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fpiedmont77
protocol on extravasation management in peds and the dosing of antidotes
im in the process of developing a pediatric PIV guidelines for our hospital and it will include management of extravasations. can anyone share their respective practices?  and can anyone please tell me where to look for the current national stats ( occurrence of PIV-related infiltrates and phlebitis ) on pediatric population?..thank  you so much. anyone who can contribute would be so appreciated.
lynncrni
There are no national

There are no national statistics on complications related to PIVs. You will find various research studies that will report on phlebitis, however there are very limited data on infiltration and extravasation injuries.  In the July August issue of JIN, you will find a thorough literature review on the management of these complications. But this review did not produce much data on the incidence rates. This review also had pediatric/neonatal experts on the panel.

1.    Doellman D, Hadaway L, Bowe-Geddes LA, et al. Infiltration and extravasation: update on prevention and management. J Infus Nurs. Jul-Aug 2009;32(4):203-211.
 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

fpiedmont77
thanks lynn. i had read that

thanks lynn. i had read that INS journal already and it did not have much discussion on pediatrics. i wish miss doellman can suggest some references that i can look into managing and dosing of antidotes in treating pediatric infiltrates and extravasations.

lynncrni
Darcy Doellman is a

Darcy Doellman is a pediatric infusion nurse specialist and there was also a neonatal nurse practitioner on the panel that created this article. We scoured the literature of everything we could find. So I don't think there is anything about specific peds doses, although Darcy's hospital may have created something just for their use. You should contact her directly. There is only one antidote drug that is infused systemically - Totect for Adriamycin extravasation. This is a relatively new drug and I am not sure if the drug literature makes any statements about peds. The remainder of antidotes are injected locally around the periphery of the area.  I am not so sure that there would be a difference in the peds dose vs an adult dose, especially for drugs such as hyaluronidase. This drug breaks down local tissue to allow the fluid leaked in the tissue to be reabsorbed into circulation. For Hylenex, the recombinant hyaluronidase, there is peds dosage for subq infusion. But there are no doses even for adults on using this drug as an antidote for extravasation. Look at the reference list from the article. There are pediatric studies listed. You will need to find those articles to determine if there is additional peds information that was not included in this literature review. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

fpiedmont77
Thanks again Lynn. I am
Thanks again Lynn. I am waiting for Darcy to email me back. I already emailed her about this.
Gwen Irwin
NDNQI has been collecting

NDNQI has been collecting information about infiltration (extravasation) for PIVs for about 3 or 4 years.  I hope they will publish their findings.

Gwen Irwin

Austin, Texas

Julie Mijatovich
Hylenex for sub q injections instead of IV access??

Hylenex for sub q injections instead of IV access??

Is anyone using this or know any research on this? A Peds MD is requesting our hospital start with using Hylenex for sub q injections of fluid bolus.

Also Baxter was saying they are using it for Rocephin.

Any words of wisdom?

Thanks,

Julie Mijatovich, CRNI, Operational Lead Vascular Access

Parkview Hosptial

Fort Wayne, In

lynncrni
There are many publications

There are many publications discussing the addition of hyaluronidase to SC infusion of fluids. This is common in the palliative/hospice care world. Hylenex is a recombinant version of hyaluronidase, and thus removes the risks associated with animal derived products. I know they were working on adding this to IM drugs but have not kept up with any publications on this. If there are no actual published articles yet, then Baxter should be able to connect you with other clients that are using it for IM meds. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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