J Korean Soc Plast Reconstr Surg.
1998 Jul;25(5):776-783.
The effectiveness of hyaluronidase for calcium gluconate-inducing extravasation necrosis : a dose and time response
Abstract
- Extravasation necrosis due to intravenously administered fluids and drugs is an increasing problem in hospital practice. The incidence of extravasation is variable but skin necrosis is a potentially devastating complication of intravenous therapy. Local injection of hyaluronidase has been recommended for several types of infusion extravasations. The previous studies found hyaluronidase to be effective in the prevention of necrosis following intradermal nafcillin, 12% dextrose, sodium bicarbonate, aminophylline or vince alkaloids.The objectives of the study are to determine the dosage of hyaluronidase which is effective in reducing extravasation necrosis caused by 10% calcium-gluconate and to establish how soon after this extravasation it must be given to retain its effectiveness.Study I evaluated control versus only normal saline group and normal saline with hyaluronidase groups (dose:75,150,300,450 units; all in volume 2 ml, treatment delay:immediate, 15-minutes delay, half hour delay, one hour delay, three hour delay). Size and rate of eschar were compared between groups. Study II was undertaken to examine the evolution of calcium-gluconate induced soft tissue injury in the rabbit. The histologic findings of extravasation sites were compared between groups. A statistically significant protective effect was found in the treated group versus the nontreated group within 15 minutes to 30 minutes. The most effective protection was achieved by the immediate injection of 300 units dosage of hyaluronidase.In conclusion, in the 10% calcium gluconate-induced extravasation, the given data suggest that one can expect the most protective effect with a 300 units dosage of hyaluronidase and within half-hour delay in the treatment group.
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