Reducing Risk of Harm From Extravasation

Clark, Eloise; Giambra, Barbara K.; Hingl, John; Doellman, Darcy; Tofani, Barbara; Johnson, Neil

doi:10.1097/nan.0b013e3182798844

Cited by 36 publications

(24 citation statements)

References 63 publications

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“…Since strong acids or strong alkalinities can damage cellular proteins, reduce durability of the venous endothelium, and inflict venous rupture, pH ranging from 5 to 9 is recommended for intravenous injection [ 14 ]. Phenytoin is as an anticonvulsant that is also a strong alkaline [ 27 ] with a pH of 12, and has been found to reduce vein durability by damaging cell proteins [ 21 , 26 ]. Vancomycin is a strong acid with a pH of 2.8–4.5 [ 27 ], and a study has shown several cases who developed infiltrations after the administration of vancomycin [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Vancomycin is a strong acid with a pH of 2.8–4.5 [ 27 ], and a study has shown several cases who developed infiltrations after the administration of vancomycin [ 28 ]. Ampicillin / sulbactam combinations have strong alkalinity with a pH of 8–10, and cause irritation to the vessel walls and facilitate the occurrence of infiltration [ 26 ]. Previous studies have reported total skin loss after administration of penicillin antibiotics [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Saline solution, 5% dextrose, and 1:4 SD were classified as isotonic infusions while 10% dextrose, total parenteral nutrition, amino acids, and lipids were classified as hypertonic infusions. Among the injections administered, vesicant [ 25 ], nafcilin, and ampicillin / sulbactam combinations regarded as moderate IV infiltration risk drugs [ 26 ] were classified as penicillin. Cefotaxime that has a risk of wide IV infiltration into blood vessel tissues and tissue damage [ 21 ] was separately classified.…”

Section: Methodsmentioning

confidence: 99%

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Identification of Risk Factors for Intravenous Infiltration among Hospitalized Children: A Retrospective Study

2016

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This retrospective study was aimed to identify risk factors of intravenous (IV) infiltration for hospitalized children. The participants were 1,174 children admitted to a general hospital, who received peripheral intravenous injection therapy at least once, and had complete records. Data were analyzed with frequency and percentage or mean and standard deviation were calculated, and odds ratio (OR) from univariate and multiple logistic regressions. The number and % of infiltrations were 92 and 7.8%, respectively. IV infiltration risk factors were lower limb (OR = 1.72), phenytoin (OR = 11.03), 10% dextrose (OR = 6.55), steroids (OR = 6.21), vancomycin (OR = 4.10), high-concentration electrolytes (OR = 3.49), and ampicillin/sulbactam combination (OR = 3.37). Nurses working at children’s hospitals should consider the risk of IV infiltration for children receiving IV infusion therapy and make a preventive effort to identify IV infiltration in high-risk children at an early stage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Identification of Risk Factors for Intravenous Infiltration among Hospitalized Children: A Retrospective Study

2016

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“…A study conducted in Chile on the TPN theme found that children with bloodstream infection increased the average length of TPN use (p <0.0001), and the hospitalization prior to the beginning of the TPN (p <0.0001) (18) . Another study adds that TPN and antibiotics are among the drugs that characterize risk for developing extravasation injuries in children when administered via PIVC (12) . In this study, the catheter puncture exclusively for blood transfusion appeared as favorable.…”

Section: Risk Factors Related To the Cathetermentioning

confidence: 99%

“…Regardless of the infused solution, its characteristics change according to the concentration of the drug and diluent used in the preparation of the intravenous mixture, causing cell damage or death of the vessel tissue. 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) .…”

Section: Incidence Of Complicationsmentioning

confidence: 99%

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

Danski

Mingorance

Johann

et al. 2016

Rev. esc. enferm. USP

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Incidence of local complications and risk factors associated with peripheral intravenous catheter in neonates * Extracted from the dissertation "Complicações relacionadas ao uso do cateter intravenoso periférico em neonatos", Universidade Federal do Paraná, 2013. ABSTRACT Objective:To evaluate the incidence of complications related to the use of peripheral intravenous catheter in neonates and identify the associated risk factors. Method: Prospective cohort study conducted in a Neonatal Intensive Care Unit. Participants were the hospitalized neonates undergoing peripheral intravenous puncture in the period from February to June 2013. Results: The incidence of complications was 63.15%, being infiltration/extravasation (69.89%), phlebitis (17.84%) and obstruction (12.27%). The risk factors were the presence of infection (p = 0.0192) and weight at the puncture day (p = 0.0093), type of intermittent infusion associated with continuous infusion (p <0.0001), endotracheal intubation (p = 0.0008), infusion of basic plan (p = 0.0027), total parenteral nutrition (P = 0.0002), blood transfusion associated with other infusions (p = 0.0003) and other drugs (p = 0.0004). Higher risk of developing complications in the first 48 hours after puncture. Conclusion: A high rate of complications related to the use of peripheral intravenous catheter, and risk factors associated with infection, weight, drugs and infused solutions, and type of infusion. DESCRIPTORS

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Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients

Kleidon,

Gibson,

Cattanach

et al. 2023

JAMA Pediatr

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ImportancePeripheral intravenous catheters (PIVCs) frequently fail during treatment causing therapy interruption, pain, recatheterization, and additional health care costs. Midline catheters (MCs) may improve functional dwell time and reduce failure compared with traditional PIVCs.ObjectiveTo compare device failure of MCs with PIVCsDesign, Setting, and ParticipantsThis was a pragmatic, randomized clinical superiority trial with an embedded internal pilot study conducted from July 2020 to May 2022. The study took place in a quaternary pediatric hospital in Brisbane, Queensland, Australia. Inclusion criteria were patients aged 1 to 18 years requiring peripherally compatible intravenous therapy for 4 days or longer.InterventionsPatients were randomly assigned 1:1 to receive a PIVC or MC, stratified by age (≤5 years, &gt;5 years). One catheter was studied per patient.Main Outcomes and MeasuresThe primary outcome was all-cause device failure, defined as premature cessation of device function. Secondary outcomes included number of insertion attempts, insertion failure, pain (on insertion), procedural time, patient/parent satisfaction (with insertion), device dwell time, device complications during dwell time, additional vascular access devices required to complete treatment, clinician satisfaction (at removal), and health care costs.ResultsOf the 128 patients randomly assigned to study groups, 127 patients (median [IQR] age, 7 [2-13] years; 71 male [56%]) had a device inserted, with 65 (51.2%) in the PIVC group and 62 (48.8%) in the MC group. All patients were included in the intention-to-treat analysis. Device failure was lower in patients in the MC group (10 [16.1%]) compared with those in the PIVC group (30 [46.2%]; odds ratio [OR], 0.22; 95% CI, 0.10-0.52; P &lt;.001). MCs were associated with fewer insertion attempts (mean difference [MD], −0.3; 95% CI, −0.5 to 0; P = .04), increased dwell time (MD, 66.9 hours; 95% CI, 36.2-97.5 hours; P &lt;.001), and fewer patients required additional vascular access devices to complete treatment in the MC group (4 [6.5%]) and PIVC group (19 [29.2%]; OR, 0.17; 95% CI, 0.05-0.52; P = .002). Compared with PIVCs, use of MCs was associated with greater patient (9.0 vs 7.1 of 10; P = .002) and parent (9.1 vs 8.2 of 10; P = .02) satisfaction and lower health care costs (AUS −$151.67 [US −$101.13] per person; 95% credible interval, AUS −$171.45 to −$131.90 [US −$114.20 to −$87.95]).Conclusions and RelevanceFindings suggest that MC insertion for patients requiring peripherally compatible intravenous therapy for 4 days or longer should be prioritized to reduce the resource intensive, expensive, and burdensome sequelae of device failure.Trial RegistrationAustralia New Zealand Clinical Trials Registry, ACTRN12620000724976

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Reducing Risk of Harm From Extravasation

Cited by 36 publications

References 63 publications

Identification of Risk Factors for Intravenous Infiltration among Hospitalized Children: A Retrospective Study

Identification of Risk Factors for Intravenous Infiltration among Hospitalized Children: A Retrospective Study

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

Midline Compared With Peripheral Intravenous Catheters for Therapy of 4 Days or Longer in Pediatric Patients

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