Cutaneous Necrosis Associated With Intravenous Nafcillin Therapy

Tilden, Samuel J.; Craft, J. Carl; Cano, Roberto Gabriel Albín; Daum, Robert S.

doi:10.1001/archpedi.1980.02130230026008

Cited by 9 publications

(4 citation statements)

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“…2,9 High subcutaneous concentrations of methicillin (500 mg/mL) and oxacillin (167 mg/mL) produced dermal necrosis in rats after 12 and 24 hours, respectively. 9 It is unclear how these concentrations correlate with those producing tissue damage in humans but confirms that high concentrations of oxacillin can damage tissue if extravasated.…”

Section: Discussionmentioning

confidence: 99%

Oxacillin-Induced Tissue Necrosis

Fromm

Graham

1999

Ann Pharmacother

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Section: Discussionmentioning

confidence: 99%

Oxacillin-Induced Tissue Necrosis

Fromm

Graham

1999

Ann Pharmacother

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“…62,64,70,75,79,87,102,104,[108][109][110][111]121,123,129,147,148,153,157,[159][160][161][162] In total, 163 individual participants were studied. Study characteristics are summarised in Table 7 with full treatment, intervention and outcome details presented in Appendix 3.…”

Section: Case Report Studiesmentioning

confidence: 99%

Treatment of extravasation injuries in infants and young children: a scoping review and survey

Corbett

Marshall

Harden

et al. 2018

Health Technol Assess

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BackgroundExtravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches.ObjectivesTo identify which treatments may be best for treating extravasation injuries in infants and young children.DesignScoping review and survey of practice.PopulationChildren aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries.InterventionsAny treatment for extravasation injury.Main outcome measuresWound healing time, infection, pain, scarring, functional impairment, requirement for surgery.Data sourcesTwelve database searches were carried out in February 2017 without date restrictions, including MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus and EMBASE (Excerpta Medica dataBASE).MethodsScoping review – studies were screened in duplicate. Data were extracted by one researcher and checked by another. Studies were grouped by design, and then by intervention, with details summarised narratively and in tables. The survey questionnaire was distributed to NHS staff at neonatal units, paediatric intensive care units and principal oncology/haematology units. Summary results were presented narratively and in tables and figures.ResultsThe evidence identified in the scoping review mostly comprised small, retrospective, uncontrolled group studies or case reports. The studies covered a wide range of interventions including conservative management approaches, saline flush-out techniques (with or without prior hyaluronidase), hyaluronidase (without flush-out), artificial skin treatments, debridement and plastic surgery. Few studies graded injury severity and the results sections and outcomes reported in most studies were limited. There was heterogeneity across study populations in age, types of infusate, injury severity, location of injury and the time gaps between injury identification and subsequent treatment. Some of the better evidence related to studies of flush-out techniques. The NHS survey yielded 63 responses from hospital units across the UK. Results indicated that, although most units had a written protocol or guideline for treating extravasation injuries, only one-third of documents included a staging system for grading injury severity. In neonatal units, parenteral nutrition caused most extravasation injuries. In principal oncology/haematology units, most injuries were due to vesicant chemotherapies. The most frequently used interventions were elevation of the affected area and analgesics. Warm or cold compresses were rarely used. Saline flush-out treatments, either with or without hyaluronidase, were regularly used in about half of all neonatal units. Most responders thought a randomised controlled trial might be a viable future research design, though opinions varied greatly by setting.LimitationsPaucity of good-quality studies.ConclusionsThere is uncertainty about which treatments are most promising, particularly with respect to treating earlier-stage injuries. Saline flush-out techniques and conservative management approaches are commonly used and may be suitable for evaluation in trials.Future workConventional randomised trials may be difficult to perform, although a randomised registry trial may be an appropriate alternative.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Tissue injury caused by nafcillin extravasation and phlebitis has been documented in a handful of case reports. 18-21 However, the mechanism of cell damage is not entirely known. It is neither acidic nor basic, with a reconstituted pH ranging from 6 to 8.5.…”

Section: Vesicants In the Literaturementioning

confidence: 99%

“…However, animal studies have shown that tissue necrosis may occur with infusions diluted to concentrations per manufacturer’s guideline. 18 The only antidote reported to have been used for the management of nafcillin extravasation is hyaluronidase. By facilitating the diffusion of extravasated fluids into surrounding tissue, hyaluronidase allows for rapid absorption and minimizes further tissue damage.…”

Section: Vesicants In the Literaturementioning

confidence: 99%