Management of TPN Extravasation

Immediate Actions

The American College of Oncology recommends stopping the TPN infusion immediately upon recognition of extravasation, leaving the IV cannula in place to aspirate as much extravasated solution as possible, and applying dry cold compresses for 20 minutes four times daily for 1-2 days, elevating the limb, and providing analgesia as needed 1, 2
The American College of Oncology suggests gently aspirating as much of the extravasated TPN solution as possible through the existing cannula, and documenting the volume removed in the patient record 1, 2, 3
The American College of Oncology advises avoiding applying manual pressure over the extravasated area, as this can worsen tissue damage 1, 2

The American College of Oncology recommends applying dry cold compresses for 15-20 minutes, four times daily for 24-48 hours, and avoiding alcohol-based compresses 1, 2
Elevating the affected limb can help reduce edema, as recommended by the American College of Oncology 1, 2, 3
Administering analgesia as necessary can help with patient comfort, according to the American College of Oncology 1, 2

Using the smallest gauge catheter compatible with therapy needs can help reduce the risk of extravasation, as suggested by Praxis Medical Insights 4
Maintaining peripheral TPN osmolarity <900 mOsmol/L can help reduce thrombophlebitis and extravasation risk, according to Clinical Nutrition 5, 6
Ensuring adequate catheter fixation can help prevent mechanical irritation and dislodgement, as recommended by Praxis Medical Insights 4

The American College of Oncology advises against using subcutaneous corticosteroids, as retrospective data shows that intralesional corticoids increased the need for surgical debridement 2, 7, 3