How to diagnose, manage, and prevent extravasation: a narrative review

Purpose: Extravasation is the unintentional leakage of vesicant or irritant drugs, contrast media, or other infused fluids into surrounding tissue into the surrounding tissue. Extravasation causes injuries ranging from mild irritation to severe necrosis. Incidence ranges from 0.1%–6% in adults and up to 58% in neonates. This review summarizes evidence-based guidelines for diagnosis, management, and prevention.Current concepts: Risk factors include patient-related (fragile veins, older age, neonates, and patients with cancer), procedure- or device-related (inexperienced staff, multiple cannulation attempts, inappropriate catheter selection or fixation, and high infusion pressure), and drug- or product-related (vesicant drugs, high osmolarity or viscosity, and extreme pH) factors. Drugs are classified as vesicants, irritants, or nonvesicants. Diagnosis is primarily clinical, presenting with pain, swelling, and erythema. Differential diagnoses include flare reaction, venous irritation, and venous spasm. Immediate intervention is crucial: stop the infusion, leave the needle in situ for aspiration, then remove the cannula, mark the area, and notify a physician. Management includes elevating the limb, administering specific antidotes, and thermal therapy. Cold compresses are used for DNA-binding vesicants and contrast media, while warm compresses are indicated for non-DNA-binding vesicants. Each session should last 15–20 minutes every 4–6 hours for 24–48 hours.Discussion and conclusion: Surgical referral depends on clinical severity rather than volume alone. Prevention requires standardized protocols, appropriate device selection, and continuous staff training. Adherence to evidence-based guidelines significantly reduces the incidence of extravasation and associated morbidity.