during IV administration, which of the following drug cause extravasation and damage to site ?

NORCET 6 Prelims -2024

Pharmacology

Easy

Appeared in: NORCET 6 Prelims -2024

Explanation

Phenytoin is a vesicant drug, which means it is capable of causing severe tissue damage and necrosis if it leaks outside the vein.
The primary mechanism of injury is its extremely high alkalinity (pH of approximately 12), which causes chemical burns to the inner lining of the vein and surrounding tissues.
Extravasation of phenytoin can lead to a specific, severe complication known as Purple Glove Syndrome, characterized by intense pain, swelling, and dark discoloration of the limb, potentially requiring surgical intervention.

Option A: Diazepam is classified as an irritant, not a vesicant. It can cause inflammation of the vein (phlebitis) and pain at the injection site, often due to the propylene glycol solvent in its formulation, but it does not typically cause the severe tissue death associated with vesicants like phenytoin.
Option B: Although epinephrine is a vesicant, its mechanism of tissue damage is different. It causes injury by inducing intense localized vasoconstriction, which cuts off blood supply to the tissue (ischemia), leading to necrosis. The question implies a direct damaging effect, for which phenytoin's chemical properties are a classic example.
Option D: Ranitidine is not classified as a vesicant or a significant irritant. It is generally well-tolerated during IV administration, and extravasation is not associated with severe tissue damage.

Visual 1: Photograph - An image showing a patient's hand and forearm with the characteristic dark purple discoloration and swelling of Purple Glove Syndrome after IV phenytoin administration. This helps visualize the severity of the complication.
Visual 2: Diagram - A flowchart illustrating the steps for managing a suspected vesicant extravasation, including stopping the infusion, attempting to aspirate the drug, notifying the provider, and administering an antidote if available.

Clinical Relevance

Nursing practice connection: Knowing Complications of IV therapy, specifically extravasation caused by vesicant drugs helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must always verify the vesicant potential of IV medications before administration and use appropriate precautions, such as selecting a large, patent vein and monitoring the site closely.
Recognizing the early signs of extravasation—pain, burning, swelling, or redness—is a critical patient safety competency. The infusion must be stopped immediately to prevent further tissue damage.
What if? If a patient receiving IV phenytoin complains of burning at the IV site, the nurse's first action is to stop the infusion immediately. Leaving the catheter in place, attempting to aspirate any residual drug, and notifying the provider are subsequent essential steps.

How to Approach the Question

First, identify the core concept of the question, which is drug-induced tissue damage during IV therapy (extravasation).
Next, recall the classification of IV drugs based on their potential to cause tissue damage: non-irritants, irritants, and vesicants.
Evaluate each option. Consider which of these drugs is well-known in clinical practice as a vesicant.
Phenytoin is a classic example of a non-chemotherapeutic vesicant due to its high pH. Epinephrine is also a vesicant but works differently. Diazepam is an irritant, and Ranitidine is generally safe.
Select Phenytoin as the most likely answer, as it is famous for causing severe chemical-based extravasation injuries like Purple Glove Syndrome.

Concept Tested & Keywords

Concept Tested: Complications of IV therapy, specifically extravasation caused by vesicant drugs.
Stem keywords: IV administration, extravasation, damage to site
Lead-in keywords: which of the following
Negative lead-in flag: false

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