Extravasering vid behandlingar med aciklovir, kaliumfosfat och kaliumklorid inom intensivvården

• Main Author: Karim, Lara
• Format: Others
• Language: Swedish
• Published: Uppsala universitet, Institutionen för farmaceutisk biovetenskap 2020
• Subjects: Extravasation; acyclovir; potassium phosphate; potassium chloride; pH; osmolality; tissue damage; Social and Clinical Pharmacy; Samhällsfarmaci och klinisk farmaci
• Online Access: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-415750

Extravasation is a condition that can occur during an intravenous administration. This means that the solution administered intravenously goes extravascular. Depending on physiochemical properties of the substance and solution, this can cause different severity of the damage. Extravasation of acyclovir, potassium phosphate and potassium chloride causes severe tissue damage that can, in worst case, lead to tissue necrosis. The purpose was therefore to investigate how acyclovir, potassium phosphate and potassium chloride causes tissue damage due to pH and osmolality and how the tissue damage can be avoided. To answer the purpose, a comprehensive literature search was conducted on three different databases; Pubmed, CINAHL and Cochrane. The literature search was in progress from February 4 to May 14 2020. The literature search generated a total of 42 articles and case reports, of which 13 of these were relevant for the purpose. These 13 articles consisted of two animal studies, three experimental observational studies, two guidelines from Västra Götalands Region, three case reports about acyclovir and three case reports of potassium phosphate and potassium chloride.   Two of the experimental observational studies showed that potassium chloride could be diluted with 100 mL of 0,9% sodium chloride or 5% dextrose in water to possibly avoid tissue damage due to extravasation. Such results were not found for either acyclovir or potassium phosphate. The conclusion that could be drawn was that acyclovir caused tissue damage because of its alkaline pH, potassium phosphate because of its hyperosmolality and potassium chloride because of its acidic pH and its hyperosmolality. One way to possibly avoid tissue damage caused by extravasation is to dilute the substances with higher dilution volumes. However, due to the lack of reliability of the included studies, it cannot be safely concluded that tissue damage can be avoided.