Management of Intravenous Infiltration Injuries

Abstract

Background Intravenous (IV) lines are ubiquitous in hospital settings. These lines can malfunction, leaking noxious contents into subcutaneous tissue. Existing literature describes invasive intervention and complex treatment protocols. These persist despite significant changes in the composition and administration of IV agents. The purpose of this study is to examine the consequences of IV infiltrations at a tertiary medical center to update protocols and treatment algorithms. Materials and Methods This study is an observational, retrospective chart review performed at a tertiary care medical center. All inpatient plastic surgery consultations for IV infiltration were reviewed from 2011 to 2017. Patients were included if IV infiltration was suspected or documented. Data were collected for each injury regarding patient demographics, substance, and intervention. Results The plastic surgery service evaluated 381 IV infiltration injuries from 2011 to 2017, with 363 meeting the criteria. Injuries per year progressively increased, with 32 consultations in 2011 and 102 consultations in 2017. The vast majority of injuries identified (91%) were treated with only elevation and observation. The minority consisted of wound care (7%) performed by nursing or any form of incision, aspiration, or antidote injection (2%) performed by the physician. Of the 363 injuries, the most common infiltrates were noncytotoxic (35%), radiographic contrast (27%), and known vesicants (18%). Interestingly, a large portion of consultations were requested by other surgical services (32%). Conclusions Although there is an increase in expert involvement for cases of IV infiltration injuries, the vast majority of these injuries are managed with minimal intervention. This is most likely owing to recent changes that have decreased the potential for harmful infiltration. Contrary to existing literature, invasive intervention is almost never indicated.

Topical treatment of tissue damage due to extravasation of iodinated contrast using thermal compresses

“…Tissue damage due to infiltration or extravasation of drugs constitutes an adverse event that represents between 10% and 30% of the complications of peripheral intravenous lines, both in adult and pediatric patients [1][2][3].…”

“…Ionic iodinated contrast agents can produce greater tissue damage than non-ionic agents due to their electrical charge and hyperosmolarity [9]. The scientific literature recommends the same interventions for both types of contrast, based only on studies on the extravasation of other drugs, rather than the current non-ionic contrast media used in CTA, which has low osmolarity and low toxicity [3,8].…”

Abordagens de cirurgias plásticas no tratamento de feridas complexas

“…e Silveira et al (2020, p.353) confirmou: "(...) orientação de minimizar ao máximo as internações e os procedimentos cirúrgicos a fim de promover maior segurança ao paciente e à equipe de saúde.". Em contrapartida, ainda se tratando de feridas com etiologias vasculares, para casos de lesões causadas por infiltração intra venosa (IV) a intervenção cirúrgica quase nunca é indicada, sendo preferido o uso de intervenções mínimas (Massan et al, 2019), ao contrário das demais feridas, em que a cirurgia plástica é utilizada para acelerar o processo de recuperação e alta.…”