Innovative Solutions in Critical Care Units

Hurst, Sue; McMillan, Michael

doi:10.1097/00003465-200405000-00009

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…Examples include a ''critical care bug team'' implemented to decrease the incidence of ventilator-associated pneumonias 336 and a ''rock and roll'' critical care program developed to prevent complications from immobility. 337 Administrators have relied upon CNSs to develop researchbased protocols, 229,338-347 clinical pathways, 348,349 guidelines, 278,[350][351][352][353][354][355][356] and policies [357][358][359][360][361][362][363][364][365][366] in their institutions. For instance, CNSs have championed policy changes related to assessment and treatment of pain.…”

Section: Second Substantive Area: Educate and Support Interdisciplinamentioning

confidence: 99%

Substantive Areas of Clinical Nurse Specialist Practice

Lewandowski

Adamle²

2009

Clinical Nurse Specialist

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Section: Second Substantive Area: Educate and Support Interdisciplinamentioning

confidence: 99%

Substantive Areas of Clinical Nurse Specialist Practice

Lewandowski

Adamle²

2009

Clinical Nurse Specialist

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“…17,23,24) Notably, several clinical case reports have shown that extravasation of less tissue invasive agents dissolved in acidic solutions, such as vancomycin (pH 4.0), doxycycline (pH 1.8-3.3), and amiodarone (pH 3.5-4.5), also induces skin lesions. [25][26][27] However, the effect of acidic pH on extravasation injury may be negligible, as in this study both pH 3.0 and pH 5.0 saline solutions did not induce skin lesions. Thus, the severity of injury induced by extravasated vasopressors might be determined mostly by their strength of vasoconstriction activity, rather than acidity.…”

Section: Discussionmentioning

confidence: 48%

Evaluation of Risk of Injury by Extravasation of Hyperosmolar and Vasopressor Agents in a Rat Model

Shibata

Sagara

Yokooji

et al. 2018

Biological & Pharmaceutical Bulletin

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Inadvertent leakage of noncytotoxic agents causes severe tissue injury. In this study, we macroscopically and histopathologically evaluated the extent of skin injury caused by extravasation of hyperosmolar or vasopressor agents in rats. Rats were intradermally administered saline (100 µL), the hyperosmolar agents mannitol (5-20 mg/100 µL) and glucose (5-50 mg/100 µL), or the vasopressors dopamine (2 mg/100 µL), adrenaline (0.1 mg/100 µL), and noradrenaline (0.1 mg/100 µL). Lesion size (erythema, induration, ulceration, and necrosis) was monitored after agent injection. Skin tissue biopsies were evaluated at 24 h after agent injection. Mannitol and glucose induced severe lesions in a concentration (and osmolarity)-dependent manner. Mannitol and glucose at 10-20% (w/v) induced inflammation, and lesions healed within 3-6 d. In contrast, ≥25% (w/v) glucose elicited severe skin lesions with ulceration and necrosis within 24 h, which healed gradually 16-22 d after injection. The severity of extravasation injury caused by vasopressors varied. Adrenaline and noradrenaline induced severe injury with ulceration and necrosis, which healed over 23.3 and 18.3 d, respectively. In contrast, dopamine induced erythema and induration, and damage duration was only 5.7 d. In conclusion, mannitol and glucose at osmolarities of 549-1098 and 833-1110 mOsm/L, respectively, can be classified as "irritants," while ≥1388 mOsm/L glucose can be classified as a "vesicant." As for vasopressors, adrenaline and noradrenaline can be classified as "vesicants" whereas dopamine can be classified as an "irritant."

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“…Extravasation guidelines specifically cite vancomycin as a potential cause, recommending the use of cold compress in the event of extravasation. [15] Hadaway and Chamallas review appropriate vancomycin administration and make clear that vancomycin will cause tissue damage if it escapes the vein to the subcutaneous tissue. [16] While common admixtures of vancomycin are isotonic, the acidic pH warrants a need for infusion through a central venous catheter, despite distinct recommendations from the package insert.…”

Section: Discussionmentioning

confidence: 99%

“…[17] With no clear evidence-based vancomycin extravasation management in the literature, certain aspects of vesicant extravasation from chemotherapy guidelines and basic wound care were extrapolated with this patient. [15,18] We applied cold compresses to the extravasated area for the 24 hours. We also applied standard gauze open dressings with frequent changes and silver sulfadiazine 1% to the wound.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin extravasation: Evaluation, treatment, and avoidance of this adverse drug event

Peyko

Sasson

2016

CRIM

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Purpose: To report the presentation, management, and potential future avoidance of vancomycin extravasation. Summary: An 84-year-old woman was admitted to the emergency department due to observed seizures that progressed to status epilepticus. Status epilepticus was controlled, but the patient developed hospital-acquired pneumonia, requiring treatment with vancomycin and cefepime. During treatment with vancomycin, extravasation occurred during peripheral administration. Cold packs were immediately applied to the lesion for the next 24 hours with common gauze open dressings with frequent changes, and silver sulfadiazine 1% topical application once daily were started on the day after extravasation. While skin necrosis developed, it did not require surgical intervention and common gauze open dressings with frequent changes and silver sulfadiazine 1% topically were continued until the wound was healed. Conclusion: Although the package insert warns of extravasation with potential necrosis during vancomycin administration, this case highlights a potentially under-reported adverse event. Vancomycin extravasation was successfully managed by utilizing cold compress for the first 24 hours post-extravasation with common gauze open dressings and silver sulfadiazine 1% until the wound was healed. With a potential for vancomycin extravasation when administered peripherally, we would recommend central venous administration.

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Innovative Solutions in Critical Care Units

Cited by 11 publications

References 10 publications

Substantive Areas of Clinical Nurse Specialist Practice

Substantive Areas of Clinical Nurse Specialist Practice

Evaluation of Risk of Injury by Extravasation of Hyperosmolar and Vasopressor Agents in a Rat Model

Vancomycin extravasation: Evaluation, treatment, and avoidance of this adverse drug event

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