Infusion ulcers - Altmeyers Encyclopedia

Definition
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Ulcerations in the area where a cannula is inserted during infusions; usually as a result of paravenous infiltration, vasoconstrictive or cytotoxic drugs.

Therapy
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It is important to take immediate measures in the event of extravasation of toxic substances in order to reduce the necrotizing process (see Table 1). Specific antidotes are described for individual cytostatic agents, see Table 2. The exact volumes of the antidotes to be applied must be determined individually by the extent of the extravasation and the age of the patient.

Tables
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Immediate measures for extravasation of tissue damaging substances

Stop the infusion immediately, leave the IV access.
Use new syringe to aspirate extravasation from the tissue, disconnect the IV access.
In case of blister formation in the extravasation area, aspirate contents with tuberculin syringes.
For special antidots (see table 2)	Unless otherwise indicated, the antidote is administered by IV access, otherwise the antidote is applied intra- and subcutaneously in a star shape from periphery to centre in the extravasation area (cannula 26 G). Remove the IV access.
Without antidote	4-8 mg of dexamethasone (e.g. decadron phosphate) in the extravasate infiltrate
Inject 1% lidocaine (without adrenaline!) for pain relief.
Apply medium to highly effective glucocorticoid such as 0.25% prednicarbate cream (e.g. Dermatop) 2 times/day until the erythema has subsided.
For all toxic substances	several times daily 15 min. ice packs for at least 3 days.
For extravasation of vinca alkaloids such as vincristine, vinblastine (Velbe), etoposide (Vepesind), vindesine, (Eldesine), teniposide (VM 26)	apply dry, mild heat once for 60 minutes
Raise the affected limb until swelling has subsided.
Document the extravasation and action taken.
Careful observation and, if necessary, early surgical removal of the necrotic area in cooperation with surgeons; see below ulcus cruris.

Specific antidotes for the treatment of cytostatic extravasations

Preparation	Measure
Doxorubicin	Na hydrogen carbonate 8.4% 2-5 ml (only suitable for immediate immediate treatment). Cave: Also necrotizing effect possible, only small amounts! Inject approx. 5000 IU heparin-Na into 5 ml physiological NaCl solution. Infiltrate dexamethasone 48 mg into the extravasated kidney. Apply dimethylsulfoxide (DMSO, e.g. Dolobene pur gel) every 34 hours for at least 3(?14) days with cotton wool carrier in the entire extravasation area and allow to dry. Further recommendation: intradermal administration of 100 mg propanolol
Dacarbazine	No severe necrosis expected. Light shield! Apply dimethylsulfoxide (DMSO, e.g. Dolobene pur gel) every 3-4 hours for at least 3(-14) days with a cotton wool carrier in the entire extravasation area and let dry.
Daunorubicin	s. Doxorubicin
Epirubicin	s. Doxorubicin
Idarubicin	s. Doxorubicin
Vincrist	Hyaluronidase 150 IU (1 ml) into the extravasated area (kinetin). Heat. Caution: Do not infiltrate glucocorticoids into the extravasation area!
Vinblastine	s. Vincrist
Vindesin	s. Vincrist
Dactinomycin	Immediate local cold application.
Mitomycin	Apply dimethyl sulfoxide (DMSO, e.g. Dolobene pur gel) immediately and every 3-4 hours for at least 3 days with a cotton wool carrier in the extravasation area and allow to dry. Dilute Na-Thiosulfate solution 10% with Aqua ad inj. 1:4. Inject 4 ml of this solution s.c. Cool additionally with ice.
Mustages	Na-thiosulfate solution; see mitomycin