Hyaluronidase

Hyaluronidase

Indication

• 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 (E.G. dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine).

Pharmacology

• 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.

Side Effects

• Possible side effects include tachycardia, hypotension, erythema, vomiting, urticaria

Warning

• Not the agent of choice for management of extravasation of vasoactive medications
• do not inject around infected or inflamed areas

Dose

• Reconstitute and then dilute to a final concentration of 15 unit/mL using 0.9% NaC1
• Reconstitution and dilution directions:
  1. Reconstitute a 1,500 unit ampoule with 1 mL 0.9% NaCI
     (concentration = 1,500 units / mL)
  2. 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
  1. Directly through IV catheter
     1. leave IV catheter or needle in place
     2. aspirate the infiltrated IV fluid, if possible
     3. pull back the IV catheter or needle 1-2 mm to remove it from the vein, but leaving it in the subcutaneous tissue
     4. inject 1 mL (15 units/mL of hyaluronidase through the catheter, then remove the catheter

2. Subcutaneous (sc) injection around affected area
   1. inject 0.2 mL (15 units/ mL) sc in up to 5 separate sites around the affected area (see Diagram)
   2. the needle (use 25 g or smaller) should be changed after each injection

• Hyaluronidase treatment of an extravasation injury may be treated by a physician, neonatal nurse practitioner or a trained registered under the supervision of an MD or CNS. 

Supplied As

• 1,500 units ampoule (lyophilized powder)
• trade name is Hyalase®
• note that "IU" means International Unit (just 'unit' is used in our monograph)