Management of non-cytotoxic drug extravasation

Abstract:

Background: The extravasation of non-cytotoxic drugs is a risk posed by intravenous therapy, particularly in critically ill patients who often require multiple intravenous medications. This risk must be promptly addressed to prevent morbidity, increased therapy costs and prolonged length of stay, especially in critical care units. Therefore, it is critical to define the specific measures that should be undertaken to approach each situation.

Aim: The aim of this research was to describe the extravasation of non-cytotoxic drugs occurring in a tertiary hospital and to assess the effectiveness and safety of the internal protocol applied.

Study design: This was a single-centre, retrospective, observational study based on real world data from adult and paediatric patients experiencing extravasation of a non-cytotoxic drug between June 2018 and June 2023. To perform the analysis, demographic, patient, intravenous therapy, extravasation and treatment variables were collected and computed using descriptive statistics.

Results: The analysis included 61 patients. The median age was 63.0 (IQR 3.5-74.5) years, and participants were grouped into neonates, children and adults. Among the subjects studied, 80% had at least one risk factor that made them liable to experience an extravasation. Drug groups involved were radiological contrasts (42.6%), parenteral nutrition and electrolytes (29.5%), vasoactive and cardiovascular system drugs (14.8%), antibiotics (8.2%), other analgesics and antipyretics (1.6%), expectorants (1.6%) and alimentary tract and metabolism drugs (1.6%). Adequacy of the protocol was reported in 73.8% of the cases with complete recovery.

Conclusions: The work reported here contributes to improving evidence about the management of extravasation episodes. Our findings suggest that patient-centred team-based protocolizing is a key strategy to achieve the effectiveness and safety of non-cytotoxic drugs in real world practice. This protocol could allow other institutions to enhance safety related to intravenous therapy. Moreover, maintaining a surveillance strategy will enable the continuous collection of data on these adverse events, facilitating ongoing improvement and reinforcement of good practices.

Relevance to clinical practice: Implementing a standardized protocol for managing non-cytotoxic drug extravasation can significantly enhance patient safety and improve outcomes in both adult and paediatric populations in critical care settings.

Blazquez-Vidal M, Garcia-Del Valle I, Amoros-Reboredo P, Diaz-Herrera MA, Val-Prat L, Sanmartin-Suñer M. Real world data on the management of non-cytotoxic drug extravasation: An observational retrospective study in paediatric and adult patients. Nurs Crit Care. 2025 Mar;30(2):e70020. doi: 10.1111/nicc.70020. PMID: 40109134.