Extravasation: Causes, Symptoms, Treatment, Diagnosis

Extravasation is a process through which a liquid, maybe a drug or a fluid leak into a surrounding tissue accidentally. In case of inflammation, it indicates white blood cells (WBC) movements from capillaries to tissues, also called diapedesis. In malignant cancer metastasis, the term is used to mean involuntary permeation of chemotherapy into the subdermal or subcutaneous tissues apart from the targeted inter-arterial or intravenous areas of the body. In the most common medical contexts, extravasation refers to leakage of blood, lymph, urine or other natural fluids in the body. That is to say, the term “Extravasation” possesses contextual meanings depending on the illnesses and their treatment procedures.

The early symptoms of extravasation include the following:

• Swelling, pain, erythema, and blistering. These signs may be absent initially if the drug leaks into the tissue slowly after completion of the drug administration.
• Shoulder pain.

The late effects of extravasation are:

• Marked induration that may last between days to months
• Invasive ulceration
• Long-term pain, dystrophy, contractures, and loss of function of the limb.

The extravasation agents cause two kinds of the local reactions: irritant and the vesicant reactions. An irritant reaction happens as temporary phlebitis. However, the extravasation of the vesicant drugs like the anthracyclines can cause reactions that can include damage to the progressive tissue, which may progress during the days and the weeks.

Patients must be told to report to the physician regarding any changes in symptoms or sensation at the time of administration of any drug and also to intimate the healthcare professional regarding the early signs of this medical condition. This disease can be suspected if any of the above-mentioned symptoms are there. The symptoms may vary from burning, swelling to blistering and ulceration. When extravasation is suspected by a physician, cannula should not be removed instantly and the general measures should be started immediately. Differential diagnosis must be carried out. Some of the chemotherapy drugs, when administered correctly, can result in a local reaction resembling the extravasation. However, this should not be confused with extravasation. Another differential diagnosis of this condition is chemical phlebitis. This is the inflammation of the veins followed by thrombosis of veins, which causes a burning sensation at cannula. Chemical phlebitis is caused by many drugs.

Immediate treatment measures include a prompt intervention when the extravasation is suspected. Leakage of bodily fluids and drugs may also take place due to other reasons as well like infiltration. As such, extravasation and infiltration are two different occurrences.

Firstly, the infusion must be discontinued and thereafter the residual drug must be aspirated without applying any pressure on the injection site, the venous device must be removed, the saline flush must not be used, local cooling may be applied, and the extremity may be elevated. The extravasation site should be marked along with the estimation of the volume. So far there are no uniform guidelines for the treatment of this medical condition. Some of the hospitals have framed their own guidelines for managing this adverse situation. Single and combined cooling application and use of corticosteroids are the commonly used treatment approaches. When this medical condition is managed through the conventional techniques, its outcome is poor and many patients experience serious sequelae. Surgery can be effective if it is performed at the right time, however, anthracyclines can stay between weeks to months in the lesion and so the surgical procedure may be extensive and this may lead to huge defects requiring skin grafting.

Most of the extravasations may be prevented using the systematic implementation and careful I.V administration techniques. Chemotherapy must be given by the trained personnel and during the infusion process, the patient must be observed thoroughly. Patients must notify the healthcare professional in case of pain, burning, and any unusual sensations experienced. The butterfly needles must be avoided while administering the vesicant agents. Before the infusion, it is mandatory to aspirate the blood along with flushing with saline. This process must be repeated after the infusion period. CVCs may reduce the extravasation though they are related to the additional problems.

Treatment is decided by the extravasation stage, availability of the specific antidotes, and nature of infiltrating solution. Regarding the infiltration, intravenous infusion must be stopped instantly and the constricting tapes must be removed. Treatment protocols may vary from being conservative to aggressive treatment with variations in the wound management. No standard treatment is prescribed for the extravasation injury in the acute phase. Once the medical condition is detected, emergency management should be done. The infusion may be stopped and intravenous canal may be aspirated.

Information regarding management and follow-up of the extravasation is rare. For initiating the proper follow-up, the clinicians must be aware that the early symptoms and signs of the disease are subtle and not evident always. However, later on, the inflammation enhances causing more redness, pain, and edema. It is highly recommended that the patient should be reviewed on a regular basis.