Schummer W, Schummer C, Müller A, Karzai W
Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena.
Anaesthesist. 2003 Aug;52(8):711-7. doi: 10.1007/s00101-003-0521-z.
Extravasation is the non-intentional leakage of substances/solutions into the perivascular or subcutaneous space that can result in significant tissue damage. The extent of destruction depends on the properties of the substance, its concentration, and the amount applied. Substances known to cause severe tissue damage include certain chemotherapeutic agents, vasoactive substances, concentrated electrolytes, and other hyperosmolar solutions. Extravasation can be avoided by meticulous monitoring of venous access. When extravasation occurs, the infusion should be stopped immediately. Substances known to cause tissue damage should be removed from perivascular or subcutaneous space within 24 hours by local incision and irrigation. A delay in early treatment may necessitate more extensive surgical debridement and skin coverage operations. Since the extent of deep soft tissue damage is difficult to predict and is often underestimated, a magnetic resonance imaging should be performed before surgery. We report here on a 73-year-old patient, in whom extravasation of potassium-chloride from a dislocated multi-lumen central venous catheter led to a life-threatening skin and soft-tissue necrosis of the neck. This article provides an overview of common vesicants, theories of tissue destruction, potential risk factors, guidelines for prevention, and current treatment strategies.
外渗是指物质/溶液非故意地漏入血管周围或皮下间隙，可导致严重的组织损伤。破坏程度取决于物质的性质、浓度和使用量。已知会导致严重组织损伤的物质包括某些化疗药物、血管活性物质、浓缩电解质和其他高渗溶液。通过仔细监测静脉通路可避免外渗。当发生外渗时，应立即停止输液。已知会导致组织损伤的物质应在24小时内通过局部切开和冲洗从血管周围或皮下间隙清除。早期治疗延迟可能需要更广泛的手术清创和皮肤覆盖手术。由于深部软组织损伤的程度难以预测且常被低估，术前应进行磁共振成像检查。我们在此报告一名73岁患者，其多腔中心静脉导管脱位导致氯化钾外渗，引发危及生命的颈部皮肤和软组织坏死。本文概述了常见的发泡剂、组织破坏理论、潜在危险因素、预防指南和当前的治疗策略。
