In this episode, I’ll discuss when to use a cold or warm compress to treat extravasation.
Extravasation is a complication of IV therapy that refers to the infiltration of tissues with a medication that is an irritant or
vesicant. The only difference between infiltration and extravasation is that the former is done with therapeutic intent (such as lidocaine for local anesthesia) and the latter is an unintended event with a harmful medication.
Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area.
Cold or warm compresses are applied with the following thought process:
Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. Exceptions are vinca alkaloids (vincristine, vinblastine, vinorelbine), epipodophyllotoxins (etoposide), and vasopressors since cold may worsen tissue damage caused by these drugs.
When a cold compress is used, the usual recommendation is to apply for 20 min 3 or 4 times/day, for the first 48–72 hrs after extravasation occurs.
Warm compresses may increase blood flow and drug removal of vinca alkaloids (vincristine, vinblastine, vinorelbine), epipodophyllotoxins (etoposide), and vasopressors.
When a warm compress is used, it is applied for the same time and frequency as a cold compress.
Members of my Hospital Pharmacy Academy have access to a video-based training on both pharmacologic and non-pharmacologic options for the management of extravasation from a pharmacist’s point of view. This is in addition to hundreds of other resources to help in your practice. The Hospital Pharmacy Academy is my online membership site that teaches pharmacists practical critical care and hospital pharmacy skills you can apply at the bedside so that you can become confident in your ability to save lives and improve patient outcomes. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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