Case Series of Neonatal Extravasation Injury: Importance of Early Identification and Management

Abstract

Extravasation injury is a common iatrogenic injury, especially in neonates. Intravenous access is essential in neonatal care, but neonatal extravasation injury is associated with severe morbidity. We present three cases of neonatal extravasation injuries with varying presentations, etiological agents, and timing of management. It shows that extravasation injuries treated with the saline flush-out technique and timely intervention have a superior outcome with almost immediate resolution and subsequent healing with no scars. This is in stark contrast with the lesions treated conservatively with dressings that took more time to heal. We are reminded to be vigilant with infusion therapies and the importance of early detection and prompt treatment in neonatal extravasation injuries.

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

“…Depending on the fluid and volume removed, manifestations include pain, swelling, erythema, tenderness, and localized blisters. Blisters and stiffness that persist for more than 24 hours indicate severe extravasation damage and the risk of ulceration (13). Capillary refill time may be prolonged, and the pulse may decrease (33).…”

“…The data also showed that out of 237 infants, 234 cases were recovered completely (11). A report by Yew et al on 3 infants showed that the flush-out technique with normal saline was effective in healing without scarring (13). Furthermore, a review study by Gopalakrishnan et al searched clinical trial studies on the effect of washing with normal saline with or without hyaluronidase on the treatment of extravasation in infants and ultimately did not find any clinical trials in this field (11).…”

Extravasation injuries in the intravenous therapy with drugs with properties vesicants and irritants in the veterinary medicine of small animals

“…Incisions should not be sutured and should be heal spontaneously. 19 Despite several recommendations for the use of antidotes in the prevention of necrosis and ulceration in extravasation of cytotoxic and non-cytotoxic drugs, there are no controlled clinical trials that prove the full effectiveness in pets or humans. Interventions to neutralize the action of extravasated agents, as well as techniques for the physical elimination of drugs from perivascular tissues, are more effective when performed in the period between the onset of extravasation and appearance of structural changes in the tissues.…”