Transcript File - Julie Teegarden

Extravasation
BY TAIQUITA ARDAN, RAÚL CARDONA, CLARA DALTON, AND JULIE TEEGARDEN
Introduction

Extravasation:
The inadvertent administration of a vesicant
solution or medication into surrounding tissue.

Learner Goals:
Identification, treatment, and prevention of
extravasation of medications.
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Objectives

Identify medications that can cause extravasation.

Identify predisposing factors to extravasation.

Identify signs and symptoms of extravasation.

Understand the treatment and management of extravasation.

Recognize ways to prevention extravasation.
Significance of Topic to Critical Care

Patients in critical care units are extremely unstable and any complication
can have major consequences.

Critical care patients have many of the risk factors associated with
extravasation.

Many of the medications used in critical care can cause extravasation
injuries.

Critical care patients typically have many IV lines.
Medications Implicated in Extravasation

Cytotoxic medications

Electrolyte solutions


Vasopressors


Dobutamine, Dopamine, Epinephrine, Norepinephrine.
Anti-infectives


Calcium chloride, Calcium gluconate, Parenteral nutrition, Potassium
chloride, Sodium bicarbonate, Sodium chloride > 0.9%.
Vancomycin.
Miscellaneous

Contrast media, Diazepam, Digoxin, Mannitol, Phenytoin.
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Factors Associated with Extravasation

Catheter-Specific Factors.

Physiologic Factors.

Pharmacologic Factors.

Patient-Specific Risk Factors.

Nurse-Specific Factors.
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Signs and Symptoms of Extravasation

Pain.

Redness.

Swelling.

Blood Return.

Ulceration.

Others.
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asation-injury-26.jpg
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KMS/jkms-22-588-g001-l.jpg
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28/2740528_IJPS-41-145-g001.png
Treatment of Extravasation

Stop the injection or infusion

Remove the IV

Notify the medical staff

Elevate the extremity for 48 hours

Depending on medication

Apply warm or cold pack

Administer hyaluronidase or phentolamine

Document

Monitor
Nursing Research

Errors in high-risk intravenous injections administered by nurses: The causes
according to healthcare professionals (Kim & Seomun, 2014).

Aim:


To identify the causes and problems of errors in the administration of IV meds.
Methods:

Qualitative study involving 13 participants divided into three focus groups.

Interviews were transcribed, analyzed, and organized in topics and subtopics.
Nursing Research

Results:

3 categories emerged from the data concerning causes of IV
administration errors:

human-related factors

injection procedure-related

environmental factors

One of the main things needed to avoid extravasation is simple
awareness.

This is even more important in the critical care setting where serious
complications are more likely to result.
Nursing Research

Increasing nurse competence in peripheral intravenous therapy (Woody
& Davis, 2013).

Aim:


To identify complications associated with extravasation and evaluate the
impact of incidents on a medical/surgical unit.
Methods:

Determine methods of documentation.

Reviewing how nursing competency is assessed.

Creation of a pretest and post-test, and educational module

Collecting info from pretest and post-test
Nursing Research

Number of reported cases before education were compared with
number of cases after.

35 participants.

Results:


Pretest scores had a mean of 12.77, post-test had a mean of 13.29 (no
significant difference).

The number of incidents over a three month period pre-intervention was
compared with three-month period post-intervention, and indicated a 50%
decrease in rates of extravasation.
Significance is that it shows the importance of reeducation of core
competencies.
Conclusion

Discussed medications that can cause extravasation.

Identified factors that predispose patients to extravasation.

Discussed how to identify signs and symptoms of extravasation.

Described the treatment and management extravasation.

Discussed how to prevent extravasation.
Evaluation of Objectives: Post Test

Which one of these medications does not cause extravasation?

A. Potassium chloride

B. Calcium gluconate

C. Epinephrine

D. Vancomycin

E. Lasix
Evaluation of Objectives: Post Test

True or False

Patient’s risk factors include…

Age

Obesity

Underlying chronic disease (diabetes)

Condition of veins

Impairment in communication

History of multiple venipunctures
Evaluation of Objectives: Post Test

Which sign or symptoms are not classified as delayed manifestations of
extravasation? Select all that apply.

A. Swelling

B. Inability to obtain blood return

C. Ulceration

D. Severe stinging or burning pain

E. Local tingling and sensory deficits
Evaluation of Objectives: Post Test

You suspect your patient has extravasation, which action do you perform
first.

A. Call the physician

B. Administer 1,500 units hyaluronidase

C. Stop intravenous infusion

D. Apply hot or cold pack
References

Coyle, C. E., Griffie, J., & Czaplewski, L. M. (2014). Eliminating Extravasation
Events: A Multidisciplinary Approach. Journal of Infusion Nursing, 37(3), 157-164.

Doellman, D., Hadaway, L., Bowe-Geddes, L. A., Franklin, M., LeDonne, J.,
Papke-O'Donnell, L. ... & Stranz, M. (2009). Infiltration and extravasation:
update on prevention and management. Journal of Infusion Nursing, 32(4),
203-211.

Dougherty, L. (2010). Extravasation: prevention, recognition and management.
Nursing Standard, 24(52), 48-55.

Dychter, S. S., Gold, D. A., Carson, D., & Haller, M. (2012). Intravenous therapy:
A review of complications and economic considerations of peripheral access.
Journal of Infusion Nursing, 35(2), 84-91.
References

Groll, D., Davies, B., Mac Donald, J., Nelson, S., & Virani, T. (2010). Evaluation of
the psychometric properties of the phlebitis and infiltration scales for the
assessment of complications of peripheral vascular access devices. Journal of
Infusion Nursing, 33(6), 385-390.

Kim, M., & Seomun, G. (2014). Errors in high-risk intravenous injections
administered by nurses: The causes according to healthcare professionals.
Health Science Journal, 8(2), 249-261.

Martin, S. M. (2013). Extravasation Management of Non-chemotherapeutic
Medications. Journal Of Infusion Nursing, 36(6), 392-396.
doi:10.1097/NAN.0000000000000010

Woody, G., & Davis, B. A. (2013). Increasing Nurse Competence in Peripheral
Intravenous Therapy. Journal Of Infusion Nursing, 36(6), 413-419.
doi:10.1097/NAN.0000000000000013