Extravasation is always a risk when administering medicines intravenously. This is when the infused drug infiltrates the tissue surrounding the injection site. The resulting injury can range from mild to lifethreatening, depending on whether the drug involved is classified as an irritant or a vesicant.
The Infusion Nurses Society (INS) defines a vesicant as “an agent capable of causing injury when it escapes from the intended vascular pathway into the surrounding tissue.”1
A call came from a nurse attending to 3 patients in the infusion clinic. One patient had received a full dose of doxorubicin (60 mg/m2) via the vein in the dorsum of her hand. Afterward, the nurse detected a trace of blood in the infusion tube. While administering post-dose hydration, she noticed that the patient’s hand was completely swollen.
Contra Costa Regional Medical Center is a public hospital with 167 beds. Despite our hospital’s cost-conscious approach to formulary management, it was one of the first in the area to add the dexrazoxane for injection (Totect) emergency treatment kit to its formulary. This addition predated the On cology Nursing Society guidelines on managing anthracycline extravasation and followed a long process involving presentations to 4 hospital committees.
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