Phlebitis and extravasation (“tissuing”) with intravenous infusions

Management of extravasation injuries

“…It is possible for the cannula to either pull out of the vein or have its tip pierce the vein wall 7,8 . However, it has been shown that, in most cases, the tip of the cannula remains in the lumen and that extravasation is through the hole made by the cannula or needle entering the vein 7,9 . In order for extravasation to occur by this means, the vein must be blocked or have constricted distal to the cannula tip to stop the flow.…”

“…The extravasated fluid causes stretching of the vessels and partial venous occlusion followed by arterial occlusion. With an increase in pressure resulting from this fluid in the tissue, ischaemia and cell death become a possibility 9,12,13 . Intravenous infusions that are gravity fed can also allow considerable amounts of fluid to extravasate, as the tissue pressure required to prevent continued extravasation is proportionate to the height of the fluid bag above the cannula.…”

Potential for extending survival of peripheral intravenous infusions.

“…The pH is lower in dextrose and dextrose saline solutions than in Ringer solution, but Ringer solution, which is buffered, contains 1-10 mmol/l of acid. 34 Normal saline is less acid in terms of pH, typically 5 Odds ratio with 95% confidence interval FIG 4-Effect ofheparin plus adrenal steroids onfailure ofinfusions. Seefigure I for explanation ofsymbol Heparin at I IUlml (at 0-5 or 1 0 IU/ml") and hydrocortisone at 10 tg/ml were added to total parentera nutrition" or crystalloid fluids infused into children (Wright et Odds ratio with 95% confidence interval FIG 5-Effects ofcombination ofheparin, steroids, and buffer or neutralisation on failure ofinfusions.…”

A randomised, controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial

“…Indeed, there was a trend towards fewer episodes of progression of IVH in all infants receiving heparin and there was a significant reduction in IVH progression in the infants under 850 g who received heparin (NNT seven). Evaluating only those infants under 850 g, none of the infants in the heparin group had progression of IVH and of the four infants in the non-heparin group to have IVH progression, two had definite infection, one had a possible infection and one had the long line removed because of extravasation (often attributed to local infection) 22. In the entire cohort two infants with heparin in TPN had progression of IVH, although neither had infection, whereas out of the seven in the non-heparin group to have IVH progression, two had definite infection, one probable infection, one possible infection, one extravasation and two had elective line removal without complications.…”