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Chapter 27 ■ Peripheral Intravenous Line Placement 151

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Emergency Medicine. 4th ed. Philadelphia: Saunders; 2004:366.

25. Cronin WA, Germanson TP, Donowitz LG. Intravascular cannula colonization and related blood stream infection in critically

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152

Jayashree Ramasethu

Management of Extravasation

Injuries

28

Extravasation or inadvertent infiltration of IV administered

solutions into subcutaneous tissue is a common adverse

event in intensive care nurseries and may result in partial or

complete skin loss, infection, and nerve and tendon damage, with the potential risk of cosmetic and functional

impairment (1–3). Parenteral alimentation fluids, calcium,

potassium, and sodium bicarbonate solutions, vasopressor

agents, and antibiotics such as nafcillin, are often implicated (1,4–6). Early identification and appropriate management are vital to minimize damage (7–9).

A. Assessment (Fig. 28.1;

see also Figs. 27.5 and 27.6)

1. Staging of extravasations is recommended for objective

evaluation to determine the degree of intervention

required. Several staging systems are in use (7–10).

Table 28.1 describes one that is commonly used.

2. Detailed descriptions or digital photographs provide

better documentation of the extent of the wound and

the healing process

3. Fussiness, crying, or withdrawal of the limb when flushing the IV cannula are early warning signs, but these

may be absent in an infant who is sedated or critically ill.

4. Blistering and discoloration of skin often portend at

least partial skin loss, but visible skin changes do not

always indicate the severity of underlying injury, which

may evolve over several days (7).

B. Management

The degree of intervention is determined by the stage of

extravasation, the nature of the infiltrating solution, and the

availability of specific antidotes. There is no consensus on

management of stage 3 or 4 lesions. In the absence of randomized controlled trials, some institutions have established

management protocols to guide therapy, based on local

experience, case series, and anecdotal evidence (1,7–13).