{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:32:48Z","timestamp":1787923968220,"version":"build-2784847793"},"reference-count":31,"publisher":"Belitung Raya Foundation","issue":"4","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"This study was funded by Health Systems Research Institute (HSRI), Thailand\n(No. 61_086), and the Faculty of Nursing, Thammasat University","award":[""],"award-info":[{"award-number":[""]}]}],"content-domain":{"domain":["belitungraya.org"],"crossmark-restriction":true},"short-container-title":["Belitung Nurs J"],"abstract":"<jats:p>Background: Extravasation is a serious complication of peripheral intravenous (PIV) therapy. It has been linked to mechanical disruption of a PIV line due to inappropriate site selection or securement, and to the pH, concentration, and cytotoxic properties of the infused solution or drug. However, evidence on extravasation in patients receiving noncytotoxic drugs remains limited. Understanding the causes and risk factors in this population is essential for prevention, early detection, and the development of interventions.\nObjective: To examine demographic and clinical factors associated with extravasation severity in adult Thai patients receiving noncytotoxic drug PIV therapy.\nMethods: This observational study included 193 participants at high risk of extravasation during PIV therapy. They were recruited from four tertiary hospitals in four regions of Thailand between December 2019 and December 2023 using purposive sampling. Extravasation severity was assessed using an artificial deep neural network for automated screening of skin images via a smartphone application, with confirmation by a dermatologist. Demographic, clinical, and medical data were collected using standardized forms and analyzed with descriptive statistics and Spearman\u2019s rank correlation coefficient.\nResults: Extravasation was mostly mild (47.67%), followed by moderate (31.09%) and severe (21.24%). Extravasation severity was strongly and negatively correlated with drug pH (r = \u22120.532; p &lt; 0.01), moderately with concentration (r = 0.411), and methods of drug administration (r = 0.327) (p &lt; 0.01). History of IV insertion showed a mild correlation with severity (r = 0.145; p &lt; 0.05) but not with comorbidities, infusion duration, or catheter size.\nConclusion: The results highlight the importance of drug administration, especially the pH and type of drug, concentration, and route of administration, which play a critical role in reducing extravasation, thereby improving PIV therapy outcomes. Nurses play a role in preventing and managing extravasation by controlling the drug\u2019s pH and concentration, carefully monitoring early signs, and promptly initiating interventions.<\/jats:p>","DOI":"10.33546\/bnj.4436","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:17:49Z","timestamp":1787883469000},"page":"509-520","update-policy":"https:\/\/doi.org\/10.33546\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with extravasation severity in Thai patients receiving noncytotoxic intravenous infusions: An observational study"],"prefix":"10.33546","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4574-1070","authenticated-orcid":false,"given":"Thitiporn","family":"Pathomjaruwat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borwarnluck","family":"Thongthawee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Padcha","family":"Pongcharoen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charturong","family":"Tantibundhit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19163","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"161054","doi-asserted-by":"crossref","unstructured":"Alexander, L. (2020). Extravasation injuries: A trivial injury often overlooked with disastrous consequences. World Journal of Plastic Surgery, 9(3), 326\u2013330. https:\/\/doi.org\/10.29252\/wjps.9.3.326","DOI":"10.29252\/wjps.9.3.326"},{"key":"161055","doi-asserted-by":"crossref","unstructured":"Blazquez Vidal, M., Garcia del Valle, I., Amoros\u2010Reboredo, P., Diaz\u2010Herrera, M. A., Val\u2010Prat, L., & Sanmartin\u2010Su\u00f1er, M. (2025). Real world data on the management of non\u2010cytotoxic drug extravasation: An observational retrospective study in paediatric and adult patients. Nursing in Critical Care, 30(2), e70020. https:\/\/doi.org\/10.1111\/nicc.70020","DOI":"10.1111\/nicc.70020"},{"key":"161056","unstructured":"Buter, J., Steele, K. T., & Chung, K. C. (2024). Extravasation injury from cytotoxic and other noncytotoxic vesicants in adults. UpToDate. https:\/\/www.uptodate.com\/contents\/extravasation-injury-from-cytotoxic-and-other-noncytotoxic-vesicants-in-adults"},{"key":"161057","unstructured":"Butsankot, P., Thosingha, O., Chanruangvanich, W., & Chawasiri, C. (2016). The influence of co-morbidity, body mass index, and depression on post - operative recovery among patients undergoing lumbar surgery [in Thai]. Journal of Nursing Science 34(2), 129\u2013141. https:\/\/he02.tci-thaijo.org\/index.php\/ns\/article\/view\/77357"},{"key":"161058","doi-asserted-by":"crossref","unstructured":"Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373\u2013383. https:\/\/doi.org\/10.1016\/0021-9681(87)90171-8","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"161059","doi-asserted-by":"crossref","unstructured":"Chiu, K., Tindholdt, T. T., & T\u00f8nseth, K. A. (2016). Extravasation injuries. Tidsskrift for Den norske legeforening, 136(3), 233\u2013235. https:\/\/doi.org\/10.4045\/tidsskr.15.0230","DOI":"10.4045\/tidsskr.15.0230"},{"key":"161060","doi-asserted-by":"crossref","unstructured":"David, V., Christou, N., Etienne, P., Almeida, M., Roux, A., Taibi, A., & Mathonnet, M. (2020). Extravasation of noncytotoxic drugs. Annals of Pharmacotherapy, 54(8), 804\u2013814. https:\/\/doi.org\/10.1177\/1060028020903406","DOI":"10.1177\/1060028020903406"},{"key":"161061","doi-asserted-by":"crossref","unstructured":"Farooq, M., Rehman, S., & Hussain, S. (2025). Incidence and risk factors of chemotherapy-induced extravasation in adult patients. medtigo Journal of Medicine, 3(1), e3062312. https:\/\/doi.org\/10.63096\/medtigo3062312","DOI":"10.63096\/medtigo3062312"},{"key":"161062","doi-asserted-by":"crossref","unstructured":"Gorski, L. A. (2017). The 2016 infusion therapy standards of practice. Home Healthcare Now, 35(1), 10\u201318. https:\/\/doi.org\/10.1097\/nhh.0000000000000481","DOI":"10.1097\/NHH.0000000000000481"},{"key":"161063","doi-asserted-by":"crossref","unstructured":"Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., & Sharpe, E. (2021). Infusion therapy standards of practice, 8th Edition. Journal of Infusion Nursing, 44(1S), S1\u2013S224. https:\/\/doi.org\/10.1097\/NAN.0000000000000396","DOI":"10.1097\/NAN.0000000000000396"},{"key":"161064","doi-asserted-by":"crossref","unstructured":"Kaphan, K., Auypornsakul, S., Somno, J., Wongwattananan, W., Jamsittikul, K., Baicha, W., Somsri, S., & Sawatrak, T. (2024). The prevalence and associated factors of peripheral intravenous complications in a Thai hospital. Journal of Infusion Nursing, 47(2), 120\u2013131. https:\/\/doi.org\/10.1097\/NAN.0000000000000538","DOI":"10.1097\/NAN.0000000000000538"},{"key":"161065","doi-asserted-by":"crossref","unstructured":"Karimee, D., Buakhong, M., Lertvipapath, P., & Limsuwat, C. (2024). Incidence of extravasation during norepinephrine administration via peripheral venous catheter in emergency patients. Journal of Health Science and Medical Research, 42(4), 20241039. http:\/\/dx.doi.org\/10.31584\/jhsmr.20241039","DOI":"10.31584\/jhsmr.20241039"},{"key":"161066","doi-asserted-by":"crossref","unstructured":"Le, A., & Patel, S. (2014). Extravasation of noncytotoxic drugs: A review of the literature. Annals of Pharmacotherapy, 48(7), 870\u2013886. https:\/\/doi.org\/10.1177\/1060028014527820","DOI":"10.1177\/1060028014527820"},{"key":"161067","doi-asserted-by":"crossref","unstructured":"Loubani, O. M., & Green, R. S. (2015). A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. Journal of Critical Care, 30(3), 653\u2013e659. https:\/\/doi.org\/10.1016\/j.jcrc.2015.01.014","DOI":"10.1016\/j.jcrc.2015.01.014"},{"key":"161068","unstructured":"Matsui, Y., Murayama, R., Tanabe, H., Oe, M., Motoo, Y., Wagatsuma, T., Michibuchi, M., Kinoshita, S., Sakai, K., & Konya, C. (2018). Factors associated with severe skin disorder after extravasation of intravenously infused antineoplastic agents. Journal of Nursing Science and Engineering, 5(1), 31\u201340. https:\/\/www.jstage.jst.go.jp\/article\/jnse\/5\/1\/5_31\/_pdf\/-char\/ja"},{"key":"161069","unstructured":"Mepap, L. D., Phanmanee, A., Sattayawong, K., Kasetkaewkan, T., Suebsao, N., Tonthap Thai, P. R., Sirisin, S., Jaichangreed, U., & Khanthong, P. (2020). Effectiveness of nursing practices for symptom management of extravasation in medical patients in Srinakarin Hospital [in Thai]. Khon Kaen University Hospital Journal, 1(4), 288\u2013303. https:\/\/kkuhj.com\/journal\/82f79f37ea3a4807909ff88590613973"},{"key":"161070","doi-asserted-by":"crossref","unstructured":"Montague, T. y., Weaver, S. B., & Wingate, L. M. T. (2023). Extravasation of non-cytotoxic drugs in older people. The Senior Care Pharmacist, 38(11), 457\u2013464. https:\/\/doi.org\/10.4140\/TCP.n.2023.457","DOI":"10.4140\/TCP.n.2023.457"},{"key":"161071","doi-asserted-by":"crossref","unstructured":"Munthuli, A., Intanai, J., Tossanuch, P., Pooprasert, P., Ingpochai, P., Boonyasatian, S., Kittithammo, K., Thammarach, P., Boonmak, T., & Khaengthanyakan, S. (2022). Extravasation screening and severity prediction from skin lesion image using deep neural networks. 2022 44th Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), Glasgow, Scotland, United Kingdom.","DOI":"10.1109\/EMBC48229.2022.9871115"},{"key":"161072","unstructured":"National Health Service [NHS]. (2025). Guidelines on treatment of extravasation with cytotoxic drugs. https:\/\/thamesvalleycanceralliance.nhs.uk\/wp-content\/uploads\/2025\/02\/Extravasation-TVSCN-Guidelines-version-5.1a.pdf"},{"key":"161073","doi-asserted-by":"crossref","unstructured":"Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., Ong, J., Clare, S., & Hagle, M. E. (2024). Infusion therapy standards of practice, 9th edition. 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