UMEM Educational Pearls

Category: Toxicology

Title: Extravasation Injuries

Keywords: phenytoin, vinca alkaloids, (PubMed Search)

Posted: 3/31/2011 by Fermin Barrueto, MD (Updated: 12/7/2019)
Click here to contact Fermin Barrueto, MD

Extravasation from radiocontrast, phenytoin and promethazine have resulted in significant tissue necrosis sometimes requiring surgical debridement and reconstructive plastic surgery. 

Pearl: Keep the infiltrated peripheral IV in and inject hyaluronidase 3-5mL (150U/mL) into the same subcutaneous pocket of medication. Hyaluronidase will increase the systemic absorption of the drug, decreasing its time in the SQ tissue. Extremely safe drug (we have the enzyme in our body) and has been used in neonates as well as adults. Also used for SQ hydration in palliative care and pediatrics.

Controversy: Hot vs Cold - Heat will cause vasodilation and hopefully increase systemic absorption but will likely also increase SQ spread possibly increasing the surface area of injury. Cold will cause vasoconstriction and decrease size of injury however will concentrate drug and possibly worsen the local injury.

References

 

  1: Sokol DK, Dahlmann A, Dunn DW. Hyaluronidase treatment for intravenous  phenytoin extravasation. J Child Neurol. 1998 May;13(5):246-7.     2: Cochran ST, Bomyea K, Kahn M. Treatment of iodinated contrast material  extravasation with hyaluronidase. Acad Radiol. 2002 Aug;9 Suppl 2:S544-6.     3: Few BJ. Hyaluronidase for treating intravenous extravasations. MCN Am J Matern Child Nurs. 1987 Jan-Feb;12(1):23.     4: Kuensting LL. Treatment of intravenous infiltration in a neonate. J Pediatr  Health Care. 2010 May-Jun;24(3):184-8. Epub 2010 Mar 20.     5: Raszka WV Jr, Kueser TK, Smith FR, Bass JW. The use of hyaluronidase in the  treatment of intravenous extravasation injuries. J Perinatol. 1990  Jun;10(2):146-9.