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Describing Intravenous Extravasation Injuries in Children (DIVE2 Study)
Jamil Alnoor Devsi1, Vanessa Paquette2, Roxane R Carr3
1, PharmD, ACPR, is with the Department of Pharmacy, Children's & Women's Health Centre of British Columbia, Lower Mainland Pharmacy Services, and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia.
Insights
Extravasation injuries in children remain rare, with common causes including IV fluids and medications like vancomycin. Most patients experience mild outcomes, and no adverse events from antidotes were reported in this study.
Area of Science:
- Pediatric Medicine
- Clinical Pharmacy
- Patient Safety
Background:
- Extravasation, the unintended administration of IV fluids or medications into surrounding tissues, can lead to severe complications, especially in children.
- Limited data exists on the management and outcomes of pediatric extravasation injuries, particularly concerning the use of pharmacologic antidotes.
Purpose of the Study:
- To determine the incidence of extravasation injuries at a tertiary pediatric center.
- To identify frequently implicated agents and assess the use and effects of antidotes.
- To describe the spectrum of complications associated with these injuries.
Main Methods:
- A retrospective review of medical records for pediatric patients with extravasation injuries was conducted.
- Data collected included injury details, management protocols, and patient outcomes over a 12-year period.
Main Results:
- The incidence of extravasation was 0.04% per patient-day, with total parenteral nutrition (TPN) with lipids, vancomycin, and IV fluids being the most common agents.
- The majority of patients, particularly neonates and infants, experienced mild outcomes with no reported adverse drug events from antidotes.
- A significant number of cases (110/242) were excluded from outcome analysis due to incomplete data.
Conclusions:
- The incidence of extravasation injuries at the institution is low, with consistent causative agents and generally mild outcomes.
- Further prospective research is necessary to evaluate the efficacy and safety of antidotes used in managing extravasation injuries in pediatric populations.
Background:
Extravasation is the erroneous delivery of IV medication or fluid into the extravascular space. Complications ranging from mild injury to amputation can result, depending on the physical and pharmacologic properties of the infusate. Children are at increased risk for extravasation injuries. There is a paucity of data on the treatment and outcomes of extravasation injuries, particularly in terms of the role of pharmacologic antidotes.
Objectives:
To describe the incidence of extravasation at a tertiary pediatric care centre (as an update to a previous study), to identify the agents most commonly involved in extravasation injuries, to describe the antidotes used for management of injuries and their related adverse drug effects, and to describe complications related to injuries.
Methods:
The medical records of pediatric patients who experienced an extravasation injury at the BC Children's and BC Women's Hospitals, between September 1, 2008, and September 30, 2020, were reviewed. Data regarding management (adherence with institutional protocol) and outcomes of injuries were collected.
Results:
The 242 charts included in the analysis noted a total of 245 extravasation injuries, for an extravasation incidence of 0.04% per patient-day. Of the 242 patients, 110 were excluded from secondary outcome analysis due to lack of data detailing the extravasation event. Of the remaining 132 patients, the majority were neonates (n = 54, 40.9%), infants (n = 33, 25.0%), and children (n = 34, 25.8%), and more than a third were treated on general pediatric wards (n = 50, 37.9%). The medications most frequently involved were total parenteral nutrition with lipids (36/132, 27.3%), vancomycin (36/132, 27.3%), and IV fluids (35/132, 26.5%). Most of the patients had mild outcomes and recovered without complications. No adverse drug events from antidotes were reported.
Conclusions:
The incidence of extravasation at the study institution remained low, with the medications involved being similar to those reported in the literature and the majority of patients having mild outcomes. Additional prospective studies are needed to assess the efficacy and safety of antidotes administered for extravasation injuries.
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