What is extravasation?

In medicine and physiology, extravasation refers to the unintentional leakage or release of fluid from the duct or vessel that contains it into the surrounding tissue and interstitial space.

It is often used to refer to leakage of plasma from blood vessels, often from veins, although it also applies to leakage of lymph from lymphatic vessels and, in general, of any other fluid or its elements from the ducts through which it circulates, e.g. urine, cells blood vessels or even for the unintentional extravasation of drugs administered intravenously.

Extravasation is present in many physiological and pathological processes. For example, edemas or exudates and transudates are formed by extravasation. Among the possible mechanisms, extravasation can be produced by diffusion of the glass, usually due to altered osmotic pressure, or due to rupture of the vessel wall.

Cell leakage in inflammation and metastasis

In inflammatory processes, extravasation refers to the migration of capillary leukocytes into the surrounding tissues. This outflow from the cell occurs through fenestrated capillaries and sinusoids, the most permeable blood vessels, and is commonly called diapedesis.

Diapedesis or cell extravasation is also used to describe a mechanism of metastasis in which cancer cells travel through the bloodstream and spill over to colonize other organs and tissues.

intravenous extravasation

Intravenous extravasation is the leakage of vesicant drugs managed intravenously into extravascular tissues around the perfusion sites.

vesicant substances and medications These are burning substances that cause tissue damage, such as irritation, inflammation, blisters, ulceration and, in the most severe cases, necrosis.

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Depending on the specific drug, the amount used, the time of exposure and the site of extravasation, the damage may be irreversible.

Complications of this type of extravasation can occur with many types of drugs, but it is especially serious during cancer chemotherapy as chemotherapy drugs often have high tissue toxicity.

Some drugs with known vesicant activity are, for example (INN names):

Vesicants with a cytotoxic effect: amsacrine, cisplatin, dactinomycin, epirubicin, mitomycin C, paclitaxel, vinblastine, etc. Vesicants without cytotoxic effect: acyclovir, adrenergic agonists, chlordiazepoxide, diazepam, digoxin, metronidazole, oxacillin, phenytoin, vancomycin, vasopressin, etc.

Intravenous extravasation of high osmolarity solutions usually has a similar effect with significant tissue destruction.

Intravenous extravasation should not be confused with drug infiltration. In the case of infiltration, drugs are injected into joints, wounds, nerves or other soft tissues to exert their action there. Infiltration, therefore, would be a therapeutic action, while extravasation is a therapeutic complication.

extravasation of irrigation fluids

Irrigation fluids are usually saline solutions that are introduced into the body for some purpose, for example, to wash out cavities during surgery. These fluids can leak into unwanted areas and cavities and cause complications in the surgical intervention.

A relatively frequent example of this type of extravasation occurs in arthroscopy. In arthroscopy, pressurized irrigation fluid is used to distend a joint and create a space for surgery.

Irrigation fluid is introduced with the help of the arthroscope. If the joint is surrounded by soft tissue, for example in the shoulder and hip joints, irrigation fluid may leak and leak into the surrounding tissues.

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urine extravasation

Urine leakage occurs when urine accumulates outside the urinary tract, for example in the scrotum or penis. Urine leakage can cause urinoma, an accumulation of encapsulated urine in the vicinity of the kidneys.

The most common cause of urine leakage is blockage of urinary ducts, such as the urethra or ureters, often associated with the presence of stones. It can also be due to kidney trauma.

Gallery

Schematic of the mechanism of leukocyte extravasation Intravenous extravasation of vesicants. Source Wound wound from intravenous extravasation of vesicant drugs. Source

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