From the Research
The antidote for levothyroxine (levo) extrasavation is not explicitly stated in the provided evidence, however, for vasoconstrictor extravasations such as those caused by norepinephrine, phentolamine mesylate is recommended 1. When managing an extravasation, it is crucial to stop the administration of the IV fluid immediately, disconnect the IV tube from the cannula, and aspirate any remaining drug from the cannula 2. The management of extravasation includes nursing intervention and thermal application, with local cooling (ice packs) aiding in vasoconstriction and limiting the drug dispersion 2. Some studies suggest the use of hyaluronidase for the management of extravasations, particularly those involving contrast media or certain vesicant agents 3, 4. However, the most recent and highest quality evidence for the management of extravasations emphasizes the importance of early recognition, prompt intervention, and the use of specific antidotes or supportive care agents based on the properties of the extravasated drug 5, 2. Key points to consider in the management of extravasations include:
- Early recognition of extravasation through regular monitoring of the IV site for signs of blanching, pain, or coolness
- Prompt intervention to minimize tissue damage and prevent long-term consequences
- Use of specific antidotes or supportive care agents based on the properties of the extravasated drug
- Application of thermal treatments, such as warm or cold compresses, to promote vasodilation or vasoconstriction as needed
- Importance of prevention through proper placement of the IV catheter, avoidance of areas with poor circulation, and use of central lines when possible 5, 2.