Saline irrigation for the management of skin extravasation injury in neonates

Gopalakrishnan, P N; Goel, Nitin; Banerjee, Sujoy

doi:10.1002/14651858.cd008404

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…46 Aggressive surgical flushing of the extravasated area with normal saline may assist with the removal of extravasated material, sparing tissue damage. 47 The recombinant enzyme hyaluronidase has emerged as a commonly used treatment modality for hyperosmolar extravasations. The enzyme causes depolymerization of acid polysaccharides such as hyaluronic acid and chondroitin sulfates, resulting in a temporary dissolution of the interstitial barrier.…”

Section: Osmotically Active Agentsmentioning

confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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Extravasations are common manifestations of iatrogenic injury that occur in patients requiring intravenous delivery of known vesicants. These injuries can contribute substantially to patient morbidity, cost of therapy, and length of stay. Many different mechanisms are behind the tissue damage during extravasation injuries. In general, extravasations consist of four different subtypes of tissue injury: vasoconstriction, osmotic, pH related, and cytotoxic. Recognition of high-risk patients, appropriate cannulation technique, and monitoring of higher risk materials remain the standard of care for the prevention of extravasation injury. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. The best therapeutic agent for treatment of vasopressor extravasation is intradermal phentolamine. Topical vasodilators and intradermal terbutaline may provide relief. Intradermal hyaluronidase has been effective for hyperosmotic extravasations, although its use largely depends on the risk of tissue injury and the severity of extravasation. Among the hyperosmotic agents, calcium extravasation is distinctive because it may present as an acute tissue injury or may possess delayed clinical manifestations. Extravasation of acidic or basic materials can produce significant tissue damage. Phenytoin is the prototypical basic drug that causes a clinical manifestation known as purple glove syndrome (PGS). This syndrome is largely managed through preventive and conservative treatment measures. Promethazine is acidic and can cause a devastating extravasation, particularly if administered inadvertently through the arteriolar route. Systemic heparin therapy remains the accepted treatment option for intraarteriolar administration of promethazine. Overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports. More research is needed to improve knowledge of patient risk, prompt recognition of the extravasation, and time course for tissue injury, and to develop prevention and treatment strategies for extravasation injuries.

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Section: Osmotically Active Agentsmentioning

confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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“…We identified one Cochrane Database systematic review on saline irrigation for neonatal extravasations. The review was inconclusive, given the lack of any eligible studies (Gopalakrishnan et al, 2012). Four controlled animal experiments were retrieved (Coleman et al, 1983; Dorr et al, 1996; Laurie et al, 1984; Loth, 1986).…”

Section: Introductionmentioning

confidence: 99%

Extravasation injuries: a review

Goutos

Cogswell

Giele

2014

J Hand Surg Eur Vol

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Extravasation injuries are common emergencies in clinical practice. If they are not recognized and treated promptly, they can lead to deleterious functional and cosmetic outcomes. There is a vast range of agents involved in these injuries and marked paucity of evidence to support their specific management. Following an extensive literature review, we outline management principles for clinicians involved in the care of patients with extravasation injuries. Key parameters in deciding appropriate management plans include the volume/toxicity of the agent, the necrosis interval of the injury, patient-related factors, as well as the facilities and expertise available in the setting of individual cases of extravasation.

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Saline irrigation for the management of skin extravasation injury in neonates

Cited by 2 publications

References 10 publications

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Extravasation injuries: a review

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