When a healthcare professional administers a drug through a venous cannula, there is a small risk of the solution leaking out of the veins and into the surrounding tissue.
If the medication is a vesicant drug — meaning that it has the potential to cause tissue damage through blistering and ulceration — doctors call this complication extravasation. Vesicants include several chemotherapy drugs.
Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the intravenous (IV) line.
The symptoms of extravasation include a painful stinging or burning sensation, swelling, and skin discoloration.
Read on to learn more about extravasation, its causes, and how doctors treat it.
The severity of extravasation depends on how much medication has entered the surrounding tissue and how strongly the tissue reacts to the medication. Very severe cases of extravasation could result in the loss of limb tissue or function.
Doctors use four grades to indicate the severity of extravasation.
Grade one is a mild case of extravasation, and the symptoms include:
Grade two is more serious than grade one and involves additional symptoms, such as:
If a person is showing signs of grade three extravasation, they should call a doctor or nurse immediately.
Symptoms include:
Pallor can be difficult to detect in dark skin, so healthcare professionals may check the eyes, palms, and nail beds for signs of discoloration.
A person should alert the medical team immediately if they notice the following symptoms:
At this stage, a person could also show signs of tissue death and loss.
The difference between extravasation and infiltration is the type of solution that leaks into nearby tissue. Vesicant drugs are those that can cause tissue death, whereas non-vesicant drugs do not have this effect.
Extravasation occurs when a vesicant drug leaks out of the vein and into the surrounding tissue. When this happens, a person will likely experience serious tissue damage, including ulceration and tissue death, if they do not receive treatment in time.
This complication arises when a non-vesicant drug seeps out of the vein into nearby tissue. Infiltration can cause symptoms and signs in the affected area, but if damage occurs, it is typically less severe than it would be with extravasation. For example, a person will not experience ulcers, blisters, and tissue death.
Extravasation occurs in 0.1–6.0% of adults. However, improvements in infusion techniques and a higher awareness among healthcare professionals of the early signs of extravasation are causing the rate to decrease.
Extravasation has many possible causes, including:
It is important that the person receiving the medication or their medical team notice the signs and symptoms of extravasation early to prevent permanent tissue and limb damage.
Some general signs and symptoms of extravasation include:
Skin that starts to discolor significantly and becomes cold to the touch indicates severe tissue damage.
Doctors diagnose extravasation by examining and inspecting the skin area around the cannula. If they suspect extravasation, they will stop the drug infusion and elevate the limb. Doing this as soon as possible should prevent serious complications from developing and stop the extravasation from escalating to a higher grade.
The medical team will continue to monitor the skin for 24 hours after stopping the infusion to check for signs of infection. The extravasation grade diagnosis will determine the treatment that the person receives. Grades three and four will require more intensive treatments than grades one and two.
As soon a doctor or nurse suspects extravasation, they will:
The healthcare team will continue to monitor the person and may take photographs to document the healing process.
Depending on the type of drug that has leaked into the tissue, doctors may warm or cool the affected area to stop the drug from spreading.
Healthcare professionals should implement standardized, evidenced-based techniques when inserting cannulas to minimize the risk of extravasation.
Other preventive strategies include:
A person should get medical help if they are experiencing pain and swelling where the cannula enters the skin. They should not wait until their symptoms get worse, as the sooner doctors treat extravasation, the better the outcome.
If healthcare teams do not treat extravasation in time, a person may experience serious complications, which can include tissue death and a loss of limb function.
Extravasation occurs when IV medications, which can destroy tissue, seep out of veins and into the surrounding skin and muscle.
Grade one is the least severe form of extravasation, and if a person receives treatment at this stage, the risk of permanent tissue damage is small.
Grade four is the most severe form, and a person could lose limb function or the affected part of the limb itself if the medication has spread from the infusion site to other areas.
As soon as a person experiences any pain or swelling at the infusion site, they should let their healthcare team know.
The sooner a person receives treatment, the greater their chance of making a full recovery with no lasting tissue damage.
Last medically reviewed on June 29, 2021
OUR BRANDS
