The knowledge and management of extravasation of medical personnel working in the neonatal ıntensive care unit

Öz

Aim: It is aimed to examine the knowledge and management of extravasation related to the vascular pathway among nurses and doctors working in the neonatal intensive care unit in this study. This study was the first survey study to evaluate the knowledge and management of extravasation. Method: This study, which was designed as aprospective cross-sectional survey study, included 300 health professionals working in the neonatal intensive care unit. Due to the conditions imposed by the pandemic, neonatal health workers who were actively engaged in in the neonatal intensive care unit were sent the 28 questions questionnaire form prepared via ”Google Forms" to their mobile phones and e-mail addresses. Results: Health professionals in the study reported that the most important health care related risk factor in the development of extravasation was insufficient follow-up while administering high-risk drugs (p=0.028). Risk factors for the baby were identified as prematurity and hypotension/hypoperfusion (p<0.001). The first approach in the treatment of extravasation was to stop the infusion and withdraw the intravenous cannula (p<0.001). Healthcare workers faced severe conditions requiring extravasation at a rate of 91.6% and limb loss or plastic surgery at a rate of 58% during their professional lives. Conclusion: All health workers working in the neonatal intensive care unit should be provided with up-to-date information by continuing in-service training, and extravasation treatment protocols should be developed to prevent variations approaches.

Anahtar Kelimeler

• Extravasation
• newborn
• health worker

Yenidoğan yoğun bakım ünitesinde çalışan sağlık personelinin ekstravazasyon bilgi birikimi ve yönetimi

Öz

Amaç: Yenidoğan yoğun bakım ünitesinde çalışan hemşire ve doktorların damar yoluna bağlı ekstravazasyon bilgi birikimi ve yönetiminin incelenmesi hedeflenmiştir. Bu çalışma ekstravazasyon bilgisini ve yönetimini değerlendiren ilk anket çalışmasıdır. Yöntem: Kesitsel anket çalışması olarak tasarlanan bu araştırmaya yenidoğan yoğun bakım ünitesinde görev alan 300 sağlık çalışanı dahil edilmiştir. Yenidoğan sağlık çalışanlarına pandemi sürecinin gerekliliği nedeni ile mobil telefonlara, mail adreslerine “Google Forms” aracılığıyla hazırlanan 28 soruluk anketin yer aldığı formun sayfa uzantısı gönderilerek doldurulması sağlanmıştır. Bulgular: Çalışmaya katılan sağlık çalışanları, ekstravazasyon gelişimi ve sağlık bakımı ile ilgili en önemli risk faktörünün yüksek riskli ilaçlar verilirken yetersiz takip yapılması (%51.7, p=0.028) idi. Bebek ile ilgili risk faktörünü ise prematürite (%33.3) ve hipotansiyon/hipoperfüzyon (%34.7) olarak belirledi (p<0.001). Ekstravazasyon tedavisinde ilk yaklaşım infüzyonun durdurulması ve damar yolunun çekilmesi oldu (p<0.001). Sağlık çalışanlarının meslek hayatları boyunca %91.6 oranında ekstravasyon, %58 oranında ise uzuv kaybı veya plastik cerrahi tedavisi gerektirecek kadar ciddi komplikasyonlar ile karşılaştıkları görüldü. Sonuç: Yenidoğan yoğun bakım ünitesinde çalışan tüm sağlık çalışanlarına hizmet içi eğitime devam edilerek bilgilerin güncelliği sağlanmalı, farklı yaklaşımların önüne geçmek için ekstravazasyon tedavi protokolleri geliştirilmelidir.

Anahtar Kelimeler

• Ekstravazasyon
• yenidoğan
• sağlık çalışanı

Kaynakça

1. Beall V, Hall B, Mulholland JT, Gephart SM. Neonatal extravasation: an overview and algorithm for evidence-based treatment. Newborn and Infant Nursing Reviews. 2013;13(4):189-95.
2. Fonzo-Christe C, Parron A, Combescure C, Rimensberger PC, Pfister RE, Bonnabry P. Younger age and in situ duration of peripheral intravenous catheters were risk factors for extravasation in a retrospective paediatric study. Acta Paediatr. 2018;107(7):1240-6.
3. Wilkins CE, Emmerson AJ. Extravasation injuries on regional neonatal units. Arch Dis Child Fetal Neonatal Ed. 2004;89(3):F274-5.
4. Kostogloudis N, Demiri E, Tsimponis A, Dionyssiou D, Ioannidis S, Chatziioannidis I, et al. Severe Extravasation Injuries in Neonates: A Report of 34 Cases. Pediatr Dermatol. 2015;32(6):830-835
5. Atay S, Sen S, Cukurlu D. Incidence of infiltration/extravasation in newborns using peripheral venous catheter and affecting factors. Rev Esc Enferm USP. 2018;52:e03360.
6. Hackenberg K, Kabir K, Müller A, Heydweiller A, Burger C, Welle K. Extravasation Injuries of the Limbs in Neonates and Children—Development of a Treatment Algorithm. Dtsch Arztebl Int. 2021;118(33-34):547-54.
7. Talbot SG, Rogers GF. Pediatric compartment syndrome caused by intravenous infiltration. Ann Plast Surg. 2011;67(5):531-3.
8. Corbett M, Marshall D, Harden M, Oddie S, Phillips R, McGuire W. Treating extravasation injuries in infants and young children: a scoping review and survey of UK NHS practice. BMC Pediatr. 2019;19(1):6.

9. Hackenberg RK, Kabir K, Müller A, Heydweiller A, Burger C, Welle K. Extravasation Injuries of the Limbs in Neonates and Children—Development of a Treatment Algorithm. Dtsch Arztebl Int. 2021;118(33-34):547-54.
10. Durmuş M, SALDIR M, YAPICI AK, Fatih Z, Avşar S, Gasimov T, et al. Ekstravazasyon yaralanmaları: Üç olgu sunumu ve literatürün gözden geçirilmesi. Türk Plastik Rekonstrüktif ve Estetik Cerrahi Dergisi. 2015;23(1):33-6.
11. Raine JE. An analysis of successful litigation claims in children in England. Arch Dis Child. 2011;96(9):838-40.
12. Bhananker SM, Liau DW, Kooner PK, Posner KL, Caplan RA, Domino KB. Liability related to peripheral venous and arterial catheterization: a closed claims analysis. Anesth Analg. 2009;109(1):124-9.
13. Hee HI, Lim SL, Tan SS. Infusion technology: a cause for alarm. Paediatr Anaesth. 2002;12(9):780-5.
14. Clifton-Koeppel R. Wound care after peripheral intravenous extravasation: What is the evidence? Newborn and Infant Nursing Reviews. 2006;6(4):202-11.
15. Clark E, Giambra BK, Hingl J, Doellman D, Tofani B, Johnson N. Reducing risk of harm from extravasation: a 3-tiered evidence-based list of pediatric peripheral intravenous infusates. J Infus Nurs. 2013;36(1):37-45.
16. Thigpen JL. Peripheral intravenous extravasation: nursing procedure for initial treatment. Neonatal Netw. 2007;26(6):379-84.
17. Amjad I, Murphy T, Nylander-Housholder L, Ranft A. A new approach to management of intravenous infiltration in pediatric patients: pathophysiology, classification, and treatment. J Infus Nurs. 2011;34(4):242-9.
18. Doellman D, Hadaway L, Bowe-Geddes LA, Franklin M, LeDonne J, Papke-O'Donnell L, et al. Infiltration and extravasation: update on prevention and management. J Infus Nurs. 2009;32(4):203-11.
19. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Pharmacotherapy. 2014;34(6):617-32.
20. Ching DL, Wong KY, Milroy C. Paediatric extravasation injuries: a review of 69 consecutive patients. Int J Surg. 2014;12(10):1036-7.
21. Corbett M, Marshall D, Harden M, Oddie S, Phillips R, McGuire W. Treatment of extravasation injuries in infants and young children: a scoping review and survey. Health Technol Assess. 2018;22(46):1-112.
22. Schaverien MV, Evison D, McCulley SJ. Management of large volume CT contrast medium extravasation injury: technical refinement and literature review. J Plast Reconstr Aesthet Surg. 2008;61(5):562-5; discussion 5.
23. Dougherty L. Extravasation: prevention, recognition and management. Nurs Stand. 2010;24(52):48-55; quiz 6, 60.
24. Martin SM. Extravasation management of nonchemotherapeutic medications. J Infus Nurs. 2013;36(6):392-6.
25. David V, Christou N, Etienne P, Almeida M, Roux A, Taibi A, et al. Extravasation of Noncytotoxic Drugs. Ann Pharmacother. 2020;54(8):804-14.
26. Wiegand R, Brown J. Hyaluronidase for the management of dextrose extravasation. Am J Emerg Med. 2010;28(2):257.e1-2.
27. Gopalakrishnan PN, Goel N, Banerjee S. Saline irrigation for the management of skin extravasation injury in neonates. Cochrane Database Syst Rev. 2012(2):Cd008404.
28. Casanova D, Bardot J, Magalon G. Emergency treatment of accidental infusion leakage in the newborn: report of 14 cases. Br J Plast Surg. 2001;54(5):396-9.
29. Mas V, Simon AL, Presedo A, Mallet C, Ilharreborde B, Jehanno P. Upper limb extravasation of cytotoxic drugs: results of the saline washout technique in children. J Child Orthop. 2020;14(3):230-5.
30. Kim JT, Park JY, Lee HJ, Cheon YJ. Guidelines for the management of extravasation. J Educ Eval Health Prof. 2020;17:21.