(1369) Optimizing Management of Non-Chemo Intravenous Extravasations

Introduction: Intravenous (IV) lines have a relatively common failure rate of ~20% due to extravasations and can cause substantial patient harm increasing morbidity, mortality, and hospital length of stay. At our institution, there is no standardized orderset for the management of non-chemo IV extravasation in our adult patient population. A baseline survey of ICU nurses found a large cohort reporting limited or no knowledge of pharmacology intervention, and no knowledge of extravasation resources.

Methods: We designed and implemented an adult non-chemotherapy IV extravasation order set. The order set 1) utilizes the most common antidotes based on literature, 2) creates a reference list of antidotes that is easily accessible for providers, and 3) includes clear antidote preparation and administration instructions. We also created nursing educational tools to increase confidence when managing IV extravasations such as an online nursing education module and an IV Extravasation Adult Nursing Procedure. We reviewed pre- (July 2020 – Dec 2022) and post-implementation (July 2023- June 2024) data.

Results: With the implementation of a nursing module, a nursing survey showed an increase in pharmacology knowledge of non-cytotoxic vesicants from 39% to 90% and an increase in knowledge of extravasation management resources from 21% to 81%. With the implementation of the orderset, there was an overall increased use of extravasation antidotes of phentolamine, nitroglycerin ointment, and hyaluronidase from 46 to 90 orders. However, there was an overall decrease in average time from medication ordering to pharmacist verification (5mins vs 4.8mins, p=0.56) and medication ordering to administration (101mins vs 60mins, p=0.12).

Conclusions: The implementation of an education module and orderset improved knowledge of extravasation management and improved time to therapy of this time-sensitive antidote. Further exploration includes the appropriateness of antidote use and outcome assessment.