due to necrosis
• Delayed Symptoms: Some symptoms, such as blistering or necrosis, may appear hours to weeks after extravasation

Common Symptoms for Both

• Redness around the IV site.
• Puffy or hard skin texture.
• Cool skin temperature near the site.
• Decreased functionality of the IV line (e.g., no blood return, slowed infusion)

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The management of extravasation involves several key steps:

1. Stop the infusion immediately and disconnect the IV tubing, but leave the cannula or needle in place initially
2. Attempt to aspirate as much of the extravasated drug as possible through the cannula using a syringe
3. Remove the cannula or needle after aspiration attempts
4. Mark and photograph the affected area
5. Notify the physician and oncology team
6. Administer drug-specific antidotes(※1) if indicated
7. Apply thermal compresses(※2)
8. Elevate the affected limb to reduce swelling and promote reabsorption
9. Provide pain relief as needed
10. Monitor the site regularly and document findings

※1. Antidotes

Drug/Vesicant	Antidote/Management	Application Method
Anthracyclines  (e.g., doxorubicin)	Dexrazoxane	Administer IV within 6 hours of extravasation
Vinca Alkaloids  (e.g., vincristine)	Hyaluronidase	Inject subcutaneously around the site; apply warm compress
Hyperosmolar Agents	Sodium thiosulfate	Inject subcutaneously into the affected area; dose depends on drug concentration
Vasopressors  (e.g., dopamine)	Phentolamine	Inject subcutaneously around the site; apply warm compress to promote vasodilation

 

※2. Thermal compresses

1. Cold Compress

  Purpose

    : Induces vasoconstriction, reducing blood flow to the affected area.
    Minimizes the spread of the vesicant drug into surrounding tissues through local blood vessels or the lymphatic system.
    Reduces inflammation, swelling, and pain in the acute phase.

  Application:

    Apply for 15-20 minutes at a time, with a recovery period of 30-60 minutes between applications.

    Use 4-5 times per day for 2-4 days, depending on the severity of extravasation.

    Avoid direct contact with the skin by wrapping the cold pack in a cloth.

  Indications:

    Effective for most vesicant drugs, including:

      Anthracyclines (e.g., doxorubicin, daunorubicin)

      Taxanes (e.g., docetaxel, paclitaxel)

      Alkylating agents (e.g., cisplatin, mitomycin)

 

2. Warm Compress

  Purpose:

    Promotes vasodilation, increasing blood flow to the area.

    Enhances drug dispersion and absorption into systemic circulation.

    Decreases local drug concentration and alleviates pain or tightness.

  Application:

    Apply for 20-30 minutes at a time, with a recovery period of approximately 1 hour between applications.

    Use 4-5 times per day for 2-4 days, as needed.

  Indications:

    Recommended for specific drugs that benefit from enhanced absorption:

      Vinca alkaloids (e.g., vincristine, vinblastine)

      Etoposide

      Oxaliplatin (to reduce neurotoxicity and inflammation)

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Prevention strategies include:

• Familiarizing staff with extravasation management guidelines
• Regularly checking and restocking extravasation kits
• Assessing patients for sensory changes or discomfort
• Using appropriate vein selection and secure IV lines
• Providing ongoing education for the medical team