Propofol extravasation is often self-limited but can cause tissue necrosis and, rarely, compartment syndrome. A healthy 13-year-old girl (35 kg) undergoing hysteroscopy developed extravasation at the antecubital fossa during the manual administration of 10 mL of propofol 1% through a previously placed 24-gauge peripheral intravenous catheter in the right cephalic vein. A 5-mL saline flush immediately beforehand caused neither pain nor visible swelling. Near the completion of the propofol administration, pain developed with marked swelling, pallor, and capillary refill of approximately four seconds; the radial pulse and hand motor and sensory function remained intact. The patient remained fully conscious and responsive without evident systemic sedative effects. Propofol administration was stopped, another intravenous line was established, and general anesthesia was induced through the new access. The actual amount of the initial 100-mg propofol dose that extravasated into the tissues could not be determined. Aspiration through the original catheter yielded no return. Five 22-gauge passive drainage punctures and subsequent aspiration and enlargement of the catheter tract with a 16-gauge needle also produced no drainage. A pediatric surgeon who was present suggested limited blunt opening of the pre-existing catheter tract. A small Klemmer clamp was introduced approximately 5 mm into the tract and gently opened in multiple radial directions, allowing the immediate drainage of a clinically estimated 8-10 mL of whitish lipid-containing fluid mixed with blood, followed by rapid tissue softening and improvement in local perfusion. Formal ultrasonography at approximately 24 hours showed soft-tissue edema without a significant fluid collection, and clinical recovery was complete at seven days. This case describes drainage through a pre-existing intravenous tract after failed catheter aspiration and needle drainage. The maneuver was nonstandard, cannot be considered an alternative to guideline-directed surgical assessment or washout, and should not delay urgent surgical evaluation when compartment syndrome or ongoing neurovascular compromise is suspected. This single-case observation is hypothesis-generating and does not support the routine adoption of the maneuver.
Reference:Taffache P. Drainage of a Tense Propofol Extravasation Through a Pre-existing Intravenous Tract in an Adolescent: A Case Report. Cureus. 2026 Sep 8;18(9):e115949. doi: 10.7759/cureus.115949. PMID: 42852107; PMCID: PMC13648259.