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Hand and Upper Limb Emergencies
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Extravasation is the leaking of fluid or medication into extra vascular tissue from an intravenous device. Most commonly it is small to moderate volumes of saline or IV contrast that have been extravasated, which rarely have severe consequences, but depending on the fluid type and the volume extravasated there are the potential serious complications of full thickness skin loss and compartment syndrome. For this reason, any extravasation referrals must be urgently investigated with the following questions:What substance has been extravasated?What volume has been extravasated?Exactly what time did it occur?Any initial management?General clinical condition of patient?
Paediatric surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The increased use of intravascular infusions has given rise to large numbers of extravasation injuries—skin necrosis, scarring around tendons and joints, and contractures—due to leakage of a drug or fluid into the subcutaneous tissues. Solutions which are particularly harmful include hypertonic solutions (e.g. parenteral nutrition, 10% dextrose), ionic solutions (e.g. potassium chloride, sodium bicarbonate, calcium chloride), chemotherapeutic drugs (e.g. vincristine, doxorubicin) and vasopressors (e.g. dopamine). Extravasation is recognized by pain and swelling at the infusion site and leakage of fluid at the point of insertion of the cannula. Regular surveillance of the infusion site with immediate cessation of the infusion pump will avoid irreversible damage.
Contrast enhancement agents and radiopharmaceuticals
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Intravascular extravasation is the accidental administration of any drug into the patients surrounding tissue, either as a result of poor needle placement and a puncture of the vessel wall, or through leakage in patients with brittle vessel walls or the elderly. Extravasation is a well-recognised complication following the administration of contrast media and is reported as having a prevalence of 0.04–1.3% with automated power injectors. Most patients who experience extravasation of contrast agents only experience mild soft-tissue injury, but in some rare cases severe skin ulceration and tissue necrosis may occur. In simple terms, extravasation can either be user dependent (by incorrect needle insertion) or due to patient-related factors. These include: Obesity.Compromised venous or lymphatic drainage.Fragile/damaged veins.Inability to communicate.
Endometritis risk factors after arterial embolisation for postpartum haemorrhage
Published in Journal of Obstetrics and Gynaecology, 2023
Tsukasa Yoshida, Takeshi Nagao, Kuniyoshi Hayashi, Michiko Yamanaka
We collected continuous variable data regarding age, body mass index, parity, gestational week, infant birth weight, caesarean section (CS) operative time, labour duration for vaginal deliveries (VDs), bleeding volume, blood transfusion, length of hospital stay, and time to AE from delivery. Bleeding volume was defined as the amount of bleeding occurring after delivery until AE. We also collected nominal variable data regarding the pregnancy type (singleton or not), conception method (assisted reproductive treatment or not), smoking history (yes or no), group B streptococcus (carrier or not), gestational diabetes mellitus (GDM; yes or no), hypertension disorder of pregnancy (yes or no), preterm rupture of membranes (PROM; yes or no) and mode of delivery (VD, CS or operative VD). Contrast medium extravasation was defined as an extravascular area of hyper attenuation between 80 and 150 Hounsfield units (Hallinan et al.2014). The computed tomography examinations were prepared as one set containing the venous phase only (90 seconds) and another set containing both arterial (40 seconds) and venous phases (Godt et al.2021). Extravasation was diagnosed by a radiologist using computed tomography before the AE procedure. Embolised blood vessels were also identified by a radiologist (e.g. the bilateral uterine artery, the bilateral internal iliac artery and the unilateral artery).
Pathology of breast cancer metastasis and a view of metastasis to the brain
Published in International Journal of Neuroscience, 2023
Md Sakibuzzaman, Shahriar Mahmud, Tanzina Afroze, Sawsan Fathma, Ummul Barakat Zakia, Sabrina Afroz, Farzina Zafar, Maksuda Hossain, Amit Barua, Sabiha Akter, Hasanul Islam Chowdhury, Eram Ahsan, Shayet Hossain Eshan, Tasnuva Tarannum Fariza
Arrived CTCs undergo extravasation (the opposite process of intravasation) to establish metastasis. Extravasation involves different steps: rolling, firm adhesion, and finally, trans-endothelial migration (TEM) (luminal to the abluminal faces of the endothelium) for crossing blood-brain barriers. BCCs slowly roll along brain microvascular endothelial cells (BMVECs) surface to establish various receptor-ligand interactions with endothelial cells (ECs) [60,62]. Once the interaction is established at a suitable site of the blood-brain barrier (BBB), firm and stable adhesion between BCCs and EC takes place. E-selectin plays an important role in this step [63]. Tumor cells release VEGF to facilitate the TEM through the endothelial barrier [55,64]. TEM mostly takes place in paracellular pathways. The involvement of the transcellular pathway in the extravasation process is unclear. Tumor cells interact first with tight junctions and then with adherens junctions to allow paracellular TEM. The absence of detectable BMVECs programmed cell death or any significant disruptive changes at TEM sites suggests that transmigration of tumor cells does not lead to BBB damage [65]. Additionally, similar to the EMT of epithelial cells, ECs may undergo an endothelial-mesenchymal transition (EndMT) [66]. Anderberg et al. [67] suggested that EndMT occurs in extravasation and intravasation. This process allows the endothelial cell to acquire a mesenchymal phenotype to weaken the endothelial barrier [67]. Thus, EndMT facilitates extravasation. As such, extravasation is a potential area of therapeutic development.
Management of a patient with unintended intravenous dihydroergotamine infusion extravasation causing brachial artery vasospasm
Published in Baylor University Medical Center Proceedings, 2023
In cases of intravenous medication extravasation, we recommend immediate discontinuation of the infusion, followed by frequent and thorough physical exam of the patient to monitor for signs of tissue injury, hematoma formation, or local ischemia (i.e., pain, swelling, numbness, distal extremity sensory and motor changes) in the area of intravenous infiltration. Conservative management with topical nitroglycerin ointment and/or intravenous vasodilator infusion can be attempted, but prompt vascular surgery evaluation is warranted if the patient develops any neurovascular symptoms. When giving medications intravenously, it is important to ensure the intravenous catheter flows and flushes easily without resistance or any other signs of infiltration, especially when using known caustic substances.