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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. Image retrieved from: http://www.medicaljournals.se/acta/content/files/web/2792-webimages/2792fig1_opt.jpeg 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. Image retrieved from: http://one2onecmo.com/drugdeliverysystems.aspx Factors Associated with Extravasation Catheter-Specific Factors. Physiologic Factors. Pharmacologic Factors. Patient-Specific Risk Factors. Nurse-Specific Factors. Image retrieved from: http://blogs.wsj.com/health/2008/04/14/end-of-lifecare-count-the-ivs/ Signs and Symptoms of Extravasation Pain. Redness. Swelling. Blood Return. Ulceration. Others. Image retrieved from: http://garyolson.net/extrav asation-injury-26.jpg Image retrieved from: http://jkms.org/ArticleImage/0063J KMS/jkms-22-588-g001-l.jpg Image retrieved from: http://openi.nlm.nih.gov/imgs/512/94/27405 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