Hello;
I was wondering if anyone has any articles/resources that they might be willing to share with respect to immediate and ongoing treatment of wounds due to extravasation. There seems to be more research available related to immediate treatment but then we are left with a necrotic wound and wondering if there is evidence to support any tretaments specific to that etiology; ie. would it be different than any necrotic wound. This may be a question better asked in a wound care community but thought I would add it here as well.
Thanks in advance for any information
Tammy
Since you are asking about necrotic ulceration, I assume you are meaning that the escaped drug is a vesicant. The initial evaluation should include a careful assessment of the nature of the drug and the estimated volume of drug in the tissue. This could indicate the need for immediate surgery to wash out the drug and remove the cause of the necrosis, or remove as much as possible. Some drugs that bind to DNA are going to expand the damage to additional tissue because cell death releases the drug to cause damage in new cells. Other than those factors, I have not seen a difference in medical management for these injuries compared to other causes of necrosis. If the drug is a weak vesicant or the volume is small, and the patient has other risk factors prohibiting surgery, the best choice could be management with silvadene or other anti-infective cream, and dressings. One the other hand a surgical procedure may be the best option to reduce the chance of a large necrotic ulcer. Most of the time, in my experience, it is a decision made in a case-by-case manner. Prevention is always the best option though. And I do believe that most extravasations can be prevented. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
In many hospitals, a plastic surgery consult is made after a major extravasation. Care of the would is guided by them and/or the wound care department.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC