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Mutsago T, Kazzazi D, Ibrahim Y, Kazzazi F, Patel H, Pafitanis G. Phenytoin Induced Purple Glove Syndrome: An Effective Management Technique. Hosp Pharm 2024; 59:276-281. [PMID: 38764997 PMCID: PMC11097927 DOI: 10.1177/00185787231224064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Background: Purple glove syndrome (PGS) is a rare condition characterized by limb edema, discoloration, and pain associated with intravenous and oral phenytoin administration. The pathophysiology is poorly understood, and there is no established treatment. Simple cases have previously been managed with hyaluronidase subcutaneous injections, with more severe cases resulting in compartment syndrome, debridement, or even amputation. Methods/Results: In this case report, a 2-year-old boy with status epilepticus developed PGS after receiving intravenous phenytoin via a cannula on the dorsum of the right hand. The patient was successfully managed by locally infiltrating subcutaneous hyaluronidase diffusely to the affected area, titrating its dose to effect, rather than aiming to adhere to any specific dosing limitation. The child was reviewed daily by the Plastic Surgery team until being discharged, and focal lesions began to demarcate after 48 hours, with epidermal loss but no deeper trauma. The epidermis peeled within one month, with healthy underlying skin found underlying when followed up in clinic. Conclusions: This case illustrates that subcutaneous administration of hyaluronidase and titrating to effect provides an effective and safe treatment for treating distal cases of early PGS in children.
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Azoury SC, Matros E. Top 25 Medications the Plastic and Reconstructive Surgery Trainee Should Know for an Emergency Medicine Department Consult. Plast Reconstr Surg 2024; 153:474e-489e. [PMID: 37141488 DOI: 10.1097/prs.0000000000010609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
SUMMARY Plastic surgery trainees are often called to render care in the emergency department (eg, for established patients, trauma, burns). Broad-based knowledge in pharmacotherapeutics during these encounters is critical. This includes an understanding of pain medications, anxiolytics, local anesthetics, antibiotics, anticoagulants, antidotes, and more to ensure optimal patient care. The purpose of this report is to describe 25 frequently used and other important medications that plastic surgery trainees should know for an adult emergency department encounter.
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Affiliation(s)
- Saïd C Azoury
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania
| | - Evan Matros
- Division of Plastic Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center
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Atay S, Üzen Cura Ş, Efil S. Nurses' knowledge and experience related to short peripheral venous catheter extravasation. J Vasc Access 2023; 24:848-853. [PMID: 34590526 DOI: 10.1177/11297298211045589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The majority of hospitalized patients receive a Peripheral Venous Catheter (PVC) in the course of their treatment. Extravasation injury is a serious complication of intravenous treatment. OBJECTIVE This cross-sectional survey designed study aims to investigate nurses' knowledge and experience related to short peripheral venous catheter extravasation. METHOD The study sample included 145 nurses working in a university hospital in the west of Turkey. A questionnaire developed in accordance with the literature was used for data collection. The data were assessed by frequency and proportions. RESULTS Of the nurses included in this study, 26.2% reported they had experienced extravasation injury in a patient; 74.5% said they had received no instruction in the management of extravasation during their in-service training program; and 85.5% stated they did not keep a record of extravasation. 89.7% of the nurses reported infused medications as a cause of extravasation, and 81.4% reported catheter sites as a cause. Among the medications reported by the nurses as causing extravasation: 89.7% reported contrast agents; 84.8% TPN solutions; 71.0% cytotoxic agents; and 65.1% mannitol. The symptoms of extravasation reported by nurses included: swelling (97.9%), redness (97.2%), pain (92.4%), rise in temperature (65.5%), and ulceration (60.0%). In responding to the occurrence of extravasation, interventions reported by the nurses included: stopping the flow of fluid (98.6%), elevation (89.7%), cold application (76.6%), and aspiration of drug (40.7%). CONCLUSION Based on these results, it is recommended that guidelines are developed for the management of extravasation, that periodic in-service training programs are provided and that observational studies are carried out into the administration of vesicant drugs.
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Affiliation(s)
- Selma Atay
- Nursing Department at School of Health, Çanakkale Onsekiz Mart University, Canakkale, Turkey
| | - Şengül Üzen Cura
- Nursing Department at School of Health, Çanakkale Onsekiz Mart University, Canakkale, Turkey
| | - Sevda Efil
- Nursing Department at School of Health, Çanakkale Onsekiz Mart University, Canakkale, Turkey
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Safety considerations related to intravenous contrast agents in pediatric imaging. Pediatr Radiol 2022:10.1007/s00247-022-05470-z. [PMID: 35941280 DOI: 10.1007/s00247-022-05470-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
Intravenous contrast media are used in MRI, CT and US studies for anatomical evaluation and lesion characterization. Safety is always of paramount importance when administering any contrast media to children, and it is important for radiologists and ordering providers to be knowledgeable of the safety profiles and potential adverse events that can occur. This manuscript reviews the frequency and types of adverse events associated with intravenous contrast agents reported in the pediatric literature. Overall, intravenous contrast agents are very safe to use in children. However, familiarity with how to treat and prevent these uncommon events is crucial in preventing poor outcomes. In addition, an understanding of gadolinium deposition in tissues can help facilitate conversations with concerned physicians and parents. This review provides a concise yet comprehensive reference for radiologists and ordering providers on intravenous contrast safety considerations in the pediatric patient.
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A new approach to skin extravasation injury management during the neonatal period. BMC Pediatr 2022; 22:451. [PMID: 35883040 PMCID: PMC9317491 DOI: 10.1186/s12887-022-03511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background To identify a standard protocol for managing extravasation injuries in neonates. Methods We recruited all the neonates with extravasation wounds from the neonatal intensive care unit of Shariati hospital, Tehran, Iran, between October 2018 and October 2020. Sixteen patients with grade 3–4 extravasation were evaluated in this retrospective study. All grade 3 and 4 extravasation wounds were injected with hyaluronidase at 5 points of the wound circle; the procedure was repeated every 5 min at different points in a smaller circle to the core. The wound was then covered with a warm compress for 24 h. Twenty-four hours after injection, the cover was changed twice a day with normal saline irrigation. Fibrinolysin ointment was applied on top of the wound. The ulcer was then dressed with phenytoin ointment until healing. Results Out of 16 neonates who were followed up, 10 of them were male, with the average birth weight being 1.37 (range 1.05–3.75) kg. The mean (± SD) wound healing duration was 13.12 (± 6) (range: 7–29) days. Factors including the cannulation duration before the appearance of the lesion (R:0.2, P = 0.2), birth weight (R = -.37, P = 015), and extravasated substances (p = 0.2) were not associated with the duration of hospital stay. The only exception to this trend is the wound size factor of 7.31(± 7.45) (R = .83, P < 0.001). Continuous and categorical variables were summarized as mean (SD) and proportions, respectively, and the Kruskal–Wallis test and Spearman correlation coefficients were used. Conclusions Limited evidence exists on the effects of different protocols on extravasation management in neonates in the NICU. We recommend our method as a standard protocol in NICU for high-stage extravasated lesions because of the shorter duration of healing, non-invasive nature of this procedure, and lack of side effects or surgical involvement.
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Alavi Farzaneh B, Alipour M, Reisi-Vanani V. Post-operative ascites of unknown origin after laparoscopic cholecystectomy: Case report. Ann Med Surg (Lond) 2022; 76:103431. [PMID: 35284068 PMCID: PMC8914458 DOI: 10.1016/j.amsu.2022.103431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Post Laparoscopic cholecystectomy ascites is a rare complication that might be due to biliary leak, lymph duct injuries, infections, peritoneal reaction bowel injuries, malignancies and etc. Case presentation Here we have reported post-cholecystectomy ascites presented with hypovolemic shock in a women of unknown origin. Different possible etiologies have been ruled out for her but her intra-peritoneal secretions had been decreased about one week of hospitalization and was discharged without figuring out its etiology. Clinical discussion Post-cholecystectomy ascites is a rare condition that could be caused by biliary leak, lymphatic leak, ovarian hyper stimulation syndrome, infections, peritoneal reactions and malignancies that all of them should be considered for these patients to manage their problem. Conclusion The exact cause of ascites in the presented case was still unknown and the condition was controlled by administration of corticosteroids, octreotide, albumin, and insertion of the stents in biliary ducts. More investigation esp. on immunologic causes are needed. Post laparoscopic ascites could be life-threatening with Iatrogenic and non-iatrogenic causes. Immunologic causes need to be studied more.
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Affiliation(s)
- Babak Alavi Farzaneh
- Department of Surgery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mehdi Alipour
- Department of Surgery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Vahid Reisi-Vanani
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Management of Chemotherapy Infusion Extravasation in Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bicer A, Ercin BS, Gürler T, Yiğittürk G, Uyanikgil Y, Cetin EO. Possibility of Taking an Offensive Stance in Extravasation Injury: Effects of Fat Injection in Vesicant (Doxorubicin) Induced Skin Necrosis Model in Rats. J INVEST SURG 2021; 35:801-808. [PMID: 34402353 DOI: 10.1080/08941939.2021.1966142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Extravasation injuries are one of the most feared complications of intravenous drug administration. The most common drugs associated with extravasation injury include chemotherapy agents and contrast media. Natural course of vesicant extravasation is discomfort, pain, swelling, inflammation, and ultimately skin ulceration. While diligence is the principle approach in prevention, immediate bed-side measures are as important in controlling the extent of tissue damage. Various options, either medical or interventional are next steps in treatment of the condition including antidotes, volume dilution, flushing, suction, hyperbaric oxygen therapy, and surgery. MATERIALS AND METHODS 12 male Wistar albino rats were divided into two groups; one group received fat injections following subdermal doxorubicin infiltration in their right thighs, while other group received saline injection following subdermal doxorubicin infiltration in their right thighs for dilution. Left thighs of both groups were left untreated following subdermal doxorubicin infiltration. Total area of necrosis, as well as resultant epidermal thicknesses were assessed. Histological analyses were conducted using modified Verhofstad scoring system for comparison. RESULTS Mean necrotic area was significantly smaller in the fat injection group compared to other groups. Median Verhofstad score was lesser in the fat injection group as well. Median epidermal thickness, on the other hand, was greater in the fat injection group. CONCLUSION Injection of fat grafts following vesicant extravasation might be beneficial in preventing the progression of tissue damage, if employed early.
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Affiliation(s)
- Ahmet Bicer
- Department of Plastic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burak Sercan Ercin
- Department of Plastic, Reconstructive and Aesthetic surgery, Bahcesehir University, Istanbul, Turkey.,Department of Plastic, Reconstructive and Aesthetic surgery, Medicalpark Pendik Hospital, Istanbul, Turkey
| | - Tahir Gürler
- Department of Plastic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gürkan Yiğittürk
- Department of Histology and Embryology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Yigit Uyanikgil
- Department of Histology and Embryology, Faculty of Medicine, Ege University, Izmir, Turkey.,Department of Stem Cell, Ege University, Health Science Institue, Izmir, Turkey.,Cord Blood, Cell and Tissue Research and Application Centre, Ege University, Izmir, Turkey
| | - Emel Oyku Cetin
- Department of Pharmaceutical Technology, Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, Ege University, Izmir, Turkey
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Measuring the Validity and Reliability of the Vascular Access Complication Staging and Treatment Instrument in a Pediatric Population. JOURNAL OF INFUSION NURSING 2021; 44:225-243. [PMID: 34197352 DOI: 10.1097/nan.0000000000000431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A multiphase study designed with Delphi and observational components was conducted to establish the preliminary validity and reliability of the 2018 Vascular Access Complication Staging and Treatment Instrument in pediatric and neonatal populations from a single, free-standing academic children's hospital. The instrument uses objective measurement criterion to determine the severity of swelling and tissue damage to inform treatment decisions. The results of the study provided preliminary empirical evidence to support a pediatric and neonatal intravenous complication staging instrument to assess degree of swelling and severity of tissue injury. The study also offered preliminary evidence that the instrument was perceived by the nurses who participated in the study to be efficient and easy to use.
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Hoefnagel AL, Timmermann TN, Riga A, Kaye MB, Braunecker S, Mongan PD. A Unique Treatment for Compartment Syndrome After Intravenous Catheter Extravasation: A Case Report. A A Pract 2021; 15:e01496. [PMID: 34185027 DOI: 10.1213/xaa.0000000000001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intravenous cannulation is performed on nearly every patient presenting for an anesthetic. Complications of the procedure include infiltration and extravasation, which can have a varied impact on the patient. Here, we present a case of severe intravenous (IV) extravasation, resulting in compartment syndrome of the hand. Rather than treating the compartment syndrome with fasciotomies as is standard, we utilized compression therapy via an Esmarch surgical dressing wrapped distal to proximal on the effected limb, which resulted in marked decrease in swelling and return of perfusion to the hand.
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Affiliation(s)
| | | | - Andrew Riga
- Orthopedic Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Marc B Kaye
- Orthopedic Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
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Ong J, Van Gerpen R. Recommendations for Management of Noncytotoxic Vesicant Extravasations. JOURNAL OF INFUSION NURSING 2021; 43:319-343. [PMID: 33141794 DOI: 10.1097/nan.0000000000000392] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
To prepare clinicians to treat extravasation of noncytotoxic vesicants with antidotes and thermal compresses, a literature review was performed to identify noncytotoxic vesicants and to create evidence and consensus-based recommendations. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. For a vasopressor extravasation, warm compresses and administration of a vasodilator are recommended. For osmolarity, pH, absorption refractory, and cytotoxic concentration-dependent vesicants, warm compresses and administration of hyaluronidase are recommended. Compared with potentially catastrophic costs of undertreatment, the cost of overtreatment is minimal.
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Affiliation(s)
- Jennie Ong
- Bryan Medical Center, Lincoln, Nebraska (Dr Ong and Ms Van Gerpen).,Jennie Ong, PharmD, is a clinical pharmacist at Bryan Medical Center in Lincoln, Nebraska, with 10 years of hospital pharmacy experience. Her specialties include formulary management and patient safety-oriented process improvements.,Ruth Van Gerpen MS, RN-BC, APRN-CNS, AOCNS®, is a clinical nurse specialist at Bryan Medical Center in Lincoln, Nebraska, with 36 years of oncology experience. Her subspecialties include pain management and infusion therapy
| | - Ruth Van Gerpen
- Bryan Medical Center, Lincoln, Nebraska (Dr Ong and Ms Van Gerpen).,Jennie Ong, PharmD, is a clinical pharmacist at Bryan Medical Center in Lincoln, Nebraska, with 10 years of hospital pharmacy experience. Her specialties include formulary management and patient safety-oriented process improvements.,Ruth Van Gerpen MS, RN-BC, APRN-CNS, AOCNS®, is a clinical nurse specialist at Bryan Medical Center in Lincoln, Nebraska, with 36 years of oncology experience. Her subspecialties include pain management and infusion therapy
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Sharma DSC, Lahiri MA. Use of hyaluronidase in plastic surgery: A review. J Plast Reconstr Aesthet Surg 2021; 74:1610-1614. [PMID: 34024740 DOI: 10.1016/j.bjps.2021.03.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/06/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
Hyaluronidase is a family of enzymes that degrade hyaluronic acid (HA). It is found to increase vascular permeability and temporarily disrupt the extracellular matrix, promoting diffusion of substances through tissues. Alongside its applications in ophthalmology, obstetrics and gynaecology, musculoskeletal medicine, radiology and drug and fluid administration, hyaluronidase has a number of roles in the field of plastic surgery. The popularity of HA fillers in recent years has led to an increase in the usage of hyaluronidase in the treatment of filler-related complications. The purpose of this article is to review the current and future uses of hyaluronidase within the field of plastic surgery. Hyaluronidase is used as an adjunct to local anaesthetics in skin infiltration, skin graft harvesting, tumescent analgesia, managing complications of dermal fillers, treatment of extravasation injury, prevention and management of oedema, treatment of ganglion and management of scars. However, it has some limitations. Hyaluronidase is known to interact with a number of common medications. Several case reports also highlight the risk of allergic reaction to the substance. Although rare and usually mild, hyaluronidase has the potential to cause anaphylaxis. Other adverse effects include bruising and swelling. Overall, hyaluronidase appears to be a very safe, cheap and effective medication for a variety of uses in the field of plastic surgery and beyond.
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Affiliation(s)
| | - Mr Anindya Lahiri
- Department of Plastic Surgery, Sandwell General Hospital, Lyndon, West Bromwich, West Midlands, B71 4HJ, UK
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Pancaro C, Shah N, Pasma W, Saager L, Cassidy R, van Klei W, Kooij F, Vittali D, Hollmann MW, Kheterpal S, Lirk P. Risk of Major Complications After Perioperative Norepinephrine Infusion Through Peripheral Intravenous Lines in a Multicenter Study. Anesth Analg 2020; 131:1060-1065. [PMID: 32925324 DOI: 10.1213/ane.0000000000004445] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Continuous infusions of norepinephrine to treat perioperative hypotension are typically administered through a central venous line rather than a peripheral venous catheter to avoid the risk of localized tissue necrosis in case of drug extravasation. There is limited literature to estimate the risk of skin necrosis when peripheral norepinephrine is used to counteract anesthesia-associated hypotension in elective surgical cases. This study aimed to estimate the rate of occurrence of drug-related adverse effects, including skin necrosis requiring surgical management when norepinephrine peripheral extravasation occurs. METHODS This retrospective cohort study used the perioperative databases of the University Hospitals in Amsterdam and Utrecht, the Netherlands, to identify surgical patients who received norepinephrine peripheral intravenous infusions (20 µg/mL) between 2012 and 2016. The risk of drug-related adverse effects, including skin necrosis, was estimated. Particular care was taken to identify patients who needed plastic surgical or medical attention secondary to extravasation of dilute, peripheral norepinephrine. RESULTS A total of 14,385 patients who received norepinephrine peripheral continuous infusions were identified. Drug extravasation was observed in 5 patients (5/14,385 = 0.035%). The 95% confidence interval (CI) for infusion extravasation was 0.011%-0.081%, indicating an estimated risk of 1-8 events per every 10,000 patients. There were zero related complications requiring surgical or medical intervention, resulting in a 95% CI of 0%-0.021% and indicating a risk of approximately 0-2 events per 10,000 patients. CONCLUSIONS In the current database analysis, no significant association was found between the use of peripheral intravenous norepinephrine infusions and adverse events.
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Affiliation(s)
- Carlo Pancaro
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Nirav Shah
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Wietze Pasma
- Department of Anesthesiology, Universitair Medisch Centrum, Utrecht, the Netherlands
| | - Leif Saager
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Ruth Cassidy
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Wilton van Klei
- Department of Anesthesiology, Universitair Medisch Centrum, Utrecht, the Netherlands
| | - Fabian Kooij
- Department of Anesthesiology, Academic Medisch Centrum, Amsterdam, the Netherlands
| | - Dave Vittali
- Department of Anesthesiology, Academic Medisch Centrum, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Academic Medisch Centrum, Amsterdam, the Netherlands
| | - Sachin Kheterpal
- From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Philipp Lirk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Nickel B. Peripheral Intravenous Administration of High-Risk Infusions in Critical Care: A Risk-Benefit Analysis. Crit Care Nurse 2020; 39:16-28. [PMID: 31961938 DOI: 10.4037/ccn2019443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In critical care, the short peripheral intravenous catheter is an essential venous access route, often used in emergency situations to administer high-risk medications and fluid resuscitation. This route of administration is generally viewed as routine and benign. However, a growing body of evidence indicates that the risks inherent to this route are much higher than reported and represent a significant area of patient harm. Few standardized definitions and surveillance methods exist for peripheral intravenous catheter-related complications such as phlebitis, bloodstream infection, and extravasation. Recommendations for peripheral intravenous catheter replacement are based on clinical indications rather than routine replacement, so standards of practice for catheter insertion and management must be consistently applied. This article reviews recent studies that challenge the need for central catheter placement for vasopressor therapy, current knowledge of peripheral intravenous catheter-related adverse events, and evidence-based standards of care for short peripheral intravenous catheter insertion and maintenance.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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Shrestha N, Acharya U, Shrestha PS, Acharya SP, Karki B, Dhakal SS. Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report. Oxf Med Case Reports 2020; 2020:omaa066. [PMID: 32793370 PMCID: PMC7416830 DOI: 10.1093/omcr/omaa066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/05/2020] [Accepted: 06/30/2020] [Indexed: 12/02/2022] Open
Abstract
Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported. Here we report a case of peripheral extravasation of vasopressors, successfully managed with topical nitroglycerin in intensive care unit in Kathmandu. To our knowledge, this is the first report of such kind from Nepal.
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Affiliation(s)
- Ninadini Shrestha
- Department of Anesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
| | - Utsav Acharya
- Department of Anesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
| | - Pramesh Sunder Shrestha
- Department of Anesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
| | - Subhash Prasad Acharya
- Department of Anesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
| | - Bipin Karki
- Department of Critical Care Medicine, Om Hospital and Research Centre, Kathmandu 44600, Nepal
| | - Subodh Sagar Dhakal
- Department of Pulmonology, Sleep Medicine and Critical Care, Kathmandu Medical College and Teaching Hospital, Kathmandu 44600, Nepal
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Abstract
BACKGROUND Intravenous (IV) lines are ubiquitous in hospital settings. These lines can malfunction, leaking noxious contents into subcutaneous tissue. Existing literature describes invasive intervention and complex treatment protocols. These persist despite significant changes in the composition and administration of IV agents. The purpose of this study is to examine the consequences of IV infiltrations at a tertiary medical center to update protocols and treatment algorithms. MATERIALS AND METHODS This study is an observational, retrospective chart review performed at a tertiary care medical center. All inpatient plastic surgery consultations for IV infiltration were reviewed from 2011 to 2017. Patients were included if IV infiltration was suspected or documented. Data were collected for each injury regarding patient demographics, substance, and intervention. RESULTS The plastic surgery service evaluated 381 IV infiltration injuries from 2011 to 2017, with 363 meeting the criteria. Injuries per year progressively increased, with 32 consultations in 2011 and 102 consultations in 2017. The vast majority of injuries identified (91%) were treated with only elevation and observation. The minority consisted of wound care (7%) performed by nursing or any form of incision, aspiration, or antidote injection (2%) performed by the physician. Of the 363 injuries, the most common infiltrates were noncytotoxic (35%), radiographic contrast (27%), and known vesicants (18%). Interestingly, a large portion of consultations were requested by other surgical services (32%). CONCLUSIONS Although there is an increase in expert involvement for cases of IV infiltration injuries, the vast majority of these injuries are managed with minimal intervention. This is most likely owing to recent changes that have decreased the potential for harmful infiltration. Contrary to existing literature, invasive intervention is almost never indicated.
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