Objective: Extravasation during peripheral intravenous injection is related to physical or biologic factors of medications, patient morbidity, and the procedure of injection. The mechanism of tissue damage from non-cytotoxic agents includes extreme pH, osmolality, and pharmacological property. Explicit definition on risk stratification of cytotoxic agents and standard operating procedure of extravasation treatment were promulgated; however, limited alert has been constructed on awareness on extravasation of non-cytotoxic vesicants. This study aims to establish the list of noncytotoxic vesicants as reference for health professionals.
Methods: Systematic reviews and narrative reviews with non-cytotoxic vesicants list have been searched in Cochrane, PubMed, and Embase. The agents which presented in two or more included studies were enrolled in the prototype list. The prototype list would be used to investigate the experience of extravasation in different wards. The final non-cytotoxic vesicants list would be established based on the best evidence and clinical experience.
Results: Four review articles were included with 53, 28, 29, and 20 non-cytotoxic vesicants, respectively. Thirty-six medications have been mentioned in two or more included studies. After the surveillance, 25 agents were reported with extravasation, which included 23 agents in the prototype list. The final list is composed of 27 noncytotoxic vesicants.
Conclusion: The development of non-cytotoxic vesicants list could enhance the awareness for nurses during the process of peripheral intravenous injection to reduce incidence of extravasation or phlebitis. Moreover, the list could also be integrated into the alert system for the comprehensive evaluation of patient before and after the procedure of injection.
Summited for publication: 2021.1.26; Accepted for publication: 2021.4.22