Extravasation

Extravasation of barium sulfate iato the peritoneal cavity through a perforated GI tract can produce serious adverse reactions. When a perforation is suspected, the use of a water-soluble iodinated contrast medium is iadicated. In this case, oral or rectal administration of sodium or meglumine-sodium salts of diatrizoic acid (6) and oral use ofiohexol (11) are the preferred procedures. 

Austreibung, /. expulsion, etc. (see austreiben), austreten, v.i. step out, go out, pass out, issue leave, retire project (Opfics) emerge (Physiol.) extravasate. — austretendt p.a. (O ptics) emergent. 

If extravasation or infiltration occurs, die IV must be stopped and restarted in anodier vein. The primary... 

When the drug is given IV, the nurse inspects the needle insertion site for signs of extravasation or infiltration (see Chap. 2). In addition, it is important to inspect the needle insertion site and the area above the site several times a day for signs of redness, which may indicate thrombophlebitis (inflammation of a vein with formation of a clot within the vein) or phlebitis (inflammation of a vein), if either problem occurs, the nurse contacts the primary health care provider and the IV must be discontinued and restarted in another vein, preferably in another extremity. 

When these drug are given intravenously (IV), the nurse should inspect the needle site and area around the needle for signs of extravasation of the IV fluid or signs... 

MONITORING DRUGS GIVEN INTRAVENOUSLY. For optimal results, die nurse inspects the needle site and die area around die needle every hour for signs of extravasation of die IV fluid. The nurse performs diese assessments more frequently if the patient is restiess or uncooperative It is important to check the rate of infusion every 15 minutes and adjust it as needed. The nurse should inspect die vein used for die IV infusion every 4 hours for signs of tenderness, pain, and redness (which may indicate phlebitis or thrombophlebitis). If tiiese are apparent, die nurse must restart the IV in another vein and bring the problem to the attention of the primary health care provider. 

Inspect die needle site and surrounding tissues at frequent intervals for leakage (extravasation, infiltration) of die solution into die subcutaneous tissues surrounding die needle site If eitiier situation occurs, establish anotiier IV line immediately, discontinue the IV containing the vasopressor, and... 

Some drugs such as norepinephrine or dopamine are particularly damaging to the surrounding tissues if extravasation (infiltration) occurs during intravenous administration. Hientolamine is used to prevent or treat tissue damage caused by extravasation of these dru. ... 

The nurse can give some of these drug (for example, aminophylline or theophylline) IV, either direct IV or as an IV infusion. When giving theophylline or aminophylline IV, the nurse monitors die patient for hypotension, cardiac arrhythmias, and tachycardia. If a bronchodilator is given IV, the nurse administers it through an infusion pump. The nurse checks die IV infusion site at frequent intervals because these patients may be extremely restless, and extravasation can occur. 

Examines the area around die IV needle insertion for signs of extravasation. 

Q Impaired Tissue Integrity related to adverse reactions of the antineoplastic drugs (extravasation)... 

Observe the IV site closely to detect any signs of extravasation (leakage into the surrounding tissues). Tissue necrosis can be a serious complication. Discontinue the infusion and notify the primary health care provider if disoomfort, redness along the pathway of the vein, or infiltration occurs. 

A lack of blood return alone is not always indicative of an extravasation, and an extravasation can occur even if a blood return is present. If an extravasation is suspected, the infusion is stopped immediately and the extravasation reported to the primary health care provider. 

If a vesicant is prescribed as an infusion, it is given through a central line only and checked every 1 to 2 hours. The nurse keeps an extravasation kit containing all materials necessary to manage an extravasation available, along with the extravasation policy and procedure guidelines. 

Patients at risk for extravasation are those unable to communicate to the nurse about the pain of extravasation, the elderly, debilitated or confused patient, and any patient with fragile veins. 

When file patient is receiving a vesicant, file nurse monitors file IV site continuously and checks for blood return frequently (every 1-2 mL). Extravasation may occur without warning, or signs may be detected by an alert nurse The earlier file extravasation is detected, file less likely soft-tissue damage will occur. 

Which of the following is die most common symptom of extravasation ... 

During the ongoing assessment, the nurse checks the needle site every 15 to 30 minutes or more frequently if the patient is restless or confused. When one of these preparations is given with a regular IV infusion set, the nurse checks the infusion rate every 15 minutes. The needle site is inspected for signs of extravasation (escape of fluid from a blood vessel into surrounding tissues) orinfiltration (the collection of fluid into tissues). 

If signs of extravasation or infiltration are apparent, the nurse restarts the infusion in another vein. 

If extravasation of file IV solution should occur, local tissue necrosis (death of tissue) may be seen. If extravasation occurs, file primary health care provider is contacted immediately and file infusion slowed to a rate that keeps file vein open. 

The nurse inspects the IV needle site every 30 minutes for signs of extravasation. Potassium is irritating to the tissues. If extravasation occurs, the nurse discontinues the IV immediately and notifies the primary health care provider. The acutely ill patient and the patient with severe hypokalemia will require monitoring of the blood pressure and pulse rate every 15 to 30 minutes during the time of the IV infusion. The nurse measures the intake and output every 8 hours. The infusion rate is slowed to keep the vein open, and the primary health care provider is notified if an irregular pulse is noted. 

In cancer treatment, passive targeting of macromolecular carriers to tumors is a commonly used approach. This passive targeting is based on the enhanced permeability and retention (EPR) effect, which leads to an accumulation of the high molecular weight carrier in the tumor tissue. The EPR effect arises from the different physiology of tumor vasculature, where the vessel walls are highly porous and lack the tight junctions that are present in healthy tissue. As a result, macromolecular carriers extravasate and accumulate preferentially in tumor tissue relative to normal tissues [63, 64]. 

The neurointerventionalist should limit the number of microcatheter injections performed during the exam, as there is growing evidence that this may increase the chances of hemorrhagic transformation of the infarcted tissue. Direct injection of contrast into stagnant vessels, which contains injured glial cells and thus breakdown of the blood-brain barrier, allows for contrast extravasation. Contrast is readily visualized on the immediate post-thrombolysis CT as an area of high attenuation in the parenchyma. In some instances, MRI with susceptibility-weighted sequences may be useful to differentiate contrast extravasation from Such a distinction... 

Osmotherapy employs agents such as mannitol, glycerol, and hypertonic saline to create an osmotic gradient between the brain (optimally, the edematous infarcted tissue) and the bloodstream, such that water is drawn out from the brain, thereby reducing edema. Each of these agents has been shown to be effective, and may be used alone or in combination with a diuretic, such as furosemide. Their action, however, depends upon an intact blood-brain barrier (BBB), and concerns have been raised for possible paradoxical worsening when one is absent. In this hypothesis, mannitol extravasates from the vessel into the interstitial tissue and water follows a new osmotic... 

Bradykinin is another chemical with important peripheral actions but, as yet, cannot be manipulated in any direct way by drugs. It is a product of plasma kininogens that find their way to C-fibre endings following plasma extravasation in response to tissue... 

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