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

Abstract

Introduction: Extravasation injuries, pressure ulcers (PU), and ocular surface disorders (OSD) like exposure keratitis are common problems that we encounter in critically ill children admitted in Paediatric Intensive Care unit (PICU). There is sparse data regarding these injuries due to under reporting by staffs in intensive care unit. The primary aim of this study was to know the prevalence of extravasation injuries, ocular surface disorders and pressure ulcers in tertiary intensive care unit of south India. The secondary objective of this study was to re-evaluate the prevalence of these injuries after interventions. 
 Methods: During pre-intervention period, number of children with extravasation injuries, pressure ulcers and ocular surface disorders were identified. The qualitative improvement practices was implemented to decrease the prevalence of these injuries. This was followed by re-evaluation of these injuries during post-intervention period.
 Results: During pre-intervention period the overall prevalence of these injuries was 36/273 (13.2%). The prevalence of extravasation injuries, pressure ulcers and ocular surface disorders was 16/273 (5.9%), 12/273 (4.4%) and 8/273 (2.9%) respectively. The qualitative improvement practices were implemented in intensive care unit. During post-intervention period, the prevalence of these injuries was reduced to 10/157 (6.4%). The extravasation injuries reduced to 4/157 (2.5%), PUs to 4/157 (2.5%) and OSD to 2/157 (1.3%).
 Conclusions: The extravasation injuries, PUs and OSD are common problems in critically ill children. The qualitative improvement practices should be implemented and reinforced in intensive care units to prevent these injuries.

Paediatric pressure injury prevention strategies: a review

“…Eight of the 15 studies were evaluated as medium-quality evidence 5,21,23,[28][29][30][31] , four were evaluated as high-quality 7,24,25,26 , and the remaining three as low quality. 20,22,27 The scores ranged from 5-13 with the mean 11.4.…”

“…[21][22][23][24]29 One was an RCT (level II) 32 , two were prospective cohort studies (level II) 30,31 , two were retrospective cohort studies (level III-2) 25,26 , one was a secondary analysis of data from a retrospective and prospective study (level III-2) 5 , two were quasi-experimental studies (level III-2) 7,27 , one a retrospective correlation analysis of secondary data (level III-2) 28 and one was a cross-sectional study (level IV). 20…”

“…The majority of studies were conducted in the USA 5,7,21-24-29 , with one each conducted in Ireland 30 , Latin America 31 , Indonesia 32 and South India. 20 Most of the studies were conducted in paediatric intensive care areas. 7,20,21,[24][25][26][27][29][30][31][32] One was conducted in the cardiac care unit 23 , only one was conducted on a general paediatric ward 5 , with the remaining two conducted in paediatric hospitals 22,28 , thus restricting the external validity of results to hospitalised ward patients.…”

“…20 Most of the studies were conducted in paediatric intensive care areas. 7,20,21,[24][25][26][27][29][30][31][32] One was conducted in the cardiac care unit 23 , only one was conducted on a general paediatric ward 5 , with the remaining two conducted in paediatric hospitals 22,28 , thus restricting the external validity of results to hospitalised ward patients. 34 Each study utilised appropriate yet different methods for data collection.…”

“…Four studies reviewed medical records 7,21,23,25 , six used data collection forms/observation forms 5,24,[29][30][31] , one conducted a retrospective chart review 26 , one analysed data from a data bank 28 , two conducted audits 22,27 , and one used a checklist. 20 Each study looked at different prevention techniques to reduce the incidence or severity of PIs. Five demonstrated the value or need for prevention bundles.…”