Heparin Extravasation Management
Stop the heparin infusion immediately, disconnect the IV tubing from the cannula, aspirate any residual drug from the cannula, and apply cold compresses (ice packs) for 15-20 minutes every 4 hours for 24-48 hours to promote vasoconstriction and limit drug dispersion. 1
Immediate Nursing Intervention
When heparin extravasation is identified, follow this algorithmic sequence:
- Stop the IV infusion immediately upon first recognition of extravasation 1
- Disconnect the IV tubing from the cannula without removing the cannula itself 1
- Aspirate any remaining drug from the cannula to remove as much extravasated medication as possible 1
- Notify the physician promptly after initial interventions 1
- Assess the affected area for sensory changes, tingling, burning, or swelling 1
Thermal Management
Cold therapy is the standard supportive care for heparin extravasation, though clear benefit has not been definitively demonstrated in controlled trials 1:
- Apply ice packs (local cooling) to the extravasation site to induce vasoconstriction and theoretically limit drug dispersion 1
- Application schedule: 15-20 minutes every 4 hours for 24-48 hours 1
- Cold application aids in vasoconstriction, which limits the spread of the infiltrated drug into surrounding tissues 1
Important Caveats
Heparin is NOT a vesicant agent that causes tissue necrosis like chemotherapeutic agents (e.g., doxorubicin), so the risk of full-thickness skin necrosis is minimal 2. The primary concern with heparin extravasation is local tissue irritation and potential hematoma formation rather than severe tissue destruction.
No specific antidote is required for heparin extravasation 1. Unlike chemotherapeutic extravasations that may require specific antidotes, heparin extravasation is managed with supportive measures only.
Monitor the site closely for development of hematoma, especially given heparin's anticoagulant properties, which may cause local bleeding into tissues even after the infusion is stopped 1.
Prevention Strategies
- Regularly assess IV sites for signs of infiltration during heparin infusion 1
- Pay attention to patient complaints of pain, burning, or tingling at the IV site 1
- Ensure proper IV catheter placement before initiating heparin therapy 1
- Consider central venous access for prolonged heparin therapy to minimize extravasation risk 1