Forum topic

 There is no research or case studies to guide this. I have just been through the literature on infiltration and extravasation to update my online course and do not remember anything published about heparin. This would be an infiltration because hepain is not a vesicant. The volume could be a serious problem however. I would assume this was infusing on a pump, which was responsible for making it worse than it would have been for a gravity infusion. Heat on an anticoagulated patient would increase blood flow to the area, and increase the potential for bleeding into the subq tissue. This can result in compartment syndrome. What fluid was used to dilute the heparin? Was this iso-osmotic or hyper-isomolar? Normal saline would be iso-osmolar but others could easily be hyperisomolar. Heat makes this worse. Hyperisomolar fluids cause fluid shifting from the cells into the interstitial space. Heat adds to the problem because it increases the spread of the infiltrated fluid to a greater area. First, I would stop the heat. If this was recent and the swelling is not improving I would immediately get a surgical consultation - plastic, hand, ortho - to rule out compartment syndrome. Then follow that surgeons recommendations. Cold might be better but again no case reports where this has happened to others. Hyaluronidase may also be used as an antidote for most drugs as it helps to cause the fluid to be re-absorbed. But heat is probably going to encourage bleeding, spread the infiltration to greater tissue, and generally make the problem worse. Lynn