extravasation from coursepack Flashcards
definition of an irritant
drug or soln with ph of 9 or osmolarity >500mOsmol/L
where are extravasation kits kept
in pharmacy (they make them)
what should nurse do before giving irritating or vesicant drug
know the extravasation protocol for it
who is at risk of extravasation
- elderly
- confused or agitated pt
- pts w fragile skin or veins
- pts ith peripheral vascular disease poor circulation or dec sensation
initial symptoms of extravasation
-blanched, translucent skin
-tight, leaking skin
-discolored, bruised or swollen
gross edema >15cm in any direction
-deep pitting tissue edema
-circulatory impairment
-moderate-severe pain
progression from initial symptoms
- sloughing
- damage to tendon and nerves, interferes w fx of the extremity
- ulceration
- necrosis-tissue death could lead to loss of limb
- hyperpigmentation
we now compare between extravasation, pasm of the vein and a flare rxn
.
pt is feeling tightness and aching along the vein
whats the cause
spasm or irritation
pt has no pain at vein. this would occur with
what is this
flare reaction-this is a localized allergic reaction
pain of extravasation presents how
severe burning pain that lasts min-hrs and then subsides
gen ocurs while drugs being given and around the needle site
redness of ….
maybe we dont need to do this?
what to do for peripheral admin of vesicant meds
you need to start a new IV site to make sure that its in right site
how long can you use peripheral iV for vsicants before you must use CVC
less than 12hrs. after 12 must use CVC
what to do after admin of vesicant drug
check for patency and flush well
after taking out needle give gentle pressure for 5 minutes
whih meds to apply warm compress to that are cytotoxic and vesicant
etoposide can be cold or warm, teniposide, and any med from the list that starts with V
(this doesnt include vancomycin as this is a non cytotoxic vesicant that gets cold as tx)
where are extravasations harder to detect
in the antecubital fossa
noncytotoxic meds to give cold compress to
(there are also cytotoxic meds to give cold compress to but I think if we memorize to give hot to the t and V meds we’re good)
aminophylline amiodarone dextrose 10% esmolol magnesium sulfate metoprolol nafcillin pamidronate parenteral nutrition phenytoin potassium sodium bicarbonate radiocontrast media vancomycin
procedure for if extravasation occurs
- stop infusion
- aspirate as much fluid as possible
- remove IV and apply pressure gently with 2x2
- put cold, dry pack in towel on site for 10min Q4h x 48hrs (this dec metb demands on damaged cells and localies the drug)
- elevate
- inform dr
- may need to give pain meds
- mark area w special pen
- may tke picture after consent
if IV therapy must continue use other arm
how do ulcers tend to present/when from vesicant drugs
insidious usually 48-96hrs later
how does redness present for extravasation vs flare rxn
extra: blotchy redness around site (this isnt always present
flare: immed blotches or streaks along the vein that usually subsides within 30min of tx
redness in spasm or irritation of vein presents how
full length of vein may be reddened or darkened
which symptoms of extravasation do spasm/irritated veins not usually present with
no ulceration
no swelling
some may be similar/different
which symptoms of extravasation do flare rxns not usually present with
pain
ulceration
generally no swelling
the rest are somewhat different in presentation
how does swelling present for extravasation vs flare rxn
spasm doesnt have swelling
extra: appears immed and has severe swelling
flare: unlikley but may have wheals on vein line
how does blood return present for extra, flare and spasm
extra=inability to get blood return with initial symptoms but with delayed symptoms may get good blood return during drug admin
flare and irritated vein-usually have blood return
other s/s of extra, flare, spasm
extra: change in quality of the infusion. pt might feel local tingling and sensory deficits
spasm-resistance may be felt on injection
flare=urticaria
