From the Guidelines
For amiodarone extravasation, the recommended dose of hyaluronidase is 1 ml of a 150 U/ml solution, which should be administered using a needle with a suitable gauge, although the exact gauge is not specified in the provided evidence, a 25-27 gauge needle is commonly used in subcutaneous injections. When administering hyaluronidase for amiodarone extravasation, it is essential to consider the dose and method of administration to minimize tissue damage and promote absorption of the extravasated drug.
- The dose of hyaluronidase can range from 1–6 ml of a 150 U/ml solution, with the usual dose being 1 ml of hyaluronidase solution for 1 ml of extravasated drug, as suggested by studies on the management of chemotherapy extravasation 1.
- The administration of hyaluronidase should be done promptly, ideally within 1 hour of detecting the extravasation, to prevent tissue necrosis and other complications.
- The injection should be given subcutaneously, potentially using a "five-point star" pattern around the periphery of the extravasation site, although this specific technique is not detailed in the provided evidence.
- After administration, the area should be gently massaged and elevated if possible, with cold compresses avoided to prevent worsening tissue damage.
- Documentation of the event, including the estimated amount of extravasated drug, site appearance, and interventions performed, is crucial for proper follow-up care. The use of hyaluronidase in such cases is supported by studies showing its efficacy in reducing ulcer formation and size when used to treat extravasation, as seen in animal models and a study on patients with accidental vinca alkaloids extravasation 1.
From the Research
Administration of Hyaluronidase
- The recommended dose of hyaluronidase for administering in cases of extravasation is not explicitly stated for amiodarone, but studies suggest using 150 U/mL of hyaluronidase 2, 3.
- The injection of hyaluronidase should be done in a circumferential fashion around the extravasation site 4, 3.
- The use of a 25-gauge needle 2 or a 27-gauge needle 4 has been reported in studies for the administration of hyaluronidase.
Needle Gauge
- A 25-gauge needle or a 27-gauge needle can be used for administering hyaluronidase, depending on the specific case and the location of the extravasation 4, 2.
- The choice of needle gauge may depend on the depth of the extravasation and the location of the injection site.
Considerations
- Hyaluronidase should be used with caution, as it can cause allergic reactions, including local and systemic reactions 5.
- Skin tests are recommended before using hyaluronidase to minimize the risk of allergic reactions 5.
- The effectiveness of hyaluronidase in preventing or treating extravasation injuries may depend on the timing of administration, with earlier treatment being more effective 4, 3.