Nonoperative Management of Full-thickness Intravenous Extravasation Injuries in Premature Neonates Using Enzymatic Debridement

Pa, Falcone; Dt, Barrall; Dr, Jeyarajah; Ja, Grossman

doi:10.1097/00000637-198902000-00010

Cited by 23 publications

(16 citation statements)

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“…21,[48][49][50][51][52][53] Most studies were small (sample sizes ranged from 4 to 51 patients) and all except one 50 were published before the year 2000. Study details are presented in Table 6.…”

Section: Debridement and Plastic Surgerymentioning

confidence: 99%

“…Study details are presented in Table 6. Three studies reported on outcomes following debridement, 48,50,53 three reported on debridement and skin grafts, 49,51,52 and one reported different types of reconstructive surgery. 21 Three studies were in neonates and all evaluated debridement techniques.…”

Section: Debridement and Plastic Surgerymentioning

confidence: 99%

“…21 Three studies were in neonates and all evaluated debridement techniques. 48,50,53 Two were of skin necrosis wounds caused by calcium gluconate, 50,53 one of them being in preterm neonates. 53 The other was in preterm neonates with full-thickness injuries, mostly caused by parenteral nutrition.…”

Section: Debridement and Plastic Surgerymentioning

confidence: 99%

“…53 The other was in preterm neonates with full-thickness injuries, mostly caused by parenteral nutrition. 48 Two studies were in older children: one in children (mean age 5.6 years) with full-thickness tissue loss arising from different types of infusate, 51 and one in children with cancer diagnoses such as acute myelogenous leukaemia or lymphoma who had extensive injuries caused by doxorubicin hydrochloride. 49 In two studies, only limited population details for surgery patients were available.…”

Section: Debridement and Plastic Surgerymentioning

confidence: 99%

“…50 The parenteral nutrition study, which was of enzymatic debridement, reported that all 16 wounds healed completely, with no infections and no functional scar contractions at up to 16 months. 48 A study of five infants receiving debridement and skin grafts reported full healing at 15 days. 52 The study in seven older children (mean age 5.6 years) reported an amputation, two contractures, hair loss and loss of motion.…”

Section: Scoping Review Of Treatments For Extravasation Injuriesmentioning

confidence: 99%

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Treatment of extravasation injuries in infants and young children: a scoping review and survey

Corbett

Marshall

Harden

et al. 2018

Health Technol Assess

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BackgroundExtravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches.ObjectivesTo identify which treatments may be best for treating extravasation injuries in infants and young children.DesignScoping review and survey of practice.PopulationChildren aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries.InterventionsAny treatment for extravasation injury.Main outcome measuresWound healing time, infection, pain, scarring, functional impairment, requirement for surgery.Data sourcesTwelve database searches were carried out in February 2017 without date restrictions, including MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus and EMBASE (Excerpta Medica dataBASE).MethodsScoping review – studies were screened in duplicate. Data were extracted by one researcher and checked by another. Studies were grouped by design, and then by intervention, with details summarised narratively and in tables. The survey questionnaire was distributed to NHS staff at neonatal units, paediatric intensive care units and principal oncology/haematology units. Summary results were presented narratively and in tables and figures.ResultsThe evidence identified in the scoping review mostly comprised small, retrospective, uncontrolled group studies or case reports. The studies covered a wide range of interventions including conservative management approaches, saline flush-out techniques (with or without prior hyaluronidase), hyaluronidase (without flush-out), artificial skin treatments, debridement and plastic surgery. Few studies graded injury severity and the results sections and outcomes reported in most studies were limited. There was heterogeneity across study populations in age, types of infusate, injury severity, location of injury and the time gaps between injury identification and subsequent treatment. Some of the better evidence related to studies of flush-out techniques. The NHS survey yielded 63 responses from hospital units across the UK. Results indicated that, although most units had a written protocol or guideline for treating extravasation injuries, only one-third of documents included a staging system for grading injury severity. In neonatal units, parenteral nutrition caused most extravasation injuries. In principal oncology/haematology units, most injuries were due to vesicant chemotherapies. The most frequently used interventions were elevation of the affected area and analgesics. Warm or cold compresses were rarely used. Saline flush-out treatments, either with or without hyaluronidase, were regularly used in about half of all neonatal units. Most responders thought a randomised controlled trial might be a viable future research design, though opinions varied greatly by setting.LimitationsPaucity of good-quality studies.ConclusionsThere is uncertainty about which treatments are most promising, particularly with respect to treating earlier-stage injuries. Saline flush-out techniques and conservative management approaches are commonly used and may be suitable for evaluation in trials.Future workConventional randomised trials may be difficult to perform, although a randomised registry trial may be an appropriate alternative.FundingThe National Institute for Health Research Health Technology Assessment programme.

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