• Extravasation injuries
    • Risk factors
      • Elderly, fragile veins
      • Neonates
      • Vein thrombosis
      • Obesity - detection difficult
      • Concurrent disease may mask pain eg raynauds, DM
      • Administration
        • Pumps can continue to infuse to peri vascular tissues
        • Pressure bags
        • CVC exit ports may be too proximal
        • High concentration drugs
        • High volume can cause compression
    • Minimising risks
      • Place your own cannulae
      • Avoid ACF
      • Direct vision
      • Aspirate central lines
    • Pathophysiology
      • Vasoconstriction and ischaemic necrosis
      • Direct toxicity
      • Osmotic damage
      • Extrinsic mechanical compession
      • Superimposed infection
    • Drugs
      • Amiodarone
      • Phenytoin
      • Thiopental
      • KCl
      • NA, vasopressin
    • Management IA
      • Recognition due to pain, pallor, cyanosis , hyperaemia
      • Anticoagulation with heparin
      • Inject LA
      • Sympatholysis
      • Iloprost
      • IV papaverine
    • Pathophysiology IA
      • Arterial spasm
      • Direct tissue destruction
      • Arteritis
      • Release of thromboxane
      • Drug precipitation
    • Intra-arterial drug injection
      • Pain on injection is common
      • Obese and dark skin pigmentation at risk
      • Hypotensive patients
      • Sedated patient
    • Management or Extravasation
      • Stop injection
      • Aspirate via the cannula if possible
      • Leave cannula in place
      • Elevate limb
      • Saline washout via incisions around the extravasated site
      • Liposuction
      • Steroids
        • Little evidence
      • Hyaluronidase
        • 1500 units in 2ml saline injected into the area
      • Phentolamine
        • 5-10mg in 10ml saline injected subQ
      • Regional sympathetic blockade
      • Documentation and follow-up
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/9/2/39.full.pdf