Extravasation

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Extravasation is the leakage of a fluid out of its contained space into the surrounding area, especially blood or blood cells from vessels. In the case of inflammation, it refers to the movement of white blood cells through the capillary wall, into the surrounding tissues. This is known as leukocyte extravasation, also called diapedesis. In the case of cancer metastasis, it refers to cancer cells exiting the capillaries and entering other tissues, where secondary tumors may form. The term is commonly used in a medical context.

More specifically, extravasation can refer to:

Extravasation of irrigation fluid[edit]

Extravasation of irrigation fluid is the unintended migration of irrigation fluid (e.g., saline) introduced into a human body. This may occur in several types of endoscopic surgery, such as minimally invasive orthopedic surgery, i.e., arthroscopy, TURP (trans-urethral resection of the prostate), and TCRE (trans-cervical resection of the endometrium).[1]

In arthroscopy, fluid under pressure is used to inflate and distend a joint and make a working surgical space. Arthroscopy is typically performed on shoulder and knee joints; however, hip arthroscopy is becoming more popular. Arthroscopy is done by making surgical portals or puncture wounds into the joint. A surgical instrument called an arthroscope is used to introduce irrigation fluid under pressure to distend the joint. The arthroscope includes a small (typically 4 mm in diameter) optic scope rod to view the joint. Other portals or puncture wounds are made to introduce surgical instruments to perform cutting or repair procedures.[2][3]

If the joint is surrounded by soft tissue, as in the shoulder and hip, fluid under pressure may leak out of the joint space through the surgical portals and collect in the patient's soft tissue. A typical arthroscopy can result in 1–3 liters of irrigation fluid being absorbed into the patient's interstitial tissue. This buildup of irrigation fluid in the soft tissue may cause edema. This swelling can interfere with the arthroscopic procedure by collapsing the surgical space, or migrating into the patient's neck and causing airway blockage.[4] In hip arthroscopy, a feared complication is abdominal flooding where the irrigation fluid leaks from the hip joint capsule and drains into the abdominal cavity.[5] Risk factors for fluid extravasation include procedure length (>90–120 min), obesity, and age (>45–50) with accompanying lack of muscle tone.[6]

Shoulder arthroscopy is typically limited to about 90–120 minutes before the swelling from fluid extravasation interferes with the procedure, and presents a potential risk to the patient. Typically, fluid extravasation is managed by controlling fluid pressure, or hastening the procedure.[7]

Extravasation of infusates[edit]

Extravasation may also refer to the leakage of infused substances from the vasculature into the subcutaneous tissue. The leakage of high-osmolarity solutions or chemotherapy agents can result in significant tissue destruction and significant complications.

See also[edit]

  1. ^ Doyle, Glynda Rees; McCutcheon, Jodie Anita. "Chapter 8. Intravenous Therapy". Clinical Procedures for Safer Patient Care. BCcampus.
  2. ^ "What Is Arthroscopy?". WebMD. Retrieved 2024-05-11.
  3. ^ "Arthroscopy - Mayo Clinic". www.mayoclinic.org. Retrieved 2024-05-11.
  4. ^ Vier, Brandon R.; Mombell, Kyle W.; Gagliano, Erin L.; King, Nicole M.; McDonald, Lucas S. (2019-06-11). "Extravasation of fluid in arthroscopic shoulder surgery requiring prolonged intubation: a case report". Patient Safety in Surgery. 13 (1): 21. doi:10.1186/s13037-019-0202-8. ISSN 1754-9493. PMC 6560911. PMID 31205484.
  5. ^ Shakuo, Tomoharu; Bito, Kiyoko; Yasuda, Seiichi; Asagi, Chie (2017-05-08). "Abdominal compartment syndrome during hip arthroscopy for an acetabular fracture: a case report". JA Clinical Reports. 3 (1): 24. doi:10.1186/s40981-017-0100-y. ISSN 2363-9024. PMC 5804609. PMID 29457068.
  6. ^ Park, Soon Mi; Jeong, Ihn Sook; Jun, Seong Sook (2016-06-28). "Identification of Risk Factors for Intravenous Infiltration among Hospitalized Children: A Retrospective Study". PLOS ONE. 11 (6): e0158045. Bibcode:2016PLoSO..1158045P. doi:10.1371/journal.pone.0158045. ISSN 1932-6203. PMC 4924835. PMID 27351488.
  7. ^ Khan, Ferhan; Padmanabha, Sampathila; Shantaram, Manjula; Aravind, M (2013). "Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy". Journal of Anaesthesiology, Clinical Pharmacology. 29 (4): 578–579. doi:10.4103/0970-9185.119171. ISSN 0970-9185. PMC 3819872. PMID 24250015.

References[edit]

  • Complications in Orthopaedics: Shoulder Arthroscopy, chapter "Severe Edema During Shoulder Arthroscopy" pp 9–16, Xavier A. Duralde, MD, editor.
  • Immediate postoperative fluid retention and weight gain after shoulder arthroscopy. LoIK, Burkhart SS. Arthroscopy. 2005 May; 21(5):605–610.
  • Life Threatening Airway Edema Resulting From Prolonged Shoulder Arthroscopy, Steven L. Orebaugh, M.D. Anesthesiology, V 99, No. 6, December 2003.
  • Severe Airway Obstruction During Arthroscopic Shoulder Surgery, Stephan Blumenthal, M.D., Marco Nadig, M.D., Christian Gerber, M.D., Alain Borgeat, M.D. Anesthesiology, V 99, No. 6, December 2003.
  • Complete Airway Obstruction During Shoulder Arthroscopy, Hynson, J.M., Tung, A., Guevara, J.E., et al. Anesthesiology Analg, 76:875–878, 1993.
  • Complications of hip arthroscopy, Sampson, T.G. Clin Sports Med. 20(4):831–835, October 2001.

External links[edit]

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