We recently dedicated one of our blog articles to the infusion of cytostatic drugs as part of chemotherapy for treating various types of cancer. One of the characteristics of these drugs is their irritating or vesicant capacity. However, chemotherapeutic agents are not the only drugs with these characteristics. Today, we are going to talk about infusing other vesicant drugs, unrelated to chemotherapy, of which there are far more than what they may seem at first.

When we talk about vesicant drugs, we are referring to drugs that, due to their chemical composition, may cause lesions to the blood vessels they circulate through when an intravenous infusion is given. These lesions may cause the drug to leave through the circulatory stream and invade the surrounding tissues, extending the scope of the lesion and its seriousness. This is what is known as extravasation.

Main non-cytostatic vesicant drugs

Nursing staff should bear in mind that many of the treatments used most widely comprise vesicant drugs, so the first step for preventing extravasation is to have a good understanding of what these are. Despite the fact that medical literature has mainly focused on the vesicant effect of cytostatic drugs, there are sufficient studies to draw up a list:

RED LIST: Well-known vesicant drugs, cited in studies and reports on extravasation multiple times YELLOW LIST:  Vesicant drugs with fewer published cases of extravasation but which should, however be handled with caution.
Calcium chloride Acyclovir
Calcium gluconate Amiodarone
Radio contrast material Arginine
Dextrose in > 12.5% concentrations Dextrose in > 10% to 12.5% concentrations
Dobutamine Mannitol > 20%
Dopamine Nafcillin
Epinephrine and norepinephrine Pentamidine
Parenteral nutrition solutions over 900 mOsm/l Sodium phenobarbital
Phenylephrine Sodium pentobarbital
Phenytoin Potassium > 60 mEq/l
Promethazine Vancomycin
Sodium bicarbonate
Sodium chloride in > 3% concentrations

In addition to those referred to in the table, there are many other types of drugs with potential, although lesser, vesicant effects, such as Diazepam, Propofol and Vasopressin.

As you can see, many vesicant drugs are used regularly in any hospital. The intensity of the vesicant effect and the consequent risk of extravasation vary greatly depending on the physical characteristics and health status of each patient.

Precautions for preventing extravasation from vesicant drugs

In addition to knowing which drugs may have vesicant effects, medical staff need to take additional precautions when giving an intravenous infusion of these drugs:

  • Avoid inserting the catheter into bending areas, such as the antecubital fossa.
  • Consider the areas that were previously punctured when considering where to insert the catheter. For example: if a patient has previously had blood extracted from the antecubital fossa, use the other arm.
  • Use the smallest calibre of catheter possible, allowing for an adequate amount of blood to flow but minimising the risk of obstruction and/or thrombosis.
  • Use the correct syphon: Not all vesicant drugs can be infused into peripheral syphons. Should you have any doubts, check with the hospital’s Pharmacy Department.
  • Properly ensure that the catheter is not moving, but without blocking it so that the insertion point can be seen.
  • Check that the syphon is permeable.
  • Frequently monitor the syphon, checking for signs of extravasation.
  • Know the suitable antidotes and the treatment that need to be applied immediately at the first sign or suspicion of extravasation, always as prescribed by the relevant doctor.
  • Inform the patient and/or their relatives of the precautions that need to be taken.

Training and updating medical staff is key for preventing extravasation lesions, especially when using new or rare drugs, as knowing their vesicant potential is necessary for taking the suitable preventative measures.