Extravasation occurs when intravenously administered fluid or medication leaks from a blood vessel into the surrounding soft tissue. It typically occurs at the IV insertion site during medical treatments, including those involving chemotherapy drugs. This leakage can lead to a range of consequences, necessitating prompt recognition and management to minimize potential harm.
Initial Signs and Symptoms
Initial indications of extravasation often appear shortly after leakage begins. Individuals may experience a sudden pain, burning, or stinging sensation at the IV site. This discomfort is frequently accompanied by visible changes. Swelling around the needle site is a common sign, and the skin may appear red (erythema).
The affected skin might also feel cool to the touch or appear blanched, indicating reduced blood flow. Tenderness and a taut or stretched appearance of the skin can also be present. Changes in the infusion flow rate, or difficulty obtaining blood return from the IV line, can also signal fluid leakage outside the vein. The severity and combination of these signs vary depending on the type and volume of the extravasated substance.
Localized Tissue Injury
Localized damage to the tissues surrounding the infusion site is a primary consequence of extravasation. The extent of this injury largely depends on the leaked substance’s properties, specifically if it is an irritant or a vesicant. Irritants are agents that cause inflammation, pain, or discomfort, but typically do not lead to tissue death. Symptoms from irritants are often self-limiting, resolving without long-term damage.
Vesicants, however, are medications that can cause significant tissue destruction, including blistering, ulceration, and necrosis (tissue death). These drugs induce severe pain and lead to progressive tissue damage, which may not be fully apparent for days or weeks after the initial leakage. Chemical properties like extreme pH, high concentration (osmolarity), or vasoconstrictive effects contribute to cellular damage. For instance, hyperosmolar substances can draw fluid from cells, causing dehydration and cell death. This direct cellular toxicity can result in blisters, progressing to open sores and deep ulcers.
Potential for Functional Impairment
Localized tissue injury from extravasation can extend beyond superficial skin damage, leading to longer-term functional limitations. Severe and extensive tissue damage, particularly from vesicant agents, can result in deep ulcers that can involve underlying structures and may not heal on their own. This can lead to scar tissue formation, which may restrict joint movement if extravasation occurs nearby.
Damage to nerves near the affected area can cause sensory and motor impairments, such as numbness, tingling, weakness, or chronic pain. Muscle or tendon damage can also occur, impacting limb strength and mobility. The long-term functional outcome is closely tied to the initial severity and location of the injury, with severe cases potentially requiring surgical interventions like debridement or skin grafting. In extreme circumstances, extensive tissue death and complications like compartment syndrome can lead to limb amputation.
Systemic Complications
While less common than localized issues, extravasation can at times lead to broader systemic complications if severe or not promptly managed. One such complication is infection, which arises when damaged tissue at the extravasation site becomes an entry point for bacteria. This can manifest as cellulitis, a bacterial skin infection characterized by redness, swelling, and warmth, and can spread if untreated. In very rare and severe cases, a localized infection might progress to sepsis, a life-threatening systemic response.
Another rare systemic complication involves absorption of extravasated medication into the bloodstream from the affected tissue. This can lead to systemic toxicity, especially with certain potent drugs, though generally uncommon as most leaked substance remains localized. Managing extravasation primarily focuses on mitigating local tissue damage, but awareness of these potential systemic risks is important for comprehensive patient care.