Saline irrigation for the management of skin extravasation injury in neonates

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

doi:10.1002/14651858.cd008404.pub3

Cited by 20 publications

(19 citation statements)

References 33 publications

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“…Although a number of treatments are advocated, no comparative clinical studies have been published. A recent review emphasized the lack of prospective randomized trials, and other retrospective reviews and case series, referring to various different approaches, did not provide strong evidence for any particular intervention .…”

Section: Discussionmentioning

confidence: 99%

Severe Extravasation Injuries in Neonates: A Report of 34 Cases

Kostogloudis

Demiri

Tsimponis

et al. 2015

Pediatric Dermatology

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Section: Discussionmentioning

confidence: 99%

Severe Extravasation Injuries in Neonates: A Report of 34 Cases

Kostogloudis

Demiri

Tsimponis

et al. 2015

Pediatric Dermatology

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“…All three of the identified reviews concurred that although immediate treatment is needed for the best outcomes, there is no consensus regarding which treatments constitute best practice. [7, 18, 19] They all mentioned saline washout with or without hyaluronidase as a frequently studied treatment but no review could make conclusive statements on its effectiveness compared to other treatments due to the limited quality of evidence. Seven published guidelines were identified.…”

Section: Resultsmentioning

confidence: 99%

Treating extravasation injuries in infants and young children: a scoping review and survey of UK NHS practice

et al. 2019

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Background: Extravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines but there is no consensus on the best treatment approaches, particularly in infants and young children. Methods: This paper presents a more succinct account of a study of treatments for extravasation injuries in infants and children which has also been reported in full as an NIHR HTA report. A systematic scoping review and survey of UK NHS practice were undertaken. Twelve databases-including MEDLINE and EMBASE-were searched for relevant studies in February 2017. Studies of children with extravasation injuries receiving any treatment for extravasation injury were eligible, providing they reported one of the following outcomes: wound healing time, infection, pain, scarring, functional impairment, and requirement for surgery. Studies were screened in duplicate. Data were extracted by one researcher and checked by another. Studies were summarised narratively. An online questionnaire was distributed to NHS staff at neonatal units, paediatric intensive care units and principal oncology/ haematology units. Results: The evidence identified in the scoping review was mostly comprised of 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 many factors. The survey yielded 63 responses from hospital units across the UK. Results indicated that although most units had written documentation for treating extravasation injuries, only one-third of documents included a system for grading injury severity. The most frequently used interventions were elevation of the affected area and analgesics. Saline washout 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. Conclusions: There is some uncertainty about which are most the promising treatments for extravasation injuries in infants and young children. Saline flush-out techniques and conservative management approaches are commonly used and may be suitable for evaluation in trials. Although conventional randomised trials may be difficult to perform a randomised registry trial may be an appropriate alternative design.

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“…It is recommended that in case of soft tissue in ltrate with suspected NE extravasation the infusion be instantly stopped and transitioned to another PVA or a CVA. If the in ltrate is con rmed, best practices for tissue salvage include leaving the cannula on site, aspirating as much as possible both the drug and blood while removing it slowly, discussing with a pharmacist the use of sub-cutaneous injection of phentolamine (5-10 mg in 10 mL of saline) at the extravasation site (13) or discussing with plastic surgeons the use of saline ushes through multiple incisions around the extravasation site (14). Nevertheless, given the high bene t of the early administration of NE in pediatric septic shock and the di culty obtaining an early CVA, peripheral infusion of NE can prove bene cial in restoring hemodynamic stability and complying with the pediatric SSC guidelines (1).…”

Section: Discussionmentioning

confidence: 99%

Safety of Early Norepinephrine Infusion Through Peripheral Vascular Access During Transport of Critically ill Children

CHARBEL

OLLIER

Julliand

et al. 2020

Preprint

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BackgroundReversal of hypotension is a priority in the management of a collapsed child. The pediatric Surviving Sepsis Campaign advocates for the rapid use of epinephrine or norepinephrine for sepsis related myocardial or vascular dysfunction following 40-60ml/kg of fluid resuscitation. Vasoactive drugs should be started within the first hour after sepsis recognition in a patient with shock. In such a short delay, central venous access can be difficult to obtain, and infusion may be initially started through a peripheral catheter. Hereby, we reported the safety of norepinephrine infusion through a peripheral catheter in retrieved shocked patients.MethodsMulticentric retrospective analysis of medical pediatric retrieval teams experience of vasopressors infusion through a peripheral vascular access. Medical pediatric retrieval teams (SMUR) and Pediatric Intensive care units (PICU) of the Paris urban region. Children 0 to 18 years necessitating norepinephrine infusion during retrieval. Modalities of infusion (drip concentration, duration, site of infusion), incidence of complication and outcome at PICU discharge were reviewed.ResultsThirty-seven children in shock received a norepinephrine infusion for a median time of 4 hours. No local adverse event was noted. One patient had transient blanching of the skin which improved after appropriate care. The overall mortality was 10.8% with one death (2.7%) during transport and 3 (8.1%) in PICU. ConclusionsDuring transport of critically ill patients requiring vasopressor infusion by a specialized pediatric retrieval team, the use of norepinephrine on a non-central catheter was safe among all patients.

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Saline irrigation for the management of skin extravasation injury in neonates

Abstract: Saline irrigation for the management of skin extravasation injury in neonates (Review)

Cited by 20 publications

References 33 publications

Severe Extravasation Injuries in Neonates: A Report of 34 Cases

Severe Extravasation Injuries in Neonates: A Report of 34 Cases

Treating extravasation injuries in infants and young children: a scoping review and survey of UK NHS practice

Safety of Early Norepinephrine Infusion Through Peripheral Vascular Access During Transport of Critically ill Children

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