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June 2004, Volume 34 Number 6 , p 22 - 23





  • Preventing extravasation

  • Managing extravasation


    WHENEVER POSSIBLE, vesicant medications should be given through a central venous device such as a peripherally inserted central catheter (PICC), tunneled or nontunneled percutaneous catheter, or implanted port. Compared with a peripheral vessel, a central vein provides more blood flow around the catheter tip, reducing the risk of vein damage. However, if a vesicant extravasation occurs, the resulting tissue damage can be extensive.

    Fluid may leak from these catheters because of catheter rupture or fracture, retrograde fluid flow caused by a fibrin sheath or a thrombus surrounding the catheter, or improper access of an implanted port.

    In the May issue, I discussed how to prevent and manage extravasation from a peripheral catheter. In this article, I'll describe how to prevent extravasation from a central catheter and how to intervene if this complication occurs.

    Preventing extravasation

    Follow these tips for preventing problems when infusing a vesicant though a central venous device.

    * Know the type of catheter being used and the vein it's inserted in. For a PICC, this will usually be the basilic vein of the upper arm. The subclavian or the internal jugular vein is the usual site for other central venous catheters. Insertion into the subclavian vein makes a catheter more prone to fracture from compression between the clavicle and first rib.

    * Confirm the tip location by noting the results of the chest X-ray after catheter insertion. If the patient complains of hearing a running stream or gurgling noises, suspect that the catheter tip has migrated from its original position and obtain a chest X-ray to determine the current position. Don't use the catheter until proper position has been confirmed.

    * Assess the external catheter length. Dislodgment—when the catheter ...

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