TREATMENT OF EXTRAVASATION FROM PARENTERAL-NUTRITION SOLUTION

OBJECTIVE: To report two cases of parenteral nutrition extravasation a nd their treatment in adult patients. CASE SUMMARIES: Case 1: A 23-yea r-old white woman was admitted to our hospital diagnosed with a gastro intestinal infection by Salmonella paratyphi sv. B. The treatment incl uded peripheral parenteral nutrition (osmolarity 652 mOsm/L). After 4 days an extravasation of parenteral nutrition was detected in the left antecubital fossa. The affected area soon became inflamed, Chondroiti nsulfatase 150 turbidity-reducing units (TRUs), diluted in 3 mt of NaC l 0.9% and administered in six subcutaneous applications around the ar ea, was prescribed. The treatment was successful. The patient was disc harged several days later with no sequelae of the extravasation. Case 2: A 33-year-old white woman was admitted to the intensive care unit a fter surgery for a necrohemorrhagic pancreatitis. The treatment includ ed parenteral nutrition via a central catheter (osmolarity 2130 mOsm/L ). Two days later the patient presented a parenteral nutrition subcuta neous extravasation in her left hemithorax around the catheter access site. Chondroitinsulfatase 200 TRUs, diluted in 2 mt of NaCl 0.9% and administered in eight subcutaneous applications around the area, was p rescribed. No sequelae of the incident remained. The patient was disch arged home 2 months later, DISCUSSION: Parenteral nutrition solution c an cause tissue harm after extravasation. Both patients presented an i ntense inflammatory reaction after the accident. Three treatments have been used in extravasation of parenteral nutrition, but in our patien ts hyaluronidase was the only applicable treatment. As this enzyme is not commercially available in Spain, chondroitinsulfatase, an enzyme v ery similar to hyaluronidase, was used. CONCLUSIONS: Chondroitinsulfat ase was useful in treating extravasation of parenteral nutrition in tw o adult patients.