extravasation

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).{{Cite book | vauthors = Doyle GR, McCutcheon JA | chapter-url = https://opentextbc.ca/clinicalskills/chapter/intravenous-therapy-peripheral-and-central-venous-catheters/ |title=Clinical Procedures for Safer Patient Care |publisher=BCcampus |chapter=Chapter 8. Intravenous Therapy| date = 23 November 2015 }}

In arthroscopy, fluid under pressure is used to inflate and distend a joint and make a working surgical space. An arthroscopy is typically performed on shoulder and knee joints; however, hip arthroscopy is becoming more popular. An 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.{{Cite web | veditors = Zelman D |title=What Is Arthroscopy? |url=https://www.webmd.com/arthritis/what-is-arthroscopy |access-date=2024-05-11 |website=WebMD |language=en}}{{Cite web |title=Arthroscopy - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/arthroscopy/about/pac-20392974#:~:text=Arthroscopy%20(ahr-THROS-kuh,a%20high-definition%20video%20monitor. |access-date=2024-05-11 |website=www.mayoclinic.org}}

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.{{cite journal | vauthors = Vier BR, Mombell KW, Gagliano EL, King NM, McDonald LS | title = Extravasation of fluid in arthroscopic shoulder surgery requiring prolonged intubation: a case report | journal = Patient Safety in Surgery | volume = 13 | issue = 1 | pages = 21 | date = 2019-06-11 | pmid = 31205484 | pmc = 6560911 | doi = 10.1186/s13037-019-0202-8 | doi-access = free }} 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.{{cite journal | vauthors = Shakuo T, Bito K, Yasuda S, Asagi C | title = Abdominal compartment syndrome during hip arthroscopy for an acetabular fracture: a case report | journal = JA Clinical Reports | volume = 3 | issue = 1 | pages = 24 | date = 2017-05-08 | pmid = 29457068 | pmc = 5804609 | doi = 10.1186/s40981-017-0100-y | doi-access = free }} Risk factors for fluid extravasation include procedure length (>90–120 min), obesity, and age (>45–50) with accompanying lack of muscle tone.{{cite journal | vauthors = Park SM, Jeong IS, Jun SS | title = Identification of Risk Factors for Intravenous Infiltration among Hospitalized Children: A Retrospective Study | journal = PLOS ONE | volume = 11 | issue = 6 | pages = e0158045 | date = 2016-06-28 | pmid = 27351488 | pmc = 4924835 | doi = 10.1371/journal.pone.0158045 | doi-access = free | bibcode = 2016PLoSO..1158045P }}

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.{{cite journal | vauthors = Khan F, Padmanabha S, Shantaram M, Aravind M | title = Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy | journal = Journal of Anaesthesiology Clinical Pharmacology | volume = 29 | issue = 4 | pages = 578–579 | date = October 2013 | pmid = 24250015 | pmc = 3819872 | doi = 10.4103/0970-9185.119171 | doi-access = free }}

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

• Arthroscopy
• Intravasation

{{Reflist}}

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• {{cite book | chapter = Severe Edema During Shoulder Arthroscopy | title = Complications in Orthopaedics: Shoulder Arthroscopy | publisher = American Academy of Orthopaedic Surgeons | date = 2006 | pages = 9–16 | veditors = Duralde XA | isbn = 978-0-89203-499-4 }}
• {{cite journal | vauthors = Blumenthal S, Nadig M, Gerber C, Borgeat A | title = Severe airway obstruction during arthroscopic shoulder surgery | journal = Anesthesiology | volume = 99 | issue = 6 | pages = 1455–1456 | date = December 2003 | pmid = 14639164 | doi = 10.1097/00000542-200312000-00033 }}
• {{cite journal | vauthors = Hynson JM, Tung A, Guevara JE, Katz JA, Glick JM, Shapiro WA | title = Complete airway obstruction during arthroscopic shoulder surgery | journal = Anesthesia and Analgesia | volume = 76 | issue = 4 | pages = 875–878 | date = April 1993 | pmid = 8466032 | doi = 10.1213/00000539-199304000-00033 }}
• {{cite journal | vauthors = Lo IK, Burkhart SS | title = Immediate postoperative fluid retention and weight gain after shoulder arthroscopy | journal = Arthroscopy | volume = 21 | issue = 5 | pages = 605–610 | date = May 2005 | pmid = 15891729 | doi = 10.1016/j.arthro.2005.01.008 }}
• {{cite journal | vauthors = Orebaugh SL | title = Life-threatening airway edema resulting from prolonged shoulder arthroscopy | journal = Anesthesiology | volume = 99 | issue = 6 | pages = 1456–1458 | date = December 2003 | pmid = 14639165 | doi = 10.1097/00000542-200312000-00034 }}
• {{cite journal | vauthors = Sampson TG | title = Complications of hip arthroscopy | journal = Clinics in Sports Medicine | volume = 20 | issue = 4 | pages = 831–835 | date = October 2001 | pmid = 11675890 | doi = 10.1016/s0278-5919(05)70288-x }}
• {{cite journal | vauthors = Syed HM, Gillham SB, Jobe CM, Phipatanakul WP, Wongworawat MD | title = Fenestrated cannulae with outflow reduces fluid gain in shoulder arthroscopy | journal = Clinical Orthopaedics and Related Research | volume = 468 | issue = 1 | pages = 158–62 | date = January 2010 | pmid = 19557486 | pmc = 2795841 | doi = 10.1007/s11999-009-0955-y }}

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• [http://www.extravasation.org.uk/ British National Health Service page on complications from extravasation of infusates].
• [http://www.cannuflow.com/research_archive.html#extravasation/ Cannuflow Research archive on extravasation in shoulder arthroscopy]

Category:Medical terminology