A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon

Maly, Connor; Fan, Kenneth L.; Rogers, Gary F.; Mitchell, Benjamin; Amling, June K.; Johnson, Kara B.; Welch, Laura S.; Oh, Albert K.; Chao, Jerry

doi:10.1097/gox.0000000000001743

Cited by 22 publications

(14 citation statements)

References 52 publications

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“…These injuries may occur if the catheter pierces the vessel wall during insertion; if it moves partially or completely outside the vein during the delivery of intravenous (IV) fluids; or if the vessel wall does not seal around the catheter (Dougherty, 2008a). PVC‐associated infiltration and extravasation injuries can be severe, with remedial surgery, life‐long scarring and functional deficit resulting (Maly et al., 2018). Another frequently reported PVC‐related complication is partial or complete catheter occlusion which is the inability to infuse fluids or medications through a previously functioning catheter (Helm et al., 2015).…”

Section: Introductionmentioning

confidence: 99%

Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis

Marsh

Webster

Ullman

et al. 2020

Journal of Advanced Nursing

103

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Aims The aim of this systematic review and meta‐analysis was to summarize and quantify peripheral intravenous catheter‐related complications. Design This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta‐analysis of Observation Studies in Epidemiology for cohort studies. Data sources The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 ‐April 2019. Review Methods Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman–Tukey double arcsine transformation using random‐effects meta‐analysis; estimates of heterogeneity were taken from inverse‐variance fixed‐effect models. Results Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter‐related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department‐inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies. Conclusion Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi‐specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced. Impact Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters.

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Section: Introductionmentioning

confidence: 99%

Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis

Marsh

Webster

Ullman

et al. 2020

Journal of Advanced Nursing

103

View full text Add to dashboard Cite

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“…The use of 2% topical GTN ointment for extravasation and tissue ischemia successfully has been described in several case reports. Topical application of 2% nitroglycerin along with phentolamine has been shown to initiate reperfusion [ 8 ]. Although we did not come across any reports where extravasation injuries due to NA were managed with topical GTN alone, there are reports of the use of topical GTN as a single agent for successful management of extravasation injuries due to epinephrine and dopamine.…”

Section: Discussionmentioning

confidence: 99%

Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report

Shrestha

Acharya

Shrestha

et al. 2020

Oxford Medical Case Reports

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Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported. Here we report a case of peripheral extravasation of vasopressors, successfully managed with topical nitroglycerin in intensive care unit in Kathmandu. To our knowledge, this is the first report of such kind from Nepal.

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“…Hyaluronidase breaks down glycosaminoglycan and hyaluronic acid and raises the clearance of the drug. However, there is still controversy over the standard dosage and appropriate injection [ 18 ]. It seems that the injection of 15 units of this agent is suitable for extravasation in children; however, the dosage has been reported to have a broad range (15–1500 units with Saline flush) [ 5 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, there is still controversy over the standard dosage and appropriate injection [ 18 ]. It seems that the injection of 15 units of this agent is suitable for extravasation in children; however, the dosage has been reported to have a broad range (15–1500 units with Saline flush) [ 5 , 18 ]. Although using a cold or warm compress for extravasation management is controversial, applying a warm compress with hyaluronidase can cause a rise in blood circulation and assist dispersal of the vesicant away from the extravasation site to reduce tissue damage [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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

2022

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Background To identify a standard protocol for managing extravasation injuries in neonates. Methods We recruited all the neonates with extravasation wounds from the neonatal intensive care unit of Shariati hospital, Tehran, Iran, between October 2018 and October 2020. Sixteen patients with grade 3–4 extravasation were evaluated in this retrospective study. All grade 3 and 4 extravasation wounds were injected with hyaluronidase at 5 points of the wound circle; the procedure was repeated every 5 min at different points in a smaller circle to the core. The wound was then covered with a warm compress for 24 h. Twenty-four hours after injection, the cover was changed twice a day with normal saline irrigation. Fibrinolysin ointment was applied on top of the wound. The ulcer was then dressed with phenytoin ointment until healing. Results Out of 16 neonates who were followed up, 10 of them were male, with the average birth weight being 1.37 (range 1.05–3.75) kg. The mean (± SD) wound healing duration was 13.12 (± 6) (range: 7–29) days. Factors including the cannulation duration before the appearance of the lesion (R:0.2, P = 0.2), birth weight (R = -.37, P = 015), and extravasated substances (p = 0.2) were not associated with the duration of hospital stay. The only exception to this trend is the wound size factor of 7.31(± 7.45) (R = .83, P < 0.001). Continuous and categorical variables were summarized as mean (SD) and proportions, respectively, and the Kruskal–Wallis test and Spearman correlation coefficients were used. Conclusions Limited evidence exists on the effects of different protocols on extravasation management in neonates in the NICU. We recommend our method as a standard protocol in NICU for high-stage extravasated lesions because of the shorter duration of healing, non-invasive nature of this procedure, and lack of side effects or surgical involvement.

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A Primer on the Acute Management of Intravenous Extravasation Injuries for the Plastic Surgeon

Cited by 22 publications

References 52 publications

Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis

Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis

Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report

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

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