Intravenous Extravasation Injuries: The Effectiveness of Hyaluronidase in Their Treatment

Laurie, Simon W. S.; Wilson, Kenna; Kernahan, Desmond A.; Bauer, Bruce S.; Vistnes, Lars M.

doi:10.1097/00000637-198409000-00003

Cited by 73 publications

(36 citation statements)

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“…Injection of hyaluronic acid into the extravasated area is based on the following pathomechanism: As a mucopolysaccharide, hyaluronic acid essentially determines the structure of interstitial connective tissue. Hyaluronidase enzymatically cleaves this structure and contributes to the distribution of the extravasate, thus promoting its absorption into the vascular and lymphatic system [28]. The enzymatic effect takes place within minutes and is time-limited.…”

Section: Hyaluronic Acid Injectionmentioning

confidence: 99%

“…In a 1984 animal study of extravasation in which no contrast medium extravasation was examined, the authors only express the hypothetical conclusion that the positive effect of hyaluronidase according to the mechanism of action is to be expected for other agents [28]. In contrast, animal studies by McAlister et al [29] in 1971 evaluated the immediate and subsequent histological effects of various ionic high osmolar contrast agents on the subcutaneous and intramuscular tissues which always show an acute inflammatory response with secondary muscle atrophy and scar formation after eight weeks.…”

Section: Hyaluronic Acid Injectionmentioning

confidence: 99%

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Contrast Media Extravasation in CT and MRI – A Literature Review and Strategies for Therapy

Mandlik

Prantl

Schreyer

2018

Fortschr Röntgenstr

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Background Contrast extravasation events in daily radiological routine may lead to serious complications, especially during CT examinations. The resulting symptoms may vary from local pain up to skin ulcers, necrosis or even acute compartment syndrome.There are no uniformly accepted radiological guidelines or recommendations regarding detection and treatment of extravasation events and immanent complications in a timely manner. Method Systematic literature research considering the last 35 years via PubMed using search terms “contrast medium extravasation/paravasation”. Results In the literature, there are conservative management approaches of contrast media extravasation without major evidence base, such as unguent dressings, cooling or splinting. This therapy is mostly symptomatic. Additionally, various invasive techniques are described. We discuss these techniques in the context of contemporary literature, such as the hyaluronidase Injection into the site of extravasation, suction/aspiration technique including flushing of the affected tissue areas and the squeezing technique. However, most citations lack scientific evidence: many articles include anecdotal enumerations, case studies or cite publications from the era, when ionic high osmolar contrast media was state-of-the-art. Besides, many authors derive their extravasation management from studies, where agents other than contrast media were investigated. Conclusion After detailed literature review, we suggest early (plastic) surgical consultation when non-ionic, low-osmolar contrast medium extravasation is about 150 cc or more. In case of extravasation less than 150 cc but in presence of additional symptoms such as impaired perfusion or altered sensibility, the (plastic) surgeon should also be consulted instantly. We do not recommend any invasive first line therapy when contrast media extravasation is less than 150 cc and the patient presents no additional symptoms, besides swelling and local pain. Nevertheless continuous monitoring and accurate conservative management such as active cooling and elevation, splinting of the affected extremity are mandatory as early detection of critical symptoms helps to initiate prompt surgical intervention and avoid sequelae. Key Points Citation Format

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Section: Hyaluronic Acid Injectionmentioning

confidence: 99%

Section: Hyaluronic Acid Injectionmentioning

confidence: 99%

Contrast Media Extravasation in CT and MRI – A Literature Review and Strategies for Therapy

Mandlik

Prantl

Schreyer

2018

Fortschr Röntgenstr

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“…Injeksjon av hyaluronidase medfører spalting av hyaluronsyre og gir bedret resorpsjon av ekstravasert materiale fra hudens ekstracellulaere matriks (10).…”

Section: Subkutan Hyaluronidaseinjeksjonunclassified

Ekstravaseringsskader

Chiu¹,

Tindholdt²,

Tønseth³

2016

Tidsskriftet

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“…b) Hyaluronidase: This drug breaks hyaluronic acid and increases the permeability of connective tissue and hence the diffusion of extravasated drug 10,15,24 . It is recommended in vinca alkaloids, epipodophylotoxin and taxanes 26,31 extravasations. It is injected through the existing cannula or subcutaneously in a clockwise manner if cannula has been removed.…”

Section: A) Dimethylesulfoxide (Dmso)mentioning

confidence: 99%

Extravasational toxicity of anticancer chemotherapy and its management

Thakur¹,

Thakur²

2013

OA Case Reports

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IntroductionAnticancer drugs have a number of side effects, including toxic effects on bone marrow, kidney, lymphoreticular tissue, mucosa and cochlea. Extravasational toxicity is a complication of anticancer drugs, unmentioned in the majority of clinical textbooks other than oncology, explaining why residents may be unaware of this preventable catastrophe. The objective of this paper is to review and present the clinical features and management of extravasation of these anticancer drugs so that first line staff get acquainted to this complication and its management. After reading this paper, residents and clinicians will be more vigilant in anticancer drug infusion and management of extravasation. ConclusionOnce extravasation occurs, tis-sue injury is inevitable but can be reduced with the proper antidote. A trained member of staff should ad-minister this, preferably from the on-cology department only.

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Intravenous Extravasation Injuries: The Effectiveness of Hyaluronidase in Their Treatment

Cited by 73 publications

References 0 publications

Contrast Media Extravasation in CT and MRI – A Literature Review and Strategies for Therapy

Contrast Media Extravasation in CT and MRI – A Literature Review and Strategies for Therapy

Ekstravaseringsskader

Extravasational toxicity of anticancer chemotherapy and its management

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