Extravasation Wound Care in the Neonatal Intensive Care Unit

Abstract

Background: Extravasation injuries occurring in neonates can have severe consequences. Because many clinicians are not familiar with the vesicant-like effect of several commonly used medications, early extravasation wound management can be difficult. We aimed to share our experience with irritant-related and vesicant-related injuries leading to neonatal extravasation wounds. Methods: This retrospective study included 36 premature neonatal patients with extravasation wounds. Patients were classified into four groups based on extravascular staging and clinical wound conditions. We compared groups according to the following factors: sex, birth weight, prematurity, wound healing duration, days since the intravenous line was placed, wound severity, use of antibiotics, complications, treatment, type of intravenous fluid, and intravenous cannulation sites. Results: Neonatal birth weight was proportional to wound severity. Except in cases involving necrosis wounds, the lesion size increased with severity. Extravasation events occurred an average of 3.2 days after cannulation. Neonatal parenteral nutrition formulas and antibiotics acted as vesicants. Conclusion: Intravenous cannulation sites must be closely monitored in neonates, particularly during the first 3 days after cannulation. Monitoring is particularly important for larger neonates because intravenous fluid is administered based on body weight. Detailed knowledge about the vesicant fluid is required.

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

“…As explained above, one of the key factors is the type of extravasant. Despite previous studies that illustrated total parenteral nutrition (TPN) as the cause of most lesions after extravasation [ 13 , 20 ], our study found that calcium chloride was responsible for most high-stage wounds ( 56.3%). Less common damages were related to TPN.…”

“…We believe that our healing duration in stage 3,4 extravasation lesions was shorter than the one in Cho et al’s previous study; (13.12 days to an average of 18.7 days) despite having more extensive wound sizes ( 7.31cm2 to 2.24 cm2). Based on our data, the cannulation duration at the extravasation injury was longer than the one in the survey conducted by Cho et al (7.87 days to 3.2) [ 13 ]. This proposes a precise observation of the intravenous line site to prevent injury, at least during this time.…”

“…Similar to previous surveys, our study demonstrates that up to 70% of all extravasation injuries occur in the upper limbs ( 68.75% to 70%). This may be due to easier access in the upper limb than lower limbs [ 3 , 4 , 13 ]. In the present research, wound healing duration was 13.12 ± 6 days, which was associated with the wound size factor ( R = 0.83, P < 0.001).…”

“…Usually, patients with stages 1 and 2 are managed by conservative dressings. More severe injuries (stages 3 and 4) typically require interventions like hyaluronidase injections, aspirations or drainage of abscesses, and debridement necrosis [ 13 ]. The common consensus is to start the treatment as soon as possible, and the first step is to cease infusion immediately.…”

Effect of Skin Injury Preventive Strategy on Neonatal Skin Condition at Neonatal Intensive Care Unit

“…(Khanali Mojen & Varzeshnejad, 2020). Damage to various skin layers results from skin injuries ranging from the epidermis to the underlying layers, and even muscles, as well as tendons (Cho et al, 2019). Skin injuries are caused by different factors which are probably occurred and continue to occur in NICUs Despite the fact that most are avoidable (Grosvenor et al, 2019).…”