[Extravasation: a rare complication of central venous cannulation? Case report of an imminent erosion of the common carotid artery]

Abstract

Extravasation is the non-intentional leakage of substances/solutions into the perivascular or subcutaneous space that can result in significant tissue damage. The extent of destruction depends on the properties of the substance, its concentration, and the amount applied. Substances known to cause severe tissue damage include certain chemotherapeutic agents, vasoactive substances, concentrated electrolytes, and other hyperosmolar solutions. Extravasation can be avoided by meticulous monitoring of venous access. When extravasation occurs, the infusion should be stopped immediately. Substances known to cause tissue damage should be removed from perivascular or subcutaneous space within 24 hours by local incision and irrigation. A delay in early treatment may necessitate more extensive surgical debridement and skin coverage operations. Since the extent of deep soft tissue damage is difficult to predict and is often underestimated, a magnetic resonance imaging should be performed before surgery. We report here on a 73-year-old patient, in whom extravasation of potassium-chloride from a dislocated multi-lumen central venous catheter led to a life-threatening skin and soft-tissue necrosis of the neck. This article provides an overview of common vesicants, theories of tissue destruction, potential risk factors, guidelines for prevention, and current treatment strategies.