Clinical Practice Guideline for the Management of Non-chemotherapeutic Extravasation: A Multidisciplinary Delphi-driven Consensus Study.

Abstract

Background: Extravasation, the unintended leakage of an intravenous drug into surrounding tissue, is a serious complication of parenteral therapy that can cause skin necrosis, functional impairment, or limb loss. Most existing guidelines focus on chemotherapeutic agents; however, serious injury also occurs with non-chemotherapeutic drugs, and comprehensive guidance for these agents is lacking.

Objectives: To develop a structured, evidence-based guideline to support the prevention, early recognition, and management of nonchemotherapy drug extravasation.

Methods: The initial draft was informed by a systematic review of studies published between 2000 and September 2024, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and by an analysis of existing protocols. The subsequent three-round Delphi consensus process was conducted in accordance with the Conducting and REporting of DElphi Studies guidelines.

Results: The panel comprised six pharmacists, three vascular surgeons, and four expert nurses. Consensus (≥ 70%) was reached on 20 final items. The guideline addresses the mechanisms of tissue injury, major complications, and preventive strategies. It also addresses previously underexplored areas, including drug risk stratification, early detection technologies, appropriate catheter selection for prevention, and emerging therapeutic approaches that require further evaluation. This guideline is intended to equip frontline clinicians (nurses, pharmacists, and surgeons) to support patient safety and standardize care for vulnerable populations receiving intravenous therapy; its effects on injury incidence and severity should be confirmed in future implementation studies.

Conclusions: This structured, consensus-based guideline incorporates novel domains and updates prior protocols. It may help standardize the recognition and management of non-chemotherapeutic drug extravasation; however, its clinical impact should be evaluated in future implementation studies.