Cath Lab Digest

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Index: Ostomy Wound Manage. 2012;58(7):40–44.

Abstract

  The intravenous administration of fluids and medications is critical for the treatment of seriously ill patients. Unfortunately, especially in infants and children, fluid infiltration into the surrounding tissue can occur. Early recognition and prompt treatment usually limits the extent of tissue damage. Early treatment may include the injection or application of medication (eg, hyaluronidase, phentolamine, or nitroglycerin ointment) and appropriate dressings. Research to guide the care of more extensive extravasation injury remains limited. At the author’s institution, the protocol of care for children and infants with extensive tissue damage and necrotic tissue consists of careful debridement followed by the use of oxidized regenerative cellulose (ORC)/collagen dressings and skin replacement if needed. Research to help clinicians develop evidence-based protocols of care for both minor and more severe intravenous fluid infiltration or extravasation injury is needed.

Keywords: IV infiltration, infants, children, wounds, extravasation

Potential Conflicts of Interest: none disclosed

Introduction

  The intravenous route of administering blood, fluid, and medications to patients is a relatively recent phenomenon that provides rapid effect of the fluid or medication without the problems of absorption from the gastrointestinal tract and the uncertainty of giving medication via the intramuscular route.¹ The first recorded intravenous administration of blood to man was done by Jean-Baptiste Denis on June 15, 1667.^2,3 Due to political issues and the fact that the different blood types and anticoagulation were not well understood, the transfusion of blood did not become acceptable until the early 20th century. The first intravenous administration of saline was performed in the 1830s, but it did not become common practice until the early 1900s.⁴ Not until medication was sufficiently pure was intravenous administration considered reasonable.¹ Unfortunately, complications soon followed; most were found to be related to delivery of the fluid and/or medication into the subcutaneous tissues instead of the vein.

  Over a 5-year period at the author’s institution, intravenous infiltration injuries were found to have occurred in 10% to 30% of pediatric patients receiving intravenous infusions; 55% of the injuries occurred in neonates (see Figure 1).⁵ The high incidence of these injuries in young patients stimulated a review of these cases and resulted in the development of a treatment protocol now in use.

Risk Factors

  Case studies^6,7 have shown several factors are important in the potential development of an intravenous infusion injury. The younger the patient, the more likely the injury is to occur; the smaller catheter size used for the infusion (the larger the gauge of the catheter) and the use of “butterfly” catheters (needles) are associated with a greater chance of extravasation of fluid and medication. According to several case studies,^5,6,8 children and neonates with darker skin are more likely to suffer from extravasation because of the difficulty visualizing the very small veins in this population. In addition, injury from extravasation of fluids and medications is directly related to the medication and/or fluid administered (see Table 1).