Incidence, risk factors and treatment outcomes of drug extravasation in pediatric patients in China

Abstract

Yan YM, Gong M, Chen JL, Li D, Xu TT, Zou H, Li AQ, Fan QL, Lu QF. Incidence, risk factors and treatment outcomes of drug extravasation in pediatric patients in China. Turk J Pediatr 2017; 59: 162-168. Extravasation injury is a common phenomenon in hospitals. Failure to detect and treat extravasation injury can lead to irreversible local injuries, tissue necrosis and malfunction of the affected tissue. Until now, it is largely unknown about incidence, risk factors and treatment outcomes of extravasation in Chinese pediatric patients. The aim of this study is to explore the incidence, risk factors and summarize the characteristics and treatment outcomes of extravasation injuries resulting in drug extravasation among Chinese children in our hospital. The children undergoing infusion therapy (0-18 years) were enrolled in this study between December 2014 and June 2015 in Shanghai Children`s Hospital. The patients` information including age, gender, injection site, estimated volume of solution extravasated, patient symptoms, severity of extravasation injury, treatment methods, and outcomes was collected. Multivariate logistic regression was used to identify the independent risk factors for the development of extravasation. The incidence of extravasations in pediatric patients was 1.79% (18/1,004). The severity of extravasation was labeled with grade range from Grade 1 through Grade 4: 4 cases with Grade 1, 8 cases with Grade 2, 5 cases with Grade 3, and 1 case with Grade 4. The risk factors of extravasation include infused high volume/day (≥1000 ml), received operation, infused agents with high osmolarity and poor vein condition. The severity of extravasation was related to the large volumes of drug or special drugs (high-osmolarity, high-risk, low pH, etc). All extravasations were treated with physical, pharmacological and surgical intervention according to our standard operation protocols. Systematic implementation of intervention can alleviate the extravasation injuries and improve the patients` outcome.

Extravasation Injuries, Pressure Ulcers and Ocular Surface Disorders in a Tertiary Paediatric Intensive Care Unit in South India

“…The overall prevalence of extravasation injuries, OSD and PUs was 13.2%. The prevalence of extravasation injuries was 5.9% which was higher compared to Ya-Min Yan et al 14 where its prevalence was only 1.79%. According to Vanessa et al 15 extravasation injuries was more common in infants (40%) which was comparable to this study (39%).…”

Surgical intervention for paediatric infusion-related extravasation injury: a systematic review

“…44 Of those studies, three state that all of the children had stage III or IV injuries before any intervention, 12 14 29 and two made reference to the grading scheme without using it to assess the injuries. 21 33 In one case series, 26 treatment was determined by the severity of extravasation injury based on a grading system similar to Millam's. Of the 18 children, the seven with grade I and II injuries were managed conservatively.…”

Surgical Intervention for Paediatric Infusion-Related Extravasation Injury: A Systematic Review

“…Thirty-five papers were deemed eligible for inclusion after studies in which conservative management or no intervention were excluded. The requisite data were immediately available in 26 study reports 4,10,[19][20][21][22][23][24][25][26][27][28]11,[29][30][31][32][33][34][12][13][14][15][16][17][18] and the authors of the remaining nine studies 5,[35][36][37][38][39][40][41][42] were contacted twice with additional requests, mainly for exclusively paediatric extravasation data, and given at least two months to reply. Unfortunately, none of the authors were able to provide these data and those studies were excluded.…”

“…This group comprised six studies and 327 children. 12,18,22,31,33,34 97 children received hyaluronidase injections, one (1%) of whom had skin necrosis at presentation that resolved, and one (1%) developed necrosis requiring further surgery. Of the remaining 230 children that did not receive hyaluronidase, none developed skin necrosis at is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

“…43 This focuses on presence of pain, erythema, oedema, capillary refill, skin temperature and breakdown and it has been proposed that stages III & IV may require intervention. 44 In one case series, 33 treatment was determined by the severity of extravasation injury based on a grading system similar to Millam's. Of the 18 children, the seven with Grade I and II injuries were managed conservatively.…”