Which combination of agents is commonly implicated in causing extravasation injuries?

• A. Sodium bicarbonate and phenergan
• B. Potassium chloride
• C. Heparin
• D. Normal saline

Answer: (A)

Extravasation injuries occur when a vesicant or caustic IV medication leaks into surrounding tissue, causing chemical burns and potential tissue necrosis. Promethazine (Phenergan) is a well-known vesicant, meaning its leakage can cause significant tissue damage. Sodium bicarbonate solutions are alkaline and can injure tissue if they escape from the vein. When these two are given together in the same IV line, the risk of severe tissue injury from extravasation is heightened, making this combination a commonly implicated cause. In practice, preventing these injuries involves careful IV site selection and minimizing peripheral administration of vesicants, with prompt action if extravasation is suspected (stop the infusion, attempt to aspirate, and assess the tissue for damage).