- 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
- 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