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Describing Intravenous Extravasation in Children (DIVE Study)
Vanessa Paquette1, Rumi McGloin, Tracie Northway
1, BSc(Pharm), ACPR, is a Clinical Pharmacist, Neonatal Critical Care, in the Department of Pharmacy, Children's and Women's Health Centre of British Columbia, and a Clinical Instructor in the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
Insights
Pediatric extravasation incidence was low, with IV fluids and potassium chloride most commonly involved. Antidotes were safe but appropriately used in only 50% of cases, highlighting a need for improved management protocols.
Area of Science:
- Pediatric patient safety
- Intravenous therapy complications
- Pharmacovigilance in pediatrics
Background:
- Extravasation, or IV medication leakage, is a significant cause of iatrogenic patient injury.
- Reported incidence ranges from 0.1% to 6.5%, potentially higher in children due to anatomical and physiological risk factors.
Purpose of the Study:
- To determine the incidence of extravasation in a pediatric tertiary care hospital.
- To identify common causative agents and assess antidote use and adverse effects.
Main Methods:
- Retrospective analysis of medical records for pediatric extravasation cases from 2006-2008.
- Evaluation of antidote appropriateness based on institutional protocol.
Main Results:
- Overall incidence of 0.04% per patient-day; 42 cases documented.
- Most common agents: IV fluids (43%), potassium chloride (26%), antibiotics (19%).
- Antidotes were appropriately used in 50% of cases; no adverse drug effects reported.
Conclusions:
- The incidence of pediatric extravasation is low.
- Commonly implicated medications align with existing literature.
- While antidotes are safe, their appropriate use requires improvement, necessitating further research.
Background:
Extravasation, the inadvertent leakage of intravenous (IV) medication from the vein into the surrounding tissue, is a iatrogenic cause of patient injury. Extravasation has been reported to occur in 0.1% to 6.5% of hospital inpatients. The incidence may be higher among children because they have multiple risk factors, including small and fragile veins, decreased peripheral circulation, capillary leakage, and flexible subcutaneous tissue.
Objectives:
To describe the incidence of extravasation at a pediatric tertiary care hospital, to identify the agents causing extravasation, and to describe the use of antidotes to manage identified cases. A secondary objective was to describe adverse drug effects associated with the antidotes administered.
Methods:
The medical records of pediatric patients with documented extravasation of an IV medication between January 1, 2006, and August 31, 2008, were analyzed retrospectively. The appropriateness of antidote use was determined in terms of adherence to the institution's protocol for treatment of extravasation.
Results:
A total of 42 patients had documented extravasation, for an overall incidence of 0.04% per patient-day. Of the 40 cases in which location was documented, 12 (30%) occurred on the general pediatric wards, 10 (25%) on the surgical ward, 9 (22%) in the neonatal intensive care unit, 5 (12%) in the pediatric intensive care unit, 3 (8%) in day care, and 1 (2%) in the emergency department. The most common medications involved were fluids for IV administration (18 [43%]), potassium chloride (11 [26%]), antibiotics (8 [19%]), total parenteral nutrition (8 [19%]), calcium chloride (2 [5%]), and epinephrine (2 [5%]). Multiple drugs were involved in some cases of extravasation. The decision to administer an antidote and the choice of antidote (if required) were appropriate in 50% of the cases. No adverse drug effects were reported with use of antidotes.
Conclusions:
The incidence of extravasation was low. The medications most commonly involved were similar to those reported in the literature. Antidotes were well tolerated but were appropriately used in only half of the events. Prospective trials are needed to determine the clinical severity of injury and to assess the effectiveness and safety of antidotes.
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