Management of Cefepime Infiltration
For cefepime infiltration, immediate discontinuation of the infusion and application of hyaluronidase injections around the infiltration site is the recommended first-line treatment to minimize tissue damage and prevent complications. 1
Initial Management
- Stop the infusion immediately upon recognition of infiltration
- Elevate the affected limb to reduce swelling and promote venous return
- Apply warm compresses to the affected area to increase blood flow and enhance drug dispersion
Specific Interventions
Hyaluronidase Treatment
- Inject 150-200 units of hyaluronidase (15 units/mL) subcutaneously in 5 small injections (0.2 mL each) around the periphery of the infiltration site
- Hyaluronidase breaks down hyaluronic acid in the connective tissue, facilitating absorption of the infiltrated medication
- Apply gentle massage after injection to promote drug distribution
Additional Measures
- For large volume infiltrations (>25 mL), consider saline flush technique:
- Insert a 25-27 gauge needle into the infiltration site
- Inject 5-10 mL normal saline subcutaneously to dilute the extravasated drug
- Apply gentle pressure to facilitate dispersion
Monitoring and Follow-up
- Assess the site every 1-2 hours for the first 8 hours
- Monitor for:
- Increasing pain, erythema, or swelling
- Skin discoloration or blanching
- Decreased capillary refill
- Sensory or motor deficits
Special Considerations
Risk Factors for Severe Reactions
- Patients with renal impairment are at higher risk for complications from cefepime infiltration due to decreased drug clearance 1
- Patients with pre-existing neurological conditions may experience exacerbated neurotoxic effects if significant systemic absorption occurs
Potential Complications
- Local tissue inflammation and irritation
- Tissue necrosis (rare with cefepime but possible with large volume infiltrations)
- Compartment syndrome in severe cases
Documentation Requirements
- Document the approximate amount of infiltrated solution
- Record the appearance of the site before and after intervention
- Document all interventions performed and patient response
Pitfalls to Avoid
- Delaying treatment after infiltration is recognized
- Using cold compresses (may worsen tissue damage by decreasing blood flow)
- Failing to monitor for systemic effects of cefepime, especially in patients with renal impairment
While cefepime is not specifically classified as a vesicant or irritant in available guidelines, it should be treated as a potential irritant due to its slightly alkaline pH. The management approach described follows standard protocols for non-vesicant medication infiltrations while considering cefepime's specific properties.