Extravasation injury management for neonates and children: A systematic review and aggregated case series

Abstract

Background: Pediatric extravasation injuries are significant healthcare-associated injuries, with sometimes significant sequelae. Evidence-based guidance on management is necessary to prevent permanent injury.Purpose: A systematic review of the literature, including aggregated case series, investigating extravasation injury management of hospitalized pediatric patients. Data Sources: PubMed, Cummulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica database (EMBASE) were searched on December 13, 2021. Study Selection: Primary research investigating extravasation injury management of hospitalized pediatric patients (to 18 years), published from 2010 onwards and in English, independently screened by two authors, with arbitration from a third author. Data Extraction: Data regarding the study, patient (age, primary diagnosis), extravasation (site, presentation, outcome), and treatment (first aid, wound management) were extracted by two authors, with arbitration from a third author.Data Synthesis: From an initial 1769 articles, 27 studies were included with extractable case data reported in 18 studies, resulting in 33 cases. No clinical trials were identified, instead, studies were primarily case studies (52%) of neonates (67%), with varied extravasation symptoms. Studies had good selection and ascertainment, but few met the causality and reporting requirements for quality assessments. Signs and symptoms varied, with scarring (45%) and necrosis (30%) commonly described.Diverse treatments were categorized into first aid, medical, surgical, and dressings.Conclusions: Despite infiltration and extravasation injuries being common within pediatric healthcare, management interventions are under-researched, with low-quality studies and no consensus on treatments or outcomes.

A call to action: Establishing an evidence base for pediatric extravasation injury management

“…Continuous IV site monitoring systems are used for early detection of extravasation with the goal of rapid intervention and prevention of serious injury. When injuries do occur, however, there is no widely accepted, standardized approach to treatment, consistent with Dufficy's findings 1 . Nurses at the bedside have varying levels of experience with wound care management; they employ the available tools and strategies to the best of their abilities consistent with local organizational practices, with intermittent consultation or guidance from a limited supply of wound care nurses with advanced training in skin injury prevention and treatment.…”

“…Although limited, the available data suggests that more than 1 in 10 pediatric patients and more than 2/3 of hospitalized neonates experience an extravasation injury. 1 The relative frequency with which these injuries occur necessitates evidence-based strategies for treatment to prevent severe injury and long-term sequelae. Yet, as Dufficy et al 1 report in the October 2022 issue of the Journal of Hospital Medicine, the evidence base for treatment of pediatric extravasation injuries is severely lacking, with low-quality, case report studies demonstrating disparate practices across settings.…”

“…When injuries do occur, however, there is no widely accepted, standardized approach to treatment, consistent with Dufficy's findings. 1 Nurses at the bedside have varying levels of experience with wound care management; they employ the available tools and Standardization of PIVIE prevention and management efforts will be a buffer against the impacts of variable nurse staffing and will enable cross-institutional comparisons and the identification of best practices, ultimately creating an evidence base upon which pediatric extravasation injury management can be grounded.…”

“…The ubiquitous nature of PIVCs can, however, contribute to a lack of recognition of the potential for injury associated with these devices. Although limited, the available data suggests that more than 1 in 10 pediatric patients and more than 2/3 of hospitalized neonates experience an extravasation injury 1 . The relative frequency with which these injuries occur necessitates evidence‐based strategies for treatment to prevent severe injury and long‐term sequelae.…”

Comment on “Sensing Technologies for Extravasation Detection: A Review”

“…With the significant patient harms caused from extravasation-associated injuries, we believe the authors could have provided additional detail around currently available tools to prevent unwarranted PIVIE injuries, particularly with their focus on the use and impact of various sensing technologies. − While technologies are continuing to develop in this domain, there is currently one medical device that now has regulatory approval for extravasation detection; however, healthcare practitioners are still expected to display greater capacities of clinical observation and assessment during infusion therapies, particularly when vesicant, irritant, or therapies with divergent pH/osmolality’s are being administered. Observational vigilance is still regarded as the gold standard and a key strategy in the detection and prevention process; however, this still remains subjective and suffers greatly in compliance.…”