I recently got a request from one of our resource nurses regarding treatment of extravasation and do not know how to respond. She was requesting clarification of our extravasation policy. If for example, IV fluids containing KCL infiltrate (raised area with no pain, burning or redness) do we need to ininiate Amphadase and also questioning vanco infiltrates. We never really treated these before but our new policy lists both meds as vesicants. I understand both can cause necrosis and sloughing of tissue but it depends on the amount and concentration, right? Does anyone have any suggestions or do you all treat all no matter what? Thanks,
Marjorie Ashley, CRNI
Vascular Access, Charlton Memorial Hospital, Fall River, MA
Based on my knowledge of the literature, I would treat the extravasation of anything greater than 40 mEq/liter of KCl. For 40 or less, you might want to try conservative measures first with application of cold, NEVER apply heat. Elevate if it increases the comfort level. If the volume was very large, regardless of the concentration, I would treat it also.
I would treat all concentrations of Vancomycin.
Since I do not know how your policy is written, it is hard to say where the confusion is coming from.
I would not rely upon the absense of burning, pain, redness as an indication that there will not be a problem. Tissue damage takes time to be seen. If you wait until you see these signs, you are far too late to have the antidote be effective.
I have not looked at the side effects or contraindications for any of the hyarulonidase products for quite some time so don't remember them. Amphadase and Vitrase are animal derived products. Hylenex is a recombinant product.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
You mentioned never use heat. Are you saying specifically for K infiltrate or any infiltrates? I believe our policy still includes some application of heat for certain infusates.
I would love to see some policies on extravasation of others; specifically the recommended regime for specific drugs that infiltrate.
thanks, Gina Ward R.N. CPAN
Gina Ward R.N., VA-BC
Heat is not indicated for hyperosmolar solutions as this exacerbates the problem. Thermal manipulation of the site for both extravasation and infiltration definitely depends upon the fluid that has escaped into the tissue. Some are cold, some are heat, some have no evidence either way. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861