Education  |   April 2017
Images in Anesthesiology: Examining the Edges of Extravasation
Author Notes
  • From the Department of Anesthesia, Duke University School of Medicine, Duke Hospital, Durham, North Carolina (Y.S.B.); and Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (E.A.B.).
  • Address correspondence to Dr. Bronshteyn: ybronshteyn@partners.org
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia / Critical Care / Infectious Disease / Pain Medicine / Pharmacology / Renal and Urinary Systems / Electrolyte Balance / Respiratory System / Technology / Equipment / Monitoring
Education   |   April 2017
Images in Anesthesiology: Examining the Edges of Extravasation
Anesthesiology 4 2017, Vol.126, 716. doi:10.1097/ALN.0000000000001487
Anesthesiology 4 2017, Vol.126, 716. doi:10.1097/ALN.0000000000001487
THESE two images were obtained 4 days apart around the site of a quadruple-lumen central venous catheter placed in the subclavian vein of a patient with septic shock. The proximal port of the line is believed to have migrated extravascularly, permitting extravasation of vesicants with resulting tissue injury.
Agents and solutions that can cause tissue destruction with extravasation are called vesicants.1  Vesicants can induce necrosis by multiple mechanisms, including direct cytotoxicity (e.g., chemotherapies), hyperosmolarity (e.g., mannitol), deviation from physiologic pH (e.g., most vasopressors), vasoconstriction (e.g., concentrated electrolytes and α-agonists), and inflammation caused by the drug diluent (e.g., benzyl alcohol).1,2 
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