Treatment of a Neonatal Peripheral Intravenous Infiltration/Extravasation (PIVIE) Injury With Hyaluronidase: A Case Report
In a neonatal population peripheral infusion therapy related complication rates up to 75%. Peripheral IV infiltration and extravasation (PIVIE) is implicated up to 65% of IV related complications. PIVIE injury has the potential to cause serious harm. Prompt recognition and timely appropriate intervention can mitigate many of these risks. Adhering to the 5Rs for Vascular Access optimizes infusion therapy and potentially reduces complications.
Introduction: Intravenous therapy-related injury, its prevention, and treatment are ubiquitous topics of interest among neonatal clinicians and practitioners. This is due to the economic costs, reputational censure, and patents’ wellbeing concerns coupled with the possibility of potentially avoidable serious and life-long harm occurring in this vulnerable patient population.
Case description: A term infant receiving a hypertonic dextrose infusion for the management of hypoglycemia developed a fulminating extravasation shortly after commencement of the infusion. This complication developed without notification of infusion pump pressure changes pertaining to a change in blood vessel compliance or early warning of infiltration by the optical sensor site monitoring technology (ivWatch®) in use. The injury was extensive and treated with a hyaluronidase/saline mix subcutaneously injected into the extravasation site using established techniques. Over a period of 2 weeks, the initially deep wound healed successfully without further incident, and the infant was discharged home without evident cosmetic scarring or functional effects.
Conclusion: This article reports on a case of a term baby who postroutine insertion of a peripherally intravenous catheter showed an extreme reaction to extravasation of the administered intravenous fluids. We discuss the condition, our successful management with hyaluronidase, and the need to remain observationally vigilant of intravenous infusions despite the advances in infusion monitoring technology.Highlights
Abstract
Image taken at the time of removal of the cannula. Note despite the evident extravasation, the return blood flow from the point of insertion, suggesting the absence of occlusion.
Image showing the order of subcutaneous injection of hyaluronidase/saline mix.
Image showing the peripheral intravenous infiltration/extravasation site immediately after hyaluronidase/saline administration. Image shows worsening erythema but some reduction in depth of fluid extravasation.
Image showing the peripheral intravenous infiltration/extravasation site 24 hours after hyaluronidase/saline administration. Image shows improving situation, less inflammation, and further reduction in depth of fluid extravasation but some possible ulceration.
Image showing the peripheral intravenous infiltration/extravasation site 3 days after hyaluronidase/saline administration. Image shows improving situation, less inflammation, and further reduction in depth of fluid extravasation but some possible ulceration.
Image showing the peripheral intravenous infiltration/extravasation site 6 days after hyaluronidase/saline administration. Image shows healing and residual possible ulceration.
Image showing the peripheral intravenous infiltration/extravasation site 2 weeks after hyaluronidase/saline administration. Image shows healing and residual cosmetic skin mark.
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