From the Guidelines
The treatment for amiodarone extravasation involves immediate cessation of the infusion, elevation of the affected limb, and application of dry heat. Local infiltration with normal saline may help dilute the extravasated drug.
- Topical application of DMSO (dimethyl sulfoxide) 50-99% solution applied to the affected area every 6-8 hours for 3-7 days has shown benefit in some cases.
- Hyaluronidase (150-1500 units) subcutaneous injection around the extravasation site may also be helpful by increasing drug absorption and reducing local tissue damage. Cold compresses should be avoided as they can worsen tissue damage. Amiodarone is highly alkaline (pH 4.08) and contains polysorbate 80, which can cause significant tissue damage including inflammation, blistering, and necrosis when extravasated. The mechanism of injury involves direct cellular toxicity and vascular compression from inflammation. Close monitoring of the site is essential, and surgical consultation should be obtained for severe cases with signs of compartment syndrome, tissue necrosis, or if conservative measures fail. Documentation of the event, including photographs of the site, is important for follow-up care 1.
From the Research
Treatment for Amiodarone Extravasation
- Amiodarone extravasation can cause skin injury, and the healing process involves inflammation 2.
- There is no specific antidote mentioned in the studies for amiodarone extravasation.
- However, a study suggests that chrysin, a natural flavonoid, can reduce injury area, reduce inflammation, and promote the secretion of bFGF, which can help in the healing of skin injury induced by amiodarone extravasation in rats 2.
- General management of extravasation includes nursing intervention and thermal application, such as local cooling (ice packs) to aid in vasoconstriction and limit the drug dispersion 3.
- The recommended application schedule for cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours 3.
- It is essential for health professionals to be familiar with the extravasation management standard guidelines and to regularly check the extravasation kit, assess patients’ sensory changes, and pay attention to patients’ words to prevent extravasation 3.
Prevention and Management
- Prevention of extravasation is crucial, and health professionals should be educated on extravasation management standard guidelines 3.
- The medical team’s continuous education on extravasation is essential to reduce the occurrence rate of extravasation and contribute to patient care improvement 3.
- Studies on amiodarone focus on its efficacy and safety in treating arrhythmias, but there is limited information on the specific treatment for amiodarone extravasation 4, 5, 6.