Neonatal extravasation injury: prevention and management in Australia and New Zealand-a survey of current practice

Abstract

BackgroundExtravasation injury remains an important cause of iatrogenic injury in neonatal intensive care. This study aims to describe the current approach to extravasation injury (EI) prevention and management in Neonatal Intensive Care Units (NICUs) in Australia and New Zealand.MethodsA literature review regarding extravasation injury in the newborn was carried out to inform questionnaire design. An internet-based survey was then conducted with the clinical directors of the 27 tertiary NICUs in Australia and New Zealand.ResultsThe survey received a 96% response rate. Approximately two thirds of Australian and New Zealand NICUs have written protocols for prevention and management of extravasation injury. Considerable practice variation was seen for both prevention and treatment of EI. 92% of units had experienced cases of significant EI.ConclusionsAustralian and New Zealand tertiary neonatal units clearly recognise EI as an important cause of iatrogenic morbidity and mortality. Significant variation still exists among units with regards to guidelines for both prevention and management of EI. We recommend that neonatal staff should remain vigilant, ensuring that guidelines for the prevention and treatment of EI are available, and rigorously followed.

Incidence of local complications and risk factors associated with peripheral intravenous catheter in neonates

“…Thus, the best way to prevent infiltration and extravasation is the continuous observation of the catheter puncture site and immediate intervention upon the occurrence of these complications. A study carried out in Australia and New Zealand shows that two-thirds of the NICU use protocols for preventing these complications by adopting measures such as the nursing continuous observation of the device insertion site, keeping the insertion ostium of the catheter visible, and saline infusion before administration of other substances (11) . In the case of fluids infused in the catheter, the literature highlights four characteristics that facilitate the risk of extravasation, namely: extreme pH (less than 5 or greater than 9); osmolarity (number of particles per kilogram of solvent); vasoactivity (ability to cause constriction of the vessel); and cytotoxicity (ability to cause cell damage or death).…”

“…The infusion of other solutions, even the isotonic, can result in serious harm to patients, including compartment syndrome, ischemia and permanent loss of tissue function (12) . In cases of infiltration/extravasation, the immediate removal of the catheter is the most prevalent conduct, followed by limb elevation, perforation of extravasation site and use of hot or cold compress (11) . After the occurrence of a complication, the size of the infiltration in relation to the affected area must be evaluated to use specific interventions (2) , a very important practice for preventing damage to newborns.…”

Iatrogenic Skin Disorders and Related Factors in Newborn Infants

“…The most important objectives are early recognition and continuous control of the position of intravenous lines, which the use of transparent dressings may assist with. The most important suggestions include immediate line removal, elevation of the limb, a saline flush through small incisions or punctures around the extravasation site, use of hyaluronidase, and local application of phentolamine or nitroglycerine after the extravasation of inotropic agents (Fig. ).…”

Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

“…Despite these benefits, complications can occur, often related to malposition, extravasation, and/or thrombosis [1, 2]. Resultant cardiac complications are rare but potentially life threatening [2].…”

“…Despite these benefits, complications can occur, often related to malposition, extravasation, and/or thrombosis [1, 2]. Resultant cardiac complications are rare but potentially life threatening [2]. In contrast, tachyarrhythmias, such as supraventricular tachycardia (SVT), are relatively common in neonates [3], but their occurrence as a complication of central venous access, particularly in association with prematurity, is not often seen or considered.…”