A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon

Abstract

Intravenous therapy is a common practice among many specialties. Intravenous therapy extravasation is a potential complication to such therapy. Hospitals without a dedicated wound care team trained in these interventions will often default to plastic surgical consultation, making an understanding of available interventions essential to the initial evaluation and management of these injuries. The goal of this article was to provide plastic surgeons and health care providers with a general overview of the acute management of intravenous infiltration and extravasation injuries. Though the decision for surgical versus nonsurgical management is often a clear one for plastic surgeons, local interventions, and therapies are often indicated and under-utilized in the immediate postinfiltration period. Thorough knowledge of these interventions should be a basic requirement in the armamentarium of plastic surgery consultants.

Fig. 1.

A 11-year-old female with dopamine extravasation 5 days post infusion. Treated with warm compress and phentolamine.

Fig. 2.

A 32-week premature infant with a dopamine extravasation 2 months post infusion.

Fig. 3.

A, A 5-day old full-term neonate with an R lower leg IV extravasation; dopamine and PPN were infusing. Treated initially with phentolamine and elevation. B, 30-day Status post healing by secondary intention, with residual cosmetic skin changes.

Fig. 4.

A, Severe epinephrine extravasation injury to the neck. Therapies including subcutaneous phentolamine and topical nitroglycerin paste were utilized after identification. Nevertheless, substantial irreversible tissue ischemia occurred, possibly due to a delay in identification. B, Debridement of necrotic skin and subcutaneous tissue was performed.

Fig. 5.

A 3-month-old infant with a TPN infiltrate 1 week post infusion. Treated with hyaluronidase and elevation.