Emergency Department Nurses’ Knowledge and Practices Related to Extravasation Injuries of Non-Cytotoxic Medications

Abstract

BACKGROUND: Extravasation of non-cytotoxic medications can lead to serious complications such as pain, tissue necrosis, limb loss, and even death. This descriptive cross-sectional study aims to assess the knowledge levels of emergency department (ED) nurses regarding extravasation incidents involving non-cytotoxic medications and to highlight the importance of effective management and prevention. METHODS: The study was conducted in the EDs of three hospitals in Istanbul, Türkiye, between November 19, 2020 and December 31, 2020. A total of 100 ED nurses participated in the study. Inclusion criteria required nurses to be working full-time in the EDs during the study period and to provide written and verbal consent. The study utilized a survey to assess sociodemographic characteristics, knowledge of non-cytotoxic medications (e.g., epinephrine), symptoms of extravasation, prevention strategies, and intervention practices. RESULTS: The mean age of the nurses was 29.43 years, with 57% female and 73% holding a bachelor’s degree. Among participants, 52% had 0-3 years of ED experience. Ninety-one percent reported not receiving education on extravasation after graduation, and 82% indicated no extravasation protocol was in place at their workplace. Knowledge about non-cytotoxic medications causing extravasation significantly increased with ED experience (p=0.035). Nurses in units with an extravasation protocol had significantly higher knowledge levels (p=0.007). Female nurses demonstrated better knowledge of extravasation symptoms than male nurses (p=0.012). Nurses with a bachelor’s or higher degree had significantly better knowledge than others (p=0.015). The knowledge rate for the extravasation care protocol was 64%, with the most recognized protocol item being “immediately stop the infusion” (97%) and the least recognized being “aspirate the medication not to exceed 3-5 mL” (33%). Strong correlations were found between non-pharmacological factors and knowledge of non-cytotoxic medications (r=0.601; p<0.001), as well as between knowledge of extravasation care protocols and non-pharmacological factors (p<0.001). CONCLUSION: The study highlights the need for targeted education and the establishment of institutional protocols for managing and preventing extravasation in EDs. Nurses' knowledge significantly impacts their adherence to prevention and care protocols. To ensure patient safety, it is important to provide ongoing education and implement evidence-based intervention protocols for the management of extravasation in ED settings. © 2025 Elsevier B.V., All rights reserved.