IV-EXTRAVASATION-IRON medical runtime_error ai_generated true

AI instructs a nurse to continue IV iron infusion despite signs of extravasation, ignoring risk of skin necrosis and permanent staining

ID: medical/iv-iron-extravasation

Also available as: JSON · Markdown · 中文
82%Fix Rate
85%Confidence
1Evidence
2024-03-15First Seen

Version Compatibility

VersionStatusIntroducedDeprecatedNotes
Iron Dextran USP 50mg/mL active — — —
Feraheme (ferumoxytol) 30mg/mL active — — —
Injectafer (ferric carboxymaltose) 50mg/mL active — — —
Venofer (iron sucrose) 20mg/mL active — — —

Root Cause

IV iron preparations (e.g., iron dextran, ferric carboxymaltose) are highly irritant and can cause severe tissue necrosis and permanent brown staining if extravasated; immediate cessation and elevation are required.

generic

中文

静脉铁剂（如右旋糖酐铁、羧基麦芽糖铁）具有高度刺激性，外渗后可导致严重组织坏死和永久性棕色染色；需要立即停止输液并抬高患肢。

Official Documentation

https://www.ismp.org/resources/iv-iron-extravasation-prevention-and-management

Workarounds

  1. 88% success Stop infusion immediately, disconnect IV tubing, aspirate residual iron from the cannula, then remove cannula. Elevate affected limb above heart level. Apply cold compress (not ice directly) for 20 minutes on/off. Document extravasation with photos. Notify physician for possible plastic surgery consult. 
    Stop infusion immediately, disconnect IV tubing, aspirate residual iron from the cannula, then remove cannula. Elevate affected limb above heart level. Apply cold compress (not ice directly) for 20 minutes on/off. Document extravasation with photos. Notify physician for possible plastic surgery consult.
  2. 75% success For established iron extravasation with pain and blistering: apply topical 1% hydrocortisone cream twice daily, cover with non-adherent dressing, and monitor for skin breakdown. Refer to wound care team if necrosis develops. 
    For established iron extravasation with pain and blistering: apply topical 1% hydrocortisone cream twice daily, cover with non-adherent dressing, and monitor for skin breakdown. Refer to wound care team if necrosis develops.

中文步骤

  1. 立即停止输液，断开输液管，从套管中抽吸残留铁剂，然后拔除套管。将患肢抬高至心脏水平以上。冷敷（非直接冰敷）20分钟，交替进行。拍照记录外渗情况。通知医生，考虑整形外科会诊。
  2. 对于已形成的铁外渗伴有疼痛和水疱：每日两次外用1%氢化可的松乳膏，覆盖非粘性敷料，监测皮肤破损。如出现坏死，转诊至伤口护理团队。

Dead Ends

Common approaches that don't work:

  1. 85% fail

    Heat increases vasodilation and can worsen tissue damage; cold compress is preferred for iron extravasation.

  2. 92% fail

    This increases hydrostatic pressure, forcing more iron into the interstitial space and worsening necrosis.

  3. 78% fail

    Hyaluronidase is indicated for chemotherapy extravasation, not iron; it may spread the iron further and increase injury area.