Extravasation

To be completed by a healthcare professional:

• Date extravasation occurred:
• Drug involved in extravasation:
• Affected area:

This page explains what extravasation is. It also outlines the steps we take when extravasation occurs. If you have any questions after reading this, please speak to the team looking after you.

What is extravasation?

Extravasation happens when a medicine or contrast agent that is being given intravenously (into a vein) leaks from the vein into the surrounding tissue.

Symptoms can include:

• a sudden onset of pain
• swelling
• redness
• leaking around the injection site.

In some people, these symptoms may develop after a period of time.

The majority of medicines and contrast agents don’t cause any lasting injury. But if extravasation is left untreated it can damage the skin or tissue. There is more information about treatment you may need below.

Why does this happen?

Extravasation is very rare and we take every precaution to prevent it. However, there is always a small risk that a medicine or contrast agent given intravenously can leak into surrounding tissue.

Initial treatment following extravasation

Initial treatment aims to minimise the risk of further problems. It usually involves a combination of the following steps:

• Elevating your arm
• Applying a hot or cold compress
• Applying topical 1% hydrocortisone cream
• Offering you painkillers if you are experiencing discomfort or pain around extravasation
• If a contrast agent leaks, massaging the area around extravasation. This can help to disperse the contrast and reduce any potential tissue damage.

Very rarely, a large volume of medicine or contrast agent may leak. You may then need a procedure called a ‘flush out’. This involves making small incisions (cuts) around
the affected area and ‘flushing out’ the medicine or contrast agent with saline to minimise the damage to the tissue. You may need to see a plastic surgeon at the Royal Free Hospital to assess you for the procedure. We will advise you if this is the case.

What happens after the initial treatment?

Depending on the type of medicine or contrast agent involved, follow the advice below at home for 3 to 5 days (to be ticked by a healthcare professional):

AND
If you are in pain, take your prescribed painkillers as advised by your healthcare team.
Elevate the affected arm to help reduce any swelling, monitor the area and report any
changes.

• Wear loose clothing around the affected area.
• Gently exercise the affected arm.
• Don’t apply any other lotions, creams or ointments unless advised by your healthcare team.

Please note that the level of discomfort and side effects you experience will depend on
the amount and type of medicine/contrast agent that has leaked.

Changes to look out for

Contact your GP or hospital team if you notice:

• redness, blistering, oozing or bleeding
• increasing pain
• swelling
• numbness or loss of function (for example if you can’t move your arm freely).

If it’s out of hours, go to your local Emergency Department (A&E).

Are there any long-term effects of extravasation?

The area may be sore for a while but you should not have any long-term side effects if
the extravasation is recognised and treated early.

Very rarely, there may be long-term damage to the affected area. This can range from minor skin discolouration at the site, to deeper skin and structural damage that can affect the look and movement of the arm. The level of damage depends on the type and volume of medicine/contrast agent that has leaked. If this occurs, we will give you support and advice to manage any long-term effects that you may experience. Please talk to your healthcare team if you have any concerns.

How do we manage extravasation events at UCLH?

We have policies that govern good practice for giving all medicines and contrast agents. These policies follow national guidance on how to manage extravasation events, and we update them regularly to keep up with changing practice. We also train all staff who administer medicines and contrast agents intravenously how to manage extravasation.

All extravasation incidents come under the Trust-wide Duty of Candour policy. This means that we investigate each incident individually to learn from the situation and improve our practice.

What do we do to prevent future extravasation events?

We investigate and monitor the type and number of extravasation events that happen. We review them at our monthly governance meetings and agree recommendations and changes to practice.

Contact details

Please contact us on one of the numbers listed below if you:

• would like to find out the results of the investigation
• are worried about any symptoms you are experiencing
• need to talk about any aspect of your or your relative’s care

Tel: (Monday to Friday, 9am to 5pm)
Tel: (out of hours)

Please bring this information sheet with you for your next treatment or follow-up appointment.