Does anyone have any information/policies on how to treat an infiltration of packed RBC's? Should heat or cold be applied to the site?
RBCs would not be considered a vesicant. Osmolarity and pH are in the range for safe peripheral infusion. Even old RBCs do not have a K level that would be a problem. A recent conversation with a pathologist about this produced nothing that would make this a vesicant solution. Also there is no real evidence about the best treatment. The rule of thumb for small infiltrations is to treat with whatever improves patient comfort. Remember that heat spreads the leaked fluid into contact with more subq tissue while cold limits the spread. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
though I've looked, because I've teaching that blood is a grade IV infiltration, i.e. extravasation. The MD of our blood bank couldn't find any literature either - we were surmising that it was because the molecules are so large that it might cause tissue damage via compartment syndrome/compression.
But - couldn't find any literature.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Good to know your thought process. I am not sure if the molecule or RBC size would lead to compression from compartment syndrome more so than the actual volume in the SC tissue. And compartment syndrome causes tissue damage from compression, a different mechanism than all other drugs classified as vesicants. Those either damage the DNA of the tissue, or cause ischemic damage that leads to tissue necrosis. Results are a necrotic ulcer. Compartment syndrome would require a relief of the compression by a fasciotomy and amputation if left unrecognized and untreated. I still have lots of questions without many answers!! Lynn
Our policy requires us to notify MD and write an incident report. With 30 years of experience, I have seen several PRBC infitrations, I have not seen necrosis as a result but I have seen severe bruising/ hematoma in the arm as a result of the infitrate and this usually cause problem beacuse if it s not documented it is considered "abuse" of some sort especially with elderly or children. The healing process may take months. We have baby that we thougth it will never heal, she is a fair skin baby and everytime the Mom takes her to a clinic she is always asked what happen, thank goodness for documentation. The MD's have to write it in their progress reports. LTF will not take patients with marked brusies. documentation too is a valuable. We've always have scaled blood infiltrate as 4+, most of the time we don't treat but cold pack maybe used if the patient complains of discomfort for the first few hrs.
So, if there isn't any evidence of infiltration of PRBCs equaling an extravasation, why is that included in the INS Phlebitis/Infiltration scales?
What does it take to make that change in the standards?
Does anyone have any information on using an antidote for blood product infiltration? I have many articles as I am revising our policy and cannot find info on use of hyaluronidase or any other agents for this. Thanks for any info, Janet