Treatment of Extravasation

Treatment of Extravasation

Emergency physicians often manage IV catheter malfunction causing extravasation, which can result in significant tissue necrosis. Hyaluronidase may significantly reduce tissue injury from extravasation by hydrolyzing mucopolysaccharides present in connective tissue. This results in a transient increased permeability of the tissue and subsequently enhances diffusion of liquids through the subcutaneous space. Although the irritating medication is distributed over a wider area, quick absorption minimizes tissue injury.

Hyaluronidase has been shown to reduce the extent of tissue damage following extravasation of parenteral nutrition solutions, radiocontrast media, phenytoin, promethazine, dextrose, mannitol, and the vinca alkaloid chemotherapeutic agents (e.g. vincristine, vinblastine). Hyaluronidase is well tolerated and has been used in neonates as well as adults.

Administration techniques differ, but most sources recommend making a ten-fold dilution of a 150 unit vial of hyaluronidase in NS to provide a concentration of 15 units/ml, then dividing the dose into 0.2 ml subcutaneous injections via a 25 gauge needle in 4-5 different sites along the leading edge of erythema.

Hyaluronidase is most effective if administered within the first 2 hours after an extravasation, however, it may still be beneficial when given up to 12 hours after the event.

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(2) Cochran ST, et al. Acad Radiol 2002;9 Suppl 2:S544-6.
(3) Kuensting LL. J Pediatr Health Care 2010;24(3):184-8.
(4) Sokol DK, et al. J Child Neurol 1998;13(5):246-7.