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Extravasation injury

Published by Bupa's health information team, November 2008.

This factsheet is for people who have an extravasation injury, or would like information about it.

Extravasation is when fluid leaks into the soft tissue close to the injection site during intravenous therapy. Extravasation injury is the name given to the soft tissue damage caused by the leakage. Extravasation injuries are a potentially serious consequence of all types of intravenous therapy.

About extravasation
Symptoms of extravasation
Causes of extravasation
Diagnosis of extravasation
Treatment of extravasation
Prevention of extravasation
Further information
Questions and answers
Related topics
Sources

About extravasation

Medicines, fluids and nutrition can be given directly into the bloodstream through a fine plastic tube (cannula) placed in a vein. This method is called intravenous delivery or therapy, often referred to as "having a drip". Many medicines such as antibiotics are given this way.

The soft tissue close to the injection site can be damaged if the fluid leaks out of the vein or is injected by mistake into the tissue. The degree of tissue damage that occurs depends on:

the type of fluid injected
the concentration of fluid
the amount of leakage into soft tissues
the area (site) of extravasation
how soon extravasation is diagnosed and treated

Symptoms of extravasation

The early symptoms of extravasation include:

tenderness
burning
stinging
swelling
redness

Delayed symptoms of extravasation include:

change in skin colour
blistering
peeling

Causes of extravasation

Extravasation injuries are a potentially serious consequence of all types of intravenous therapy. Factors that can increase your risk of having extravasation include:

your age and medical condition - elderly people, babies and cancer patients have very fragile veins
repeated injections - having repeated intravenous therapy can damage your veins and reduce the number of optimal injection sites
type and concentration of fluid - certain medicines such as cytotoxic drugs and anti-coagulants weaken the veins
cannula site - certain areas of the body such as the hand, foot and joint spaces are more prone to injury because they have little protection

Diagnosis of extravasation

Extravasation is usually diagnosed by examining the symptoms and checking patient history.

Your doctor or nurse will usually ask you about your symptoms and examine the injection site.

While you are on a drip, it's important that you keep an eye on the injection area and report any pain or burning immediately to your nurse or doctor.

After having a drip, keep a check on the area in the days after your treatment. Contact the hospital immediately for advice if you notice any change in skin colour, blistering or peeling, or if the area becomes sore, painful or swollen.

Treatment of extravasation

Extravasation injuries must be treated as quickly as possible to prevent serious tissue damage. If extravasation is suspected, the drip is stopped and the area is immediately flushed with hyaluronidase and saline (salt water). This is done to remove as much of the leakage as possible from the area. Corticosteriods, painkillers and antihistamines may be used to treat symptoms such as inflammation, pain and stinging.

You may be given an antidote if it's available for the type of medicine you are having. You may also have hot and cold compresses placed on the area three or four times during the day.

If treatment is delayed it can lead to permanent tissue damage and may require surgery to remove the damaged tissue and clean the area. Sometimes a skin graft is needed.

Prevention of extravasation

The following steps are usually taken by the medical staff to reduce the risk of extravasation.

Medicines likely to cause extravasation are usually given through a central line or drum catheter.
The fluid is passed into your bloodstream very slowly.
Injection area is checked at regular intervals.
Patients are asked to report any feelings of pain or burning immediately.
For repeat intravenous therapy the injection site is regularly changed.

Further information

The National Extravasation Information Service
www.extravasation.org.uk