Extravasation Injuries of the Limbs in Neonates and Children—Development of a Treatment Algorithm

Area of Science:

• Pediatric Medicine
• Intravenous Therapy
• Injury Management

Background:

• Intravenous therapy is common in children and neonates.
• Systematic data on pediatric extravasation injuries is scarce.
• Existing studies report high incidence (18-46%) in neonates, with serious complications in 2.4-4%.

Purpose of the Study:

• To review the current literature and clinical experience regarding pediatric extravasation injuries.
• To highlight the lack of evidence-based guidelines for managing these injuries in children.

Main Methods:

• Selective literature search of PubMed (1979-2020).
• Inclusion of own clinical experience.
• Analysis of existing studies, case series, and conservative, pharmacological, and surgical treatment options.

Main Results:

• Lack of randomized controlled trials limits evidence to small comparative studies and case series.
• Treatment is based on extravasated substance properties, volume, and patient factors.
• Assessment includes tissue damage, color, swelling, and capillary refill.
• Treatment options range from conservative measures to antidotes, hyaluronidase, vasodilators, and surgical interventions.

Conclusions:

• No single treatment is evidence-based superior for pediatric extravasation injuries.
• Therapy requires individualized decision-making.
• Off-label use of treatments carries inherent risks.