Prevention or Minimisation of the Problems of Extravasation

The position, size and age of the venepuncture site are the factors which have greatest bearing on the likelihood of problems occurring. However, if the following points are borne in mind, the likelihood of extravasation can be significantly reduced.

  • For slow infusion of high-risk drugs, a central line or drum catheter should be used
  • To ensure patency of a peripheral IV site, it is best to administer cytotoxics through a recently-sited cannula. Site the cannula so it cannot become dislodged; use the forearm and avoid, if possible, sites near joints.
  • Administer vesicants by slow IV push into the side-arm port of a fast-running IV infusion of compatible solution. The most vesicant drug should be administered first.
  • Assess a peripheral site continually for signs of redness or swelling.
  • Verify patency of the IV site prior to vesicant infusion and regularly throughout; if there are any doubts, stop and investigate. Resite the cannula if the patency of the cannulation is still not entirely satisfactory.
  • Ask the patient to report any sensations of burning or pain in the infusion site. Some investigators suggest delaying the administration of antiemetics until after vesicant administration. The sedative and anti-inflammatory effects of antiemetics often mask the early warning signs of extravasation and may impede the patient’s ability to report any sensation at the infusion site.
  • Never hurry. Administer drugs slowly to allow the drug to be diluted by the carrier solution and to allow careful assessment of the IV site.
  • Document carefully the rate of administration, location and condition of site, verification of patency, and patient’s responses, on giving any potentially extravasable drugs.

If vein diameter or vein collapse are a problem, then the use of glyceryl trinitrate patches distal to the cannula may be helpful.

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