Extravasation is derived from the Latin word ‘extra’ meaning ‘outside’ and ‘vas’ meaning ‘vessel’. It dates back to the 1670s, and means ‘escape of fluid into the tissues after a rupture’ (Online Etymology Dictionary, 2022). Today, extravasation is defined as the inadvertent leakage of any liquid or medicines, such as anticancer drugs, from a blood vessel or vascular access device into the surrounding tissues, which can cause serious harm to the patient (National Cancer Institute, 2022).
The impact of extravasation
We know that an extravasation injury may require surgical intervention, such as debridement and potentially lavage, with the subsequent risk of long-term consequences for the patient and costs to the NHS. A recent report from NHS Resolution (2022a) stated that extravasation cost the NHS £16 million in injury claims between 2010 and 2021.
This summer, the National Infusion and Vascular Access Society (NIVAS) partnered with NHS Resolution and the Patient Safety Learning team to hold a virtual roundtable, hosted by BD. This focused on a national campaign to raise awareness of extravasation injuries and claims, to spread insight as well as promote process reviews across health providers, supporting hospitals and organisations to improve patient safety. Andrew Barton, Chair of NIVAS, talked about the collaborative work with the UK Chemotherapy Board and outlined the planned, national campaign to help prevent non-chemotherapy extravasation. It will focus on the awareness, prevention, treatment and reporting of all extravasations with a strong focus on non-chemotherapy drugs.
NHS Resolution (2022b) has set out its strategic priorities for 2022–2025. Its strategic plan, entitled Advise, Resolve and Learn, aims to reduce harm to patients, and reduce the distress caused to both patients and healthcare staff involved when a claim or concern arises.
Chemotherapy is not the leading cause of extravasation and there are no standardised national guidelines specifically for preventing extravasation of non-chemotherapy drugs (NHS Resolution, 2022a). And there is currently no national reporting structure for the harm caused by extravasation.
There are nine major causes of extravasation, namely: infusion problems; inadequate nursing care; error in agent/dose/route; treatment delay/failure; inappropriate treatment; failure to recognise complications; operation error; foreign body left in situ; and recanalisation.
The report further highlighted seven contributory factors, as follows:
- Incorrect medication infusion pump pressures
- Bandaging the cannula in infants, leading to lack of access and observations
- Wrong route of administration
- Failure to act on patient complaints of pain or discomfort
- Delay in identifying extravasation injury
- Staff not following manufacturer's or local guidance on administration of intravenous drugs
- Cannula being placed in another department and initially working.
What is the solution?
Up-to-date training, backed with evidence-based standards, is fundamental for the prevention and optimal management of extravasation. Knowledge of the drug or fluids being administered is vital, coupled with awareness of current evidence (or absence of evidence) for various types of extravasation treatment.
Unfortunately, due to ethical considerations, very few controlled studies have been conducted in this area and, certainly, evidence for managing extravasations secondary to non-cytotoxic medications is almost non-existent. More research is needed to improve knowledge and promote early recognition, to support the development of prevention and treatment protocols for extravasation.
It is my hope that, with the ongoing collaborative work by the UK Chemotherapy Board led by Dr Elaine Tomlins and NIVAS to develop national guidelines, their use will in due course reduce the incidence rate of extravasation and help achieve better patient outcomes.