extravasation from coursepack

Question 1

definition of an irritant

Answer 1

drug or soln with ph of 9 or osmolarity >500mOsmol/L

Question 2

where are extravasation kits kept

Answer 2

in pharmacy (they make them)

Question 3

what should nurse do before giving irritating or vesicant drug

Answer 3

know the extravasation protocol for it

Question 4

who is at risk of extravasation

Answer 4

• elderly
• confused or agitated pt
• pts w fragile skin or veins
• pts ith peripheral vascular disease poor circulation or dec sensation

Question 5

initial symptoms of extravasation

Answer 5

-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

Question 6

progression from initial symptoms

Answer 6

• sloughing
• damage to tendon and nerves, interferes w fx of the extremity
• ulceration
• necrosis-tissue death could lead to loss of limb
• hyperpigmentation

Question 7

we now compare between extravasation, pasm of the vein and a flare rxn

Answer 7

.

Question 8

pt is feeling tightness and aching along the vein

whats the cause

Answer 8

spasm or irritation

Question 9

pt has no pain at vein. this would occur with

what is this

Answer 9

flare reaction-this is a localized allergic reaction

Question 10

pain of extravasation presents how

Answer 10

severe burning pain that lasts min-hrs and then subsides

gen ocurs while drugs being given and around the needle site

Question 11

redness of ….

Answer 11

maybe we dont need to do this?

Question 12

what to do for peripheral admin of vesicant meds

Answer 12

you need to start a new IV site to make sure that its in right site

Question 13

how long can you use peripheral iV for vsicants before you must use CVC

Answer 13

less than 12hrs. after 12 must use CVC

Question 14

what to do after admin of vesicant drug

Answer 14

check for patency and flush well

after taking out needle give gentle pressure for 5 minutes

Question 15

whih meds to apply warm compress to that are cytotoxic and vesicant

Answer 15

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)

Question 16

where are extravasations harder to detect

Answer 16

in the antecubital fossa

Question 17

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)

Answer 17

aminophylline
amiodarone
dextrose 10%
esmolol
magnesium sulfate
metoprolol
nafcillin
pamidronate
parenteral nutrition
phenytoin
potassium
sodium bicarbonate
radiocontrast media
vancomycin

Question 18

procedure for if extravasation occurs

Answer 18

• 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

Question 19

how do ulcers tend to present/when from vesicant drugs

Answer 19

insidious usually 48-96hrs later

Question 20

how does redness present for extravasation vs flare rxn

Answer 20

extra: blotchy redness around site (this isnt always present
flare: immed blotches or streaks along the vein that usually subsides within 30min of tx

Question 21

redness in spasm or irritation of vein presents how

Answer 21

full length of vein may be reddened or darkened

Question 22

which symptoms of extravasation do spasm/irritated veins not usually present with

Answer 22

no ulceration
no swelling

some may be similar/different

Question 23

which symptoms of extravasation do flare rxns not usually present with

Answer 23

pain
ulceration
generally no swelling
the rest are somewhat different in presentation

Question 24

how does swelling present for extravasation vs flare rxn

spasm doesnt have swelling

Answer 24

extra: appears immed and has severe swelling
flare: unlikley but may have wheals on vein line

Question 25

how does blood return present for extra, flare and spasm

Answer 25

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

Question 26

other s/s of extra, flare, spasm

Answer 26

extra: change in quality of the infusion. pt might feel local tingling and sensory deficits
spasm-resistance may be felt on injection
flare=urticaria