Extravasation injuries: prevention and treatment

A survey of 26 NICUs in Australia and New Zealand describes the practices in place in those units to prevent and treat intravenous catheter-related extravasation injuries. Methods to prevent peripheral IV extravasations included frequent observation of the site, ensuring visibility of the skin over the tip of the IV catheter, and use of a saline flush before injecting a potentially harmful substance. Most of the units allowed infusion of TPN through a peripheral IV catheter, some only reluctantly. More than two-thirds allowed dopamine or other inotrope to be infused through a peripheral IV catheter. When extravasation occurred, many units used a staging system to grade the degree of injury, and one monitored these injuries by using serial photographs of the site. Treatment of injuries consisted of immediate line removal, elevation of the limb, saline washout through small incisions around the extravasation site, use of hyaluronidase, and a warm or cold compress. Extravasation of dopamine or other inotrope was sometimes treated with a specific antidote such as phentolamine.

Neonatal extravasation injury. Restieaux et al. 2013