IV Vesicants: How to Avoid Extravasation

Even if you're the most skilled iv clinician, your patient is never completely shielded from the risk of a drug extravasating into subcutaneous tissue. Whether he suffers tissue necrosis - besides the inevitable pain and inflammation at the injection site and along the vein - depends on the drug, its concentration, the amount that extravasates, the patient's condition, and how you manage the extravasation.

While extravasation of a vasopressor, such as epinephrine, or even a highly concentrated solution of an apparently nontoxic substance, such as potassium chloride, can produce necrosis, antineoplastic agents probably comprise the largest class of drugs toxic to subcutaneous tissue. The antineoplastics that are most likely to damage, not just irritate, tissue are called vesicants. Among the most familiar are doxorubicin (Adriamycin, Rubex), vinblastine (Velban, Velsar), and vincristine (Oncovin, Vincasar).

Tissue damage from these drugs may seem slight initially. But the site may also become inflamed and painful to the touch after three to five days, and may display ulcers within two weeks(l). In the worst-case scenario, tissue damage renders tendons and nerves dysfunctional(2).

How can you protect your patients receiving vesicants from the dangers of extravasation? What signs and symptoms should alert you to this serious problem? Here's a rundown of the key points to keep in mind.

AJN/April 1993