Extravasation Identification and Management in Neonates and Pediatrics: A Cross Sectional Survey

Abstract

Objective: To explore current practice and guidelines surrounding the identification and management of extravasation injuries in Australian and New Zealand neonatal and pediatric settings.; Methods: Between February and September 2023, an internet-based descriptive cross-sectional survey was distributed to Australian and New Zealand neonatal and pediatric clinicians using exponential nondiscriminative snowball sampling. Survey data domains included demographics, extravasation identification, management, local guidelines, and resources.; Results: Of the 141 responses, the majority of respondents were registered nurses (n = 96, 68.1%), with greater than 20 years of experience (n = 51, 36.2%). Over two-thirds of respondents had no extravasation identification and management training (n = 98, 69.5%). Half of the respondents (n = 70, 49.6%) reported that increased presentation of risk factors did not alter monitoring frequency. Extravasations were primarily associated with the hand and wrist region (n = 118, 43.7%). Maintenance fluids, antibiotics and parenteral nutrition accounted for extravasation events. Acute management practices (immediate cessation of infusion) showed consistency (n = 124, 87.9%), whereas varying degrees of adoption were observed for aspirating the residual fluid. The majority of respondents (n = 119, 84%) reported the absence of a formal grading scale for extravasation severity.; Conclusions: Clinicians reported challenges and inconsistencies in neonatal and pediatric extravasation injury identification and management. This underscores the need for effective monitoring and identification, standardized management practices, and education to minimize the burdens of extravasation for patients, families, and the health care system.; Competing Interests: CONFLICT OF INTEREST DISCLOSURES: Dr Ullman’s employer has received investigator-initiated research grants and speaker fees from product manufacturers (3M, Becton Dickinson, Biolife, Medline) unrelated to the current submission; Dr August’s employer has received investigator-initiated grants from product manufacturers (3M and NAVI technologies) unrelated to this work; and Ms Nguyen, Ms Takashima, and Ms Cunninghame have no conflicts of interest relevant to this article to disclose. (Copyright © 2024 by the American Academy of Pediatrics.)