Surgical intervention for paediatric infusion-related extravasation injury: a systematic review (original) (raw)
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Journal of Hospital Medicine
Background: Pediatric extravasation injuries are significant healthcare-associated injuries, with sometimes significant sequelae. Evidence-based guidance on management is necessary to prevent permanent injury. Purpose: A systematic review of the literature, including aggregated case series, investigating extravasation injury management of hospitalized pediatric patients. Data Sources: PubMed, Cummulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica database (EMBASE) were searched on December 13, 2021. Study Selection: Primary research investigating extravasation injury management of hospitalized pediatric patients (to 18 years), published from 2010 onwards and in English, independently screened by two authors, with arbitration from a third author. Data Extraction: Data regarding the study, patient (age, primary diagnosis), extravasation (site, presentation, outcome), and treatment (first aid, wound management) were extracted by two authors, with arbitration from a third author. Data Synthesis: From an initial 1769 articles, 27 studies were included with extractable case data reported in 18 studies, resulting in 33 cases. No clinical trials were identified, instead, studies were primarily case studies (52%) of neonates (67%), with varied extravasation symptoms. Studies had good selection and ascertainment, but few met the causality and reporting requirements for quality assessments. Signs and symptoms varied, with scarring (45%) and necrosis (30%) commonly described. Diverse treatments were categorized into first aid, medical, surgical, and dressings. Conclusions: Despite infiltration and extravasation injuries being common within pediatric healthcare, management interventions are under-researched, with low-quality studies and no consensus on treatments or outcomes.
Treatment of extravasation injuries in infants and young children: a scoping review and survey
Health technology assessment (Winchester, England), 2018
Extravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches. To identify which treatments may be best for treating extravasation injuries in infants and young children. Scoping review and survey of practice. Children aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries. Any treatment for extravasation injury. Wound healing time, infection, pain, scarring, functional impairment, requirement for surgery. Twelve 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). Scoping 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 ta...
Management of extravasation injuries
ANZ Journal of Surgery, 2001
Background: Various agents have been implicated in causing tissue necrosis after intravenous infusions have extravasated. These include solutions of calcium, potassium, bicarbonate, hypertonic dextrose, cytotoxic drugs and antibiotics. Views on management of these injuries differ, and range from a non-operative conservative approach to early debridement and grafting. Methods: A retrospective review was undertaken of the hospital files of patients with extravasation injuries seen in three Australian hospitals. Nine patients were identified, and their management and long-term follow up are reported. Results: Age ranged from 17 days to 60 years. Two patients received their injuries from solutions containing isotonic dextrose/saline. The other seven patients received injuries from a variety of solutions including calcium gluconate (n = 1), parenteral nutrition (n = 1), sodium bicarbonate (n = 1), immunoglobulin (n = 1), gentamicin and penicillin (n = 1), flucloxacillin (n = 1), and the chemotherapeutic agents epirubicin and cyclophosphamide (n = 1). The sites involved included the dorsum of the right foot (n = 3), the dorsum of the left foot (n = 3), the right groin (n = 1), the right hand (n = 1) and the left hand (n = 1). Four patients were managed by delayed debridement and split skin grafting, while five were treated non-operatively. Prolonged scar management was necessary in seven of the nine patients. Final results were satisfactory in all patients who received skin grafting and in all patients who were managed conservatively. Conclusions: Management of extravasation injuries should be conservative if possible. Delayed debridement and split skin grafting is required if the area of skin loss is extensive. Scar management remains a problem. Prevention of these injuries with the education of both medical and nursing staff remains the ultimate aim.
Extravasation Injuries in Adults
Extravasation Injuries in Adults, 2013
Insertion of an intravascular catheter is one of the most common invasive procedures in hospitals worldwide. These intravascular lines are crucial in resuscitation, allow vital medication to be administered, and can be used to monitor the patients' real-time vital parameters. There is, however, growing recognition of potential risks to life and limb associated with their use. Medical literature is now replete with isolated case reports of complications succinctly described by Garden and Laussen (2004) as "An unending supply of "unusual" complications from central venous catheters. " This paper reviews complications of venous and arterial catheters and discusses treatment approaches and methods to prevent complications, based on current evidence and endeavours to provide information and guidance that will enable practitioners to prevent, recognise, and successfully treat extravasation injuries in adults.
Extravasation: Surgical Management and Prevention
European journal of medical and health sciences, 2022
II. METHODOLOGY OF THE LITERATURE REVIEW Our study consists of a review of the existing literature with the presentation of some cases admitted to the Department of Plastic and Reconstructive Surgery in Casablanca, Morocco. The scientific literature search was conducted to review the current evidence of effective therapies that may provide benefit in reducing the severity of extravasation injury in our patients. The PubMed database and the ScienceDirect publisher platform were used. All types of studies evaluating one or more treatments were included in the search, without date limitation. Bibliographies of key articles, guidelines and case reports were also evaluated for other treatment-related
Extravasation Injury in the Perioperative Setting
Anesthesia & Analgesia, 2005
Extravasation is an unintentional injection or leakage of fluid in the perivascular or subcutaneous space. Extravasation injury results from a combination of factors, including solution cytotoxicity, osmolality, vasoconstrictor properties, infusion pressure, regional anatomical peculiarities, and other patient factors. We reviewed the hospital files of patients who had sustained a significant extravasation injury in the perioperative setting at two German hospitals. These cases highlight the risk of devastating consequences from extravasation injury. Vasoactive drugs and hyperosmolar and concentrated electrolyte solutions are the predominant vesicants in the perioperative setting. Prompt and appropriate intervention is important for avoiding or minimizing extensive tissue injury. (Anesth Analg 2005;100:722-7)
Extravasation Injuries: A Trivial Injury Often Overlooked with Disastrous Consequences
2020
With the advent of parenteral, intravenous infusion for various purposes like chemotherapy, parenteral nutrition, radiocontrast intravenous injection for imaging studies, extravasation injuries are emerging as a serious problem with often disastrous complications, if not recognized early. Fortunately, if treated early, the affected extremities can be salvaged and hence the role of plastic surgeons cannot be over-emphasized, especially when it comes to the reconstruction of necrotic and ischemic wounds as a result of these injuries. Proper monitoring and immediate intervention will go a long way in minimizing the morbidity associated with these injuries. However, if there is a delay in recognition and treatment, it can lead to complications like skin necrosis, gangrene, extensive soft tissue defects and contractures. Treatment in these circumstances needs an individualized approach and entails wound debridement followed by skin grafts and flap cover. Documentation and prompt interven...
Surgical treatment of extravasation injuries
Journal of Surgical Oncology, 2005
The authors present their experience of treating anti-cancer drug extravasation by means of a composite surgical technique that consists of infiltration with physiological solution and hyaluronidase and subsequent manual aspiration of solutes alternated with profuse irrigation of the infiltrated area. In the immediate post-op we carry out a medical therapy that consists of calciparine and topic antibiotic and/or steroid creams.