Year: 2026
Type: article
Study design: Case Report
Abstract: Case seriesquantification, characteristics of injected vesicant extravasation, and monitoring therapeutic response to lignocaine patch therapy.Written and informed consent for publication was taken from the patients. Case DesCriptionHere, we are going to report the applicability of POCUS quantification of vesicant extravasation and monitoring of therapeutic response to lignocaine patch in five patients who developed significant soft tissue swelling after extravasation of injected fluid.In cases 1 and 3, there occurs extravasation of a mixture of two and three drugs, respectively.Serial thickness measurements of skin, subcutaneous tissue, and extravesicant were done at 12, 24, and 36 hours.After baseline measurements introDuCtion Extravasation is the inadvertent leakage of a drug or fluid from a vessel into surrounding tissue, potentially causing pain, swelling, inflammation, and in severe cases, tissue necrosis and fibrosis.1 While vesicants and irritants are well recognized for causing damage, nonvesicants can also result in persistent induration and fibrosis, affecting future venous access.Risk factors include fragile veins, high infusion rates, prolonged cannulation, and impaired sensation.Clinical grading scales such as Millam scale and INS are limited in detecting early deep-tissue injury, especially in neonates and critically ill patients.2 Ultrasound measurements of extravasation as a point-of-care (POCUS) approach allow direct visualization of the epidermal, dermal, and subcutaneous layers, quantification of swelling via skin elevation ratio, and characterization of fluid echotexture.3 Preventive management includes prompt cessation of the infusion, aspiration of fluid from the cannula, application of heat to increase local vasodilation, and drug reabsorption.1 Severe cases may require local steroid therapy, local and systemic antibiotics, surgical incision with saline washout, or liposuction of the affected area, which can be performed to reduce tissue injury. 1 Lignocaine patches provide local analgesia and potential antiinflammatory effects, improving patient comfort and possibly reducing secondary tissue injury.Lignocaine after transdermal migration from lignocaine patch also decreases the inflammatory edema by decreasing histamine release from macrophages and thus reduces capillary hyperpermeability.4 This is a clinical case series of five cases that describes the applicability of ultrasound as a point of care for the 1-
Authors: Amarjeet Kumar, Kunal Singh, Purnaa Mandal
Institution: All India Institute of Medical Sciences, Patna
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7133185179