IV Infiltration & Extravasation

This Page Teaches:

Section 1. Detail Medical Information on Extravasation + IV Infiltration
Section 2. Legal IV Drug Injection Error Issues

Intravenous (IV) Medication Administration Drug Errors

Extravasation

The placement of an IV catheter into a patient’s body is one of the most frequent invasive procedures medical professionals perform. IV catheter lines are known as “intravascular lines.” These do a number of things:

1. Allow liquids to be replaced in the body
2. Put medication into the circulatory system (blood vessels)
3. Monitor a patient’s bodily functions and vitals

There are risks with any IV catheter line.  The seminal literature on this subject is authored by Garden and Laussen. In 2004, they wrote an article titled “An Unending Supply of ‘Unusual’ Complications from Central Venus Catheters.” This article addressed the risks, complications, the reasons for extravasation and IV infiltration errors.

What is Extravasation?

Extravasation is an injury. It is caused by the placement of a liquid (a drug) that should go into a patient’s circulatory (vascular) system (blood vessels), but rather goes into other tissues in the body. Damage can incur in places like:

1. Skin
2. Muscle
3. Nerves
4. Tendons
5. Ligaments
6. Joints
7. Bone

Injury from extravasation is particularly problematic when it is undetected or unreported.  A delay in time of realizing the extravasation error exacerbates the IV and filtration injury, which often makes the harm worse.

How Common are Extravasation Injuries?

A recent study in Britain discovered that nearly 40% of patients undergoing IV catheter medication treatments experienced an error in the treatment. Other studies show that chemotherapy incidents of extravasation injuries are between .1% and 6%.

When do Extravasation Injuries become Noticeable?

Extravasation typically begins with localized pain or discomfort. It is often described as a “burning” sensation. Swelling can occur. The full extent of an extravasation injury may not become noticeable for a significant period of time.

As an injury worsens, the victim may notice skin discoloration.  Skin blistering and even a rotting appearance may occur. Extravasation harm can last for a long period of time because certain medications bind to DNA within cells and the resulting harm is then passed from cell generation to generation. This is known as “doxorubicin extravasation.”

IV medication errors that can cause permanent damage

The fastest acting medications are the ones that are delivered directly to the blood stream. Intravenous (IV) medications are the most likely to cause fatal medication errors.

For example, extravasation is when the intravenous (IV) medications accidentally leak into the tissue around the infusion site (where the needle punctured). The most damaging medications have the potential to cause permanent harm and disfigurement (such as loss of a limb). This occurs when the medication leaks out of the infusion site. The leakage of the IV medication into the surrounding tissues of the injection site can happen due to inproper set-up of the infusion device.[1]

How Does the Severity of an Extravasation Injury Differ?

There is a difference in the severity of injury from an extravasation error based upon the drug involved. Some drugs are more caustic (or acidic) than others. Please look to through this page to our list of the most harmful extravasation drugs.

What Body Parts are Most Likely Injured by Extravasation?

Some body parts are more likely to be harmed by an extravasation error. These includ:

• Hand
• Foot
• Ankle
• Antecubital Fossa
• Joints
• Joint spaces

There are two main reasons for some body parts being more susceptible to extravasation injury:

1. The location of where the drug was administered. The place where the IV catheter was placed and was exposed to the drug.
2. Some body parts are more susceptible to injury than others. In particular, joints and joint spaces have less blood flow, therefore the harmful drug pools there. Furthermore, these areas have softer tissues that are more susceptible to harm.

How much Damage can Extravasation Cause?

Extravasation can cause merely inflammation and irritation, but some drugs cause the tissues affected to die.

Chemotherapy drugs are considered particularly toxic.  Doxorubicin (Doxil, Adriamycin) can remain in the tissues for an extensive period of time; side effects may not present immediately.[2]^,[3]

Severe skin ulcers are a common side effect of these medications that can require skin grafts and plastic surgery.^20,[4]

Epidurals or intrathecal drugs given directly into the spinal cord can lead to death or permanent disability. These include:

• Morphine,
• Vincristine (a chemotherapy agent)
• Ad Bupivacaine (numbing medication)

These drugs have reports of wrongful administration to the spinal cord leading to fatal or near death incidents. ^{13,[5],[6][7]}

How is Extravasation Treated?

How medical professionals try to heal an extravasation injury depends upon when it is discovered. First, the professional stops the drug treatments that are occurring to help and limit the amount of damage caused by the error. Tape and other items accompanying the IV catheter are removed.  Emergency management procedures are implemented.

The location can be aspirated.  Cleaning and draining the tissues around the site can occur. In some cases, the limbs are elevated over the height of the heart to assist. In other situations, surgery is needed to clean out the injury site. Cold packs are used to reduce pain and slow the progress of the damage. Whether or not cold packs are used will depend upon the type of drug that caused the extravasation injury. Antidotes to the drug may be given.

Treatment can include the following:

1. Surgery
2. Skin grafts
3. Amputation
4. Burn-like treatments

A list of chemotherapy medications that can cause irritation and tissue breakdown.[8]

• Taxol (paclitaxel)
• Mutamycin (mitomycin)
• Mustargen (mechlorethamine hydrochloride)
• Platinol AQ (cisplatin)
• Cosmegen (dactinomycin)
• Cerubidine (duanorubicin)
• Doxil (doxorubicin)
• Ellence (epirubicin)
• Not available (Idarubicin)
• Velban (vinblastine)
• Vincasar (vincristine)
• Navelbine (vinorelbine)
• DTIX-Dome (dacarbazine)
• Taxotere (docetaxel)
• Etopophos (etoposide)
• Adrucil (fluorouracil)
• Doxil Liposomal (liposomal doxorubicin)
• Novantrone (mitoxantrone)
• Eloxatin (Oxaliplatin)

Chemotherapy Patients are Particularly Vulnerable to Extravasation

Patients undergoing cancer treatment through chemotherapy are especially vulnerable to extravasation injury. There are three main reasons for this added vulnerability.

1. Chemotherapy drugs are particularly harmful to tissues outside of the circulatory system (vascular system). The drugs are acidic  and therefore caustic.
2. Chemotherapy cancer patients have weakened bodies. In particular, their blood vessels are thinner, smaller, and more difficult to keep stationary.
3. Some cancer patients have reduced circulation rates. Because their blood flow is less, more pooling of the drug occurs, and this added time of interaction worsens the resulting injury.

Diabetes Patients are More Susceptible to Extravasation Harm

Patients undergoing diabetic treatments are more susceptible to extravasation errors. This is because they have reduced nerve responses because the of the diabetes. Patients are less likely to feel the injury from the extravasation. They are therefore less likely to timely report the injury symptoms to a medical professional.

Some diabetic patients suffer from “Superior Vena Cava Syndrome.” This causes diabetic patients to have high blood pressure. High blood pressure means blood is more likely to leak out of the veins to other areas of the body and cause harm.

Video Resources

• Extravasation – IV Catheter Infiltration Errors Explained