From the Guidelines
Ceftriaxone extravasation is a medical emergency that requires immediate intervention to prevent tissue damage and necrosis. In the event of ceftriaxone extravasation, the first step is to stop the infusion immediately while leaving the cannula in place. Aspirate any remaining drug if possible, then remove the IV. Some key considerations for managing extravasation include:
- Apply cold compresses to the affected area for 20-30 minutes every 6 hours for the first 24 hours to reduce inflammation and limit tissue damage.
- Elevate the affected limb to reduce swelling.
- Monitor the site for signs of tissue necrosis, including persistent pain, erythema, induration, or blistering. Although the provided evidence 1 discusses the use of hyaluronidase in the management of chemotherapy extravasation, it is not directly applicable to ceftriaxone extravasation. However, the general principles of managing extravasation, such as stopping the infusion, aspirating remaining drug, and applying cold compresses, can be applied to ceftriaxone extravasation. It is essential to document the event, including the approximate amount extravasated, appearance of the site, and interventions performed, and to educate the patient on monitoring the site and seeking further medical attention if necessary. In severe cases with signs of compartment syndrome or tissue necrosis, prompt surgical consultation is necessary.
From the FDA Drug Label
LOCAL REACTIONS – pain, induration and tenderness was 1% overall. Phlebitis was reported in < 1% after IV administration GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS — injection site pain (0.6%).
The most likely outcome of ceftriaxone extravasation is local reaction, which may include:
- Pain at the injection site
- Induration (hardening of tissue)
- Tenderness
- Phlebitis (inflammation of the vein) 2
From the Research
Ceftriaxone Extravasation
- Ceftriaxone is a third-generation cephalosporin antibiotic with a broad spectrum of activity against Gram-positive and Gram-negative bacteria 3.
- However, there is limited information available on the specific effects of ceftriaxone extravasation.
- Extravasation, in general, can cause tissue necrosis, pain, and swelling, and may lead to serious complications such as necrotizing fasciitis or cellulitis 4, 5.
- The management of extravasation includes stopping the administration of the drug, aspirating any remaining drug from the cannula, and applying local thermal treatments such as ice packs to decrease the site reaction and absorption of the infiltrate 6, 7.
- Nursing interventions, such as early recognition and prevention, are crucial in preventing further morbidity and optimizing outcomes 6, 7.
- It is essential for healthcare professionals to be aware of the potential risks and complications associated with extravasation and to take prompt action in case of an extravasation event 6, 4, 7, 5.