Extravasation: Surgical Management and Prevention

Abstract

Extravasation is defined as the leakage of fluid from a blood vessel into the surrounding area at the injection site. These accidents occur during injection for diagnostic or therapeutic purposes, carried out through the peripheral or central venous lines (Chemotherapy, metabolites, or contrast agent for radiographic examination). They can be the cause of skin necrosis able to progress to significant functional, cosmetic, and psychological sequelae.  The saline washout technique is the emergency surgical treatment of choice for extravasations of certain products, allowing the elimination of the toxicant and the preservation of the skin. In the event of skin necrosis, covering techniques such as directed healing, grafts and flaps allow healing.  The difficulty of the therapeutic management of these lesions and their unpredictable evolution, require prevention, by the development of protocols for the installation and monitoring of the venous catheters, and by the continuous training of the nursing staff to know the symptoms of extravasation, and their immediate management.  The aim of this work is to present a review of the existing literature, allowing to know the diagnostic criteria, insist on the means of prevention, and propose a protocol of management.