Lynn I
always appreciate your comments. Do you have any comments on this excerpt
from micromedex on non-cytotoxic extravasations? Potassium is
listed. This is what is says:
COMPRESSES: Recommendations for application of heat or cold vary. Heat can
increase drug distribution and absorption by inducing vasodilation. However, use
of warm, moist compresses has resulted in maceration and subsequent tissue
necrosis. Application of cold packs, through vasoconstriction and localization
of the extravasated fluid, may be helpful if an antidote were to be locally
injected; however, if no antidote is available, cold packs may result in more
severe tissue damage at the site of infiltration[2].
It
also talks about hyaluronidase:
HYALURONIDASE (Wydase(R) ): Hyaluronidase is
an enzyme that temporarily decreases the viscosity of hyaluronic acid, the
ground substance or intracellular cement of the tissues. Subcutaneous
administration of hyaluronidase increases permeability into the tissues and
facilitates absorption of the infiltrated solution by allowing diffusion of
extravasated fluid over a larger area. This minimizes tissue injury through
rapid absorption and dilution in tissue fluids. The enzyme has an almost
immediate onset of action and a 24 to 48 hour duration of effect on the "tissue
cement." Allergic reactions, usually manifested as urticaria, occur rarely;
otherwise, clinical reports emphasize minimal or lack of toxicity. The enzyme
should not be injected into cancerous or acutely inflamed areas since there is a
potential for disseminating infection or increasing the invasiveness or
metastasis of neoplasms. The recommended concentration of hyaluronidase is
prepared by either using 150 units/1 ml of the stabilized solution or
reconstituting the vial of 150 units of lyophilized powder with 1 ml of 0.9%
sodium chloride, followed by further dilation of 0.1 ml of either solution with
saline to a final volume of 1 ml, resulting in a final concentration of 15 units
per ml. After cleansing the infiltration site and surrounding area with
povidone-iodine, approximately five 0.2-ml injections are administered
subcutaneously or intradermally into the leading edge of the extravasation site,
using a 25-gauge needle. The needle should be changed after each injection. A
dose of 30 units has been used for severe, large infiltrates. Doses less than 15
units have been employed in preterm infants weighing less than one kg. Swelling
is usually significantly decreased within 15 to 30 minutes following
hyaluronidase administration. The enzyme must be used promptly, ie, within 60
minutes of the infiltration, since the potential for tissue damage increases
with the duration of exposure to extravasated fluid. Hyaluronidase has been used
successfully to prevent tissue injury due to infiltration of both nafcillin and
the hyperosmotic agents listed in Table 1[13].
Donna Fritz, MN, RN,
OCN
Oncology/Pain Clinical Nurse Specialist
Cancer Center
St. Mary-Corwin
Medical Center
719.560-5215
[EMAIL PROTECTED]
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Lynn Hadaway
Sent: Tuesday, October 04, 2005 5:50 PM
To: gerald and kim; [EMAIL PROTECTED]
Subject: Re: KCL infiltrationCold application immediately due to osmolarity of this solution. Heat exacerbates the problem. Also an immediate consult with a plastic surgeon due to the risk of tissue injury from KCl. This patient may need a fasciotomy to relieve compartmental pressure or at least to flush this vesicant from the tissue. Also I would want this worked up as a sentinel event with root cause analysis as this has the great potential to result in long-term and/or permanent damage to limb function. "IV site is patent or benign or any other such word" actually means nothing because we can not determine exactly what the nurse looked at. Patent based on what? Benign due to what level of assessment? LynnAt 5:49 PM -0400 10/4/05, gerald and kim wrote:Found out today about a patient that had an infiltrated IV over the weekend. NS 1000cc with 40meq/kcl. When found by nurse at 0730 site was bruised and had blisters. It gets worse-- The last entry on the patients chart is from 0100 that IV site was patent (he has periods of confusion and agitation). Day shift nurse charts site with 2-3+ edema, bruising and blisters and of course the skin tore when the tape was taken off at the site. I can't find anywhere in the chart that the physician was notified of the severity of the infiltration or that any measures were taken to address the site. It is 48 hours later, he still has 1+ edema from wrist to mid forearm, bruising and blisters. Does any one have a guideline or info I can print out to address how to treat such infiltrates or any advice.Sorry this is so long!Kim Dockery RNEducation/Inservice
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