A new approach to skin extravasation injury management during the neonatal period

Abstract

Background To identify a standard protocol for managing extravasation injuries in neonates. Methods We recruited all the neonates with extravasation wounds from the neonatal intensive care unit of Shariati hospital, Tehran, Iran, between October 2018 and October 2020. Sixteen patients with grade 3–4 extravasation were evaluated in this retrospective study. All grade 3 and 4 extravasation wounds were injected with hyaluronidase at 5 points of the wound circle; the procedure was repeated every 5 min at different points in a smaller circle to the core. The wound was then covered with a warm compress for 24 h. Twenty-four hours after injection, the cover was changed twice a day with normal saline irrigation. Fibrinolysin ointment was applied on top of the wound. The ulcer was then dressed with phenytoin ointment until healing. Results Out of 16 neonates who were followed up, 10 of them were male, with the average birth weight being 1.37 (range 1.05–3.75) kg. The mean (± SD) wound healing duration was 13.12 (± 6) (range: 7–29) days. Factors including the cannulation duration before the appearance of the lesion (R:0.2, P = 0.2), birth weight (R = -.37, P = 015), and extravasated substances (p = 0.2) were not associated with the duration of hospital stay. The only exception to this trend is the wound size factor of 7.31(± 7.45) (R = .83, P < 0.001). Continuous and categorical variables were summarized as mean (SD) and proportions, respectively, and the Kruskal–Wallis test and Spearman correlation coefficients were used. Conclusions Limited evidence exists on the effects of different protocols on extravasation management in neonates in the NICU. We recommend our method as a standard protocol in NICU for high-stage extravasated lesions because of the shorter duration of healing, non-invasive nature of this procedure, and lack of side effects or surgical involvement.

Tissue Necrosis Following Extravasation of Human Immunoglobulin in an Infant

“…4 Drug extravasation can cause swelling and pain at the site in mild cases, and tissue necrosis, muscle contracture, and functional sequelae may result in severe cases, which may cause medical or nursing disputes. 5 The occurrence of adverse reactions of subcutaneous exudation of intravenous human immunoglobulin is related to many factors, such as the age of the child, dosage, infusion site, and infusion speed. 1,6 In this case, the child was a small infant with congenital heart disease and severe pneumonia with recurrent infections, poor peripheral circulation in the extremities, and suboptimal vascular conditions.…”

Management of Extravasation Injury in Infants: A Systematic Review of Clinical Trials

“…Although the efficacy of hyaluronidase in preventing injury in IV injuries has not been demonstrated in randomized controlled trials in humans, it remains a recommended antidote (28). Several studies have shown the positive effect of hyaluronidase (150 U/mL solution) in managing extravasation in infants (14,19,20,24,25,29). However, this drug is not recommended in infants less than 28 weeks because the skin of these infants is considered too premature (3).…”

“…In their study in Iran, Sagheb et al used hot compresses in 16 infants in the first 24 hours after extravasation injury and the subcutaneous administration of hyaluronidase. After 24 hours, they applied other managements (washing with normal saline, using fibrinolysin ointment, and dressing with phenytoin) (20). In a study in Turkey, Altan et al used limb elevation and cold compress for a 23-day-old girl who was injured in the forearm after contrast injection (17).…”

A clinical study of using a phentolamine alcohol wet dressing in the treatment of extravasation after a 20% fat emulsion intravenous infusion - a randomised trial

“…Preface Fat Emulsion is an intravenously administered nutrition drug, and it is widely used in clinical practice [1,2]. However, skin damage is common due to its high concentration and high permeability, and extravasation is a common complication that affects drug absorption [3,4,5], destroys the integrity of skin and tissue, and causes obvious pain [6,7]. A detachable hydropathic compress is a new kind of wet compress method, which could effectively dilate blood vessels, improve blood circulation and reduce local pain.…”