Department of Pharmaceutical Services, Hiroshima University Hospital.
School of Pharmaceutical Sciences, Hiroshima University.
Biol Pharm Bull. 2022;45(9):1254-1258. doi: 10.1248/bpb.b22-00170.
Cytotoxic agents are classified according to the severity of skin injury after extravasation. However, injuries caused by extravasation of noncytotoxic agents have not been sufficiently investigated, although the risk of extravasation is mentioned in medical safety information published by the Japan Council for Quality Health Care. Therefore, in this study, we focused on noncytotoxic electrolyte solutions and infusions and evaluated skin injuries during leakage using extravasation model rats. Rats were anesthetized and intradermally injected with 100 µL of an electrolyte solution or infusion. Injection lesions were macroscopically and histopathologically evaluated for extravasation injuries. Each electrolyte solution and infusion were classified into three categories (vesicants, irritants, and non-tissue-damaging agents) depending on the degree of skin injury. Similar to saline, 0.3% potassium chloride and 0.6% magnesium sulfate showed almost no injury, and 3% sodium chloride and BFLUID caused erythema and induration. Erythema, induration, and ulceration were observed with the following: 10% sodium chloride, 2% calcium chloride, 8.5% calcium gluconate, 12.3% magnesium sulfate, MAGSENT, FESIN, and Intralipos. The duration of damage with these agents was markedly prolonged. Electrolyte solutions and infusions can be classified into vesicants (10% sodium chloride, 2% calcium chloride, 8.5% calcium gluconate, 12.3% magnesium sulfate, MAGSENT, FESIN, and Intralipos), irritants (3% sodium chloride and BFLUID), and non-tissue-damaging agents (0.3% potassium chloride and 0.6% magnesium sulfate) according to their composition. The characteristic symptoms and severity of each drug extravasation revealed in this study will provide basic information for preparation of guidelines for treatment of extravasation.
细胞毒性药物根据外渗后皮肤损伤的严重程度进行分类。然而，尽管日本医疗质量保证协会在发布的医疗安全信息中提到了外渗的风险，但非细胞毒性药物引起的外渗损伤尚未得到充分研究。因此，在这项研究中，我们专注于非细胞毒性电解质溶液和输液，并使用外渗模型大鼠评估了渗漏过程中的皮肤损伤。大鼠被麻醉并皮内注射 100 μL 的电解质溶液或输液。通过宏观和组织病理学评估注射损伤来评估外渗损伤。根据皮肤损伤程度，将每种电解质溶液和输液分为三类（腐蚀性、刺激性和非组织损伤剂）。与生理盐水类似，0.3%氯化钾和 0.6%硫酸镁几乎没有损伤，而 3%氯化钠和 BFLUID 引起红斑和硬结。10%氯化钠、2%氯化钙、8.5%葡萄糖酸钙、12.3%硫酸镁、MAGSENT、FESIN 和 Intralipos 引起红斑、硬结和溃疡。这些药物的损伤持续时间明显延长。根据组成，电解质溶液和输液可分为腐蚀性药物（10%氯化钠、2%氯化钙、8.5%葡萄糖酸钙、12.3%硫酸镁、MAGSENT、FESIN 和 Intralipos）、刺激性药物（3%氯化钠和 BFLUID）和非组织损伤药物（0.3%氯化钾和 0.6%硫酸镁）。本研究中揭示的每种药物外渗的特征症状和严重程度将为制定外渗治疗指南提供基础信息。
