362 Managing Intravenous Infiltration Injuries in the Neonatal Intensive Care Unit

Abstract Introduction Complications of intravenous (IV) access is can be devastating for the critically ill neonate. IV extravasation into surrounding into the surrounding soft tissue can result in full thickness wounds complicating an already complex patient. The characteristics, ideal management and outcomes of these wounds require further investigation. We describe our experience at a tertiary burn care center with management of IV infiltrate and extravasation injury in neonatal intensive care unit (NICU). Methods A retrospective chart review of the institutional burn database was performed for infants under one year of age with reported IV infiltrate or extravasation injury hospitalized in the NICU between May 2010 and June 2017. Demographic information as well as data specific to the injury and management were collected and analyzed. Results Twenty-eight patients under the age of one year old evaluated for IV extravasation or infiltration injury were identified. Average age was 38 days (0 days to 8 months). The most common comorbidities were congenital heart disease, respiratory distress, and necrotizing enterocolitis. Offending agents included parenteral nutrition (TPN) (administered through a peripheral IV), vasopressors, antibiotics and calcium containing solutions. Location of injury was split evenly between upper extremity (50%) and lower extremity (46%) with one wound located on the scalp. Burn Surgery was consulted and the following wound care regiment was administered: daily cleansing, petroleum-based antibiotic ointment, Xeroform and coarse gauze wrapping. Half of the patients received hyaluronidase injections per nursing protocol with no difference in outcomes. Time to healing averaged 16.2 days (range 1–82 days) and average size of the wound was 0.59% of total body surface area (range 0.01–2.56%). It is important to note that no patient required surgical intervention with diligent wound care. Conclusions Intravenous infiltration and extravasation injuries in the NICU were identifying a diversity of offending agents and wound severity. Though these complications can be devastating, early involvement of the Burn Surgery team with diligent wound care, all injuries experiences modest healing times, all with conservative management. Applicability of Research to Practice Guidelines at the authors’ institutions dictate that the Burn Surgery service be consulted for wound care recommendations for IV infiltrate and extravasation injuries meeting cer