Describing Intravenous Extravasation in Children (DIVE Study)

Paquette, Vanessa; McGloin, Rumi; Northway, Tracie; Dezorzi, Pia; Singh, Avash; Carr, Roxane

doi:10.4212/cjhp.v64i5.1069

Cited by 40 publications

(60 citation statements)

References 7 publications

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“…Infants and children have multiple risk factors for phlebitis and extravasation: small fragile veins, decreased peripheral circulation, capillary leakage, and flexible subcutaneous tissue. This makes short peripheral intravenous devices difficult to place and maintain, resulting in the need for repeated attempts at intravenous insertion, which can lead to complications, pain, and stress 14 , 25 , 26 …”

Section: Question 6: In Which Patients Is Peripheral Pn a Reasonable mentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

180

202

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Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

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Section: Question 6: In Which Patients Is Peripheral Pn a Reasonable mentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

180

202

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“…Although there is a reasonable availability of antidotes for extravasation injuries, only a minority of patients with these injuries receive an available antidote. 5 In a retrospective study of 42 documented pediatric extravasations, only 33% of patients received an appropriate antidote, although 81% of patients qualified for treatment. 5 Specific guidelines are available for radiographic contrast and chemotherapy extravasations, 1,6 but comprehensive evidence-based management recommendations for each specific extravasation are lacking.…”

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confidence: 99%

“…5 In a retrospective study of 42 documented pediatric extravasations, only 33% of patients received an appropriate antidote, although 81% of patients qualified for treatment. 5 Specific guidelines are available for radiographic contrast and chemotherapy extravasations, 1,6 but comprehensive evidence-based management recommendations for each specific extravasation are lacking. Thus, our main purpose was to evaluate the primary literature for available interventions for the management of extravasations and to provide recommendations based on treatment literature for specific therapeutic modalities for noncytotoxic medications.…”

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confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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Extravasations are common manifestations of iatrogenic injury that occur in patients requiring intravenous delivery of known vesicants. These injuries can contribute substantially to patient morbidity, cost of therapy, and length of stay. Many different mechanisms are behind the tissue damage during extravasation injuries. In general, extravasations consist of four different subtypes of tissue injury: vasoconstriction, osmotic, pH related, and cytotoxic. Recognition of high-risk patients, appropriate cannulation technique, and monitoring of higher risk materials remain the standard of care for the prevention of extravasation injury. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. The best therapeutic agent for treatment of vasopressor extravasation is intradermal phentolamine. Topical vasodilators and intradermal terbutaline may provide relief. Intradermal hyaluronidase has been effective for hyperosmotic extravasations, although its use largely depends on the risk of tissue injury and the severity of extravasation. Among the hyperosmotic agents, calcium extravasation is distinctive because it may present as an acute tissue injury or may possess delayed clinical manifestations. Extravasation of acidic or basic materials can produce significant tissue damage. Phenytoin is the prototypical basic drug that causes a clinical manifestation known as purple glove syndrome (PGS). This syndrome is largely managed through preventive and conservative treatment measures. Promethazine is acidic and can cause a devastating extravasation, particularly if administered inadvertently through the arteriolar route. Systemic heparin therapy remains the accepted treatment option for intraarteriolar administration of promethazine. Overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports. More research is needed to improve knowledge of patient risk, prompt recognition of the extravasation, and time course for tissue injury, and to develop prevention and treatment strategies for extravasation injuries.

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“…[12] Paquette and colleagues simply identify quantitatively one occurrence of vancomycin extravasation in patients under 18 years of age from one facility, without any further details. [13] Hoelen et al is the only case we found in the literature to describe tissue necrosis as a result of vancomycin extravasation, yet without a description of management of the event. [14] Thus, it is clear that information regarding skin necrosis as a result of vancomycin extravasation is scant, however, it is not unrecognized.…”

Section: Discussionmentioning

confidence: 98%

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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Describing Intravenous Extravasation in Children (DIVE Study)

Cited by 40 publications

References 7 publications

When Is Parenteral Nutrition Appropriate?

When Is Parenteral Nutrition Appropriate?

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

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

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