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Skin necrosis from extravasation of intravenous fluids in children
Insights
Intravenous (I.V.) fluid extravasations in children occurred at an 11% rate, with hypertonic fluids and pumps increasing risk. Prompt monitoring and wound care prevented skin grafts in most cases.
Area of Science:
- Pediatric Medicine
- Nursing Care
- Wound Management
Background:
- Extravasation of intravenous (I.V.) fluids is a common complication in pediatric care.
- Skin sloughs and loss can occur, potentially requiring advanced treatment.
- Understanding risk factors and effective management is crucial for patient outcomes.
Purpose of the Study:
- To analyze the incidence and outcomes of I.V. fluid extravasations in children.
- To identify factors associated with severe extravasation injuries.
- To evaluate conservative treatment protocols for skin loss due to extravasation.
Main Methods:
- Retrospective review of 16,380 I.V. fluid administrations over 6 months.
- Identification of 1,800 extravasation events (11%), with 40 resulting in skin sloughs.
- Comparison of 3 conservative treatment protocols for skin loss.
Main Results:
- Most skin loss extravasations were linked to hypertonic fluids and infusion pumps.
- No skin grafts were required for any cases of partial or full-thickness skin loss.
- No significant differences in healing were observed among the three treatment regimens.
Conclusions:
- Systematic hourly monitoring by nursing personnel is essential for children receiving I.V. fluids.
- Elevation of the affected extremity and appropriate wound care are important management strategies.
- Conservative treatment protocols appear effective in managing extravasation-induced skin loss, avoiding the need for skin grafts.
Abstract:
From 16,380 administrations of I.V. fluid in children during a 6-month period, there were 1,800 extravasations (11%) with 40 skin sloughs. All that resulted in either partial or full-thickness skin loss were treated by one of 3 conservative protocols, and no skin grafts were needed in this series. Most of the extravasations resulting in skin loss were associated with hypertonic fluids and the use of infusion pumps. Careful hourly monitoring of such cases seems highly desirable. We found no discernible differences in the healing among the 3 treatment regimens used. The importance of systematic monitoring of children receiving I.V. fluids by nursing personnel, the elevation of an extremity involved in an extravasation, and the care of any resulting wounds are discussed.