- the management of IV extravasations (leakage of an IV fluid out of a vein and into surrounding tissue).
- NOT for the management of extravasation due to vasoactive medications (eg. dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine).
- hyaluronidase is an enzyme that breaks down hyaluronic acid, which is a major component of the normal interstitial barrier of the body's connective tissues
- this results in the diffusion of the extravasated fluids, causing a dilution effect and a reduction in tissue destruction
- the interstitial barrier is reported to be completely restored within 24 to 48 hours
- first described in 1929 and referred to as a "spreading factor"
- hyaluronidase has been shown to be effective with extravasation of calcium, parenteral nutrition, penicillin, gentamicin, aminophylline, potassium, radiographic dye, sodium bicarbonate and mannitol
- most effective if administered within 1 hour of the extravasation, but may still be beneficial as long as 12 hours later
- in less than 10 minutes hyaluronidase use results in diffusion of the extravasated fluid over an area 3 to 5 times larger than if the injury was left untreated.
- possible side effects include tachycardia, hypotension, erythema, vomiting, urticaria
- NOT the agent of choice for management of extravasation of vasoactive medications
- do NOT inject around infected or inflamed areas
- Reconstitute and then dilute to a final concentration of 15 unit/mL using 0.9% NaC1
- Reconstitution and dilution directions:
- Reconstitute a 1,500 unit ampoule with 1 mL 0.9% NaCI
(concentration = 1,500 units / mL)
- Draw up 0.1mL (of 1,500 units/mL solution) and add to 9.9 mL 0.9% NaCI
(concentration = 150 units / 10mL = 15 units / mL)
- may be given by 2 methods
- Directly through IV catheter
- leave IV catheter or needle in place
- aspirate the infiltrated IV fluid, if possible
- pull back the IV catheter or needle 1-2 mm to remove it from the vein, but leaving it in the subcutaneous tissue
- inject 1 mL (15 units/mL of hyaluronidase through the catheter, then remove the catheter
- Subcutaneous (sc) injection around affected area
- inject 0.2 mL (15 units/ mL) sc in up to 5 separate sites around the affected area (see Diagram)
- the needle (use 25 g or smaller) should be changed after each injection
HYALURONIDASE TREATMENT OF AN EXTRAVASTION INJURY MAY BE TREATED BY A PHYSICIAN, NEONATAL NURSE PRACTITIONER OR A TRAINED REGISTERED NURSE UNDER THE SUPERVISION OF AN MD OR CNS.
Figure 1 is from Reference #134
- 1,500 units ampoule (lyophilized powder)
- trade name is Hyalase®
- note that "IU" means International Unit (just 'unit' is used in our monograph)
- Banta C : Hyaluronidase, Neonatal Network 1992; 11: 103-5.
- Flemmer L and Chan JSL : A pediatric protocol for management of extravasation injuries, Pediatric Nursing 1993; 19 : 355-8, 424.
- "Hyaluronidase" in Taketomo CK, Hodding JH and Kraus DM : Pediatric Dosing Handbook, 1998-99, 5th Edition, American Pharmaceutical Association.
- Zenk KE, Dungy CI and Greene GR : Nafcillin extravasation injury - use of hyaluronidase as an antidote, Am J Dis Child 1981; 135 : 1113-4.
New: October 2002