General treatment guidelines

• Stop the infusion, disconnect the IV line but do not remove the cannula.

• Mark the area of injury around the cannula tip.

• Seek the help of a more experienced individual if available.

• Aspirate the site of extravasation to remove as much of the offending drug as possible through cannula with a fresh 10mL syringe; this may be facilitated with SC injection of 0.9% saline.

• Administer 100mg hydrocortisone intravenously at another site.

• Administer a further 100mg hydrocortisone locally by 6-8 SC injections around the area of injury.

• Administer SC injections of specific antidote where available.

• Apply 1% hydrocortisone cream to the area and repeat bd whilst erythema persists.

• Cover with gauze and apply heat to disperse the drug or cool to localise the extravasation.

• Administer oral antihistamine (terfenadine 60mg/chlorpheniramine 4mg).

• Administer analgesia if required (indomethacin 25mg tds).

• Document site and extent of extravasation and treatment in case notes.

• Photograph site if possible.

• Complete a 'Green Card' to report the extravasation episode.

• Monitor injured site twice daily for erythema, induration, blistering or necrosis.

• Photograph injured site weekly until healed.

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