Herbal Spotlight
Clinical Pearls
Infusion Therapy
Geriatric
Considerations
Special Alerts
Medication
Administration
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Extravasation — infiltration of a drug into the surrounding tissue — can result from a punctured vein or from leakage around a venipuncture site. If vesicant (blistering) drugs extravasate, severe local tissue damage often results. To avoid extravasation of these drugs, adhere strictly to proper administration techniques and follow these guidelines:
- Don't use an existing I.V. line unless it's patent. Perform a new venipuncture to ensure correct needle placement and vein patency.
- Select the site carefully. Use a distal vein that allows successive proximal venipunctures. To avoid tendon and nerve damage if extravasation does develop, avoid using the dorsum of the hand. Also, avoid the wrist and digits, which are hard to immobilize, as well as areas that were previously damaged or have compromised circulation.
- If you need to probe for a vein, you may cause trauma. Stop and begin again at another site.
- Start the infusion with D5W or normal saline solution.
- Use a transparent film dressing to allow inspection.
- Before starting the infusion, check for extravasation. Apply a tourniquet above the needle to occlude the vein and see if the flow continues. If the flow stops, the solution isn't infiltrating. Another (less reliable) method is to lower the I.V. container and watch for blood backflow. Flush the needle to ensure patency. If swelling occurs at the I.V. site, the solution is infiltrating.
- Give vesicant drugss by slow I.V. push through a free-flowing I.V. line or by small-volume infusion (50 to 100 ml).
- Don’t use an infusion pump to administer vesicants. A pump infuses even if infiltration occurs.
- During administration, observe the infusion site for erythema and infiltration. Tell the patient to report burning, stinging, itching, or temperature changes.
- After drug administration, instill several milliliters of normal saline solution to flush the drug from the vein and to preclude drug leakage when the needle is removed.
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