1. In all cases

a. Stop the IV infusion promptly.

b. Remove constricting bands that may act as tourniquets (e.g., armboard restraint).

c. Elevation of the limb may help to reduce edema.

d. The application of warm or cold packs is controversial.

Warm packs may, by local vasodilation, help to reabsorb infiltrating solutions. However, warm moist packs

have been reported to cause maceration of the skin.

2. Stage 1 or 2 extravasation

a. Remove IV cannula.

b. Consider antidote (see stage 3 or 4 extravasation

below).

3. Stage 3 or 4 extravasation

a. Leave the IV cannula in place and, using a 1-mL

syringe, aspirate as much fluid as possible from the

area. Usually, very little fluid can be aspirated.

b. Remove the cannula unless it is needed for administration of the antidote.

c. Consider use of hyaluronidase or a specific antidote

(see below).The use of hyaluronidase may obviate

the need for the multiple puncture or saline washout techniques described below.

i. Multiple-puncture technique (11): In infants who

develop tense swelling of the site with blanching

of the skin owing to infiltration of acidic or hyperosmolar solutions, multiple punctures of the

edematous area using a blood-drawing stylet (and

strict aseptic technique) has been used to allow

free drainage of the infiltrating solution, decrease

the swelling, and prevent necrosis. The area is

then dressed with saline soaks to aid drainage.

ii. Saline flush out: A technique of saline flushing of

the subcutaneous tissue has been advocated by

some authors (2,12,14). After cleaning and infiltrating the area with 1% lidocaine, 500 to 1,000

units of hyaluronidase is injected subcutaneously.

Four small stab incisions are then made in the tissue plane with a scalpel blade at the periphery of

the area. Saline is injected through a blunt cannula inserted subcutaneously through one of the

puncture sites and flushed through the other puncture sites, massaging the fluid toward the incisions

to facilitate removal of the extravasated material.