Vancomycin extravasation: Evaluation, treatment, and avoidance of this adverse drug event

Abstract

Purpose: To report the presentation, management, and potential future avoidance of vancomycin extravasation.

Summary: An 84-year-old woman was admitted to the emergency department due to observed seizures that progressed to statusepilepticus. Status epilepticus was controlled, but the patient developed hospital-acquired pneumonia, requiring treatment withvancomycin and cefepime. During treatment with vancomycin, extravasation occurred during peripheral administration. Coldpacks were immediately applied to the lesion for the next 24 hours with common gauze open dressings with frequent changes, andsilver sulfadiazine 1% topical application once daily were started on the day after extravasation. While skin necrosis developed, itdid not require surgical intervention and common gauze open dressings with frequent changes and silver sulfadiazine 1% topicallywere continued until the wound was healed.

Conclusion: Although the package insert warns of extravasation with potential necrosis during vancomycin administration, thiscase highlights a potentially under-reported adverse event. Vancomycin extravasation was successfully managed by utilizing coldcompress for the first 24 hours post-extravasation with common gauze open dressings and silver sulfadiazine 1% until the woundwas healed. With a potential for vancomycin extravasation when administered peripherally, we would recommend central venousadministration.