From the Guidelines
The management of immunoglobulin extravasation involves elevating the limb and administering analgesia if necessary.
Initial Management
- Elevate the limb to reduce swelling
- Administer analgesia if necessary to manage pain, as recommended by 1
Topical Treatment
- Topical DMSO is a treatment option for extravasations, particularly those occurring during anthracyclines, mitomycin C, or platin salts infusion, as stated in 1
- Apply DMSO 99% topically at four drops per 10 cm2 of skin surface, twice, and leave to air dry without dressing, repeating every 8 hours for 1 week
Surgical Management
- Surgical debridement is considered for unresolved tissue necrosis or pain lasting more than 10 days, as mentioned in 1
- The procedure involves wide, three-dimensional excision of all involved tissue, temporary coverage with a biologic dressing, and simultaneous harvesting and storage of a split-thickness skin graft
Limitations of Current Evidence
- No randomized trials on the treatment of extravasation have been carried out, making it difficult to define the efficacy of an antidote, as noted in 1
- Many reported management policies for extravasations are based on non-biopsy confirmed data, and simultaneous treatment with antibiotics was often initiated, which may affect the accuracy of the recommendations.
From the Research
Management of Immunoglobulin Extravasation
- The management of immunoglobulin extravasation involves stopping the administration of IV fluids immediately, disconnecting the IV tube from the cannula, aspirating any remaining drug from the cannula, administering a drug-specific antidote, and notifying the physician 2
- Local thermal treatments, such as cooling with ice packs, can be used to decrease the site reaction and absorption of the infiltrate, although the clear benefit of thermal applications has not been demonstrated 2
- The recommended application schedule for thermal treatments is 15 to 20 minutes, every 4 hours, for 24 to 48 hours 2
- Health professionals should be familiar with the extravasation management standard guidelines and regularly check the extravasation kit, assess patients’ sensory changes, and pay attention to patients’ words to prevent extravasation 2
- Immunoglobulin is listed as one of the noncytotoxic agents that can cause extravasation, and its management may involve the use of antidotes and supportive care agents such as hyaluronidase, phentolamine, and topical anesthetics 3
Prevention of Extravasation
- Prevention of extravasation is crucial, and health professionals should be aware of the risk factors and take measures to prevent it, such as regularly checking the extravasation kit and assessing patients’ sensory changes 2
- The medical team’s continuous education on extravasation is essential to reduce the occurrence rate of extravasation and contribute to patient care improvement 2