IV Infiltration

[Ellen59]

1

[Gompers, BSN, RN]

We had an IV infiltrate on one of our babies today. Infusing HAL. It was checked it at 0715. At 1045 the arm was puffy/edema and there was a .5 to 1cm blister 2cm above the site. Warm soaks took away the edema within hours but the blister still remains. Does anyone have any experience with this type of injury. What are your thoughts. Will it scar and what else could have done or should be done.

When we have an infiltrate like that the docs inject Wydase (sp?) sub-q into the site. Most units check their IV sites every hour, so the real problem is that it wasn't checked between 0715 and 1045.

[2curlygirls]

I hate peripheral TPN (I mean PPN). We had a baby who's IV infiltrated and he ended up needing plastic surgery and PT. IV hadn't been checked for 2 hours. Watch those things like a hawk!

We used Wydase when I started but don't anymore.

Most of our kiddos end up with PICC's for TPN.

[Gompers, BSN, RN]

Most of our kiddos end up with PICC's for TPN.

Most of ours, do, too, but I can't believe that EVERYBODY always uses PICC lines for all their fluids. When we first get a baby, say a 32 weeker, we will use peripheral more often than not. The plan is to start feeds and advance quick enough that the IV is only needed a couple of days. Other times, if a baby is septic and the PICC culture comes back positive, we are forced to pull the line and not allowed to insert another one until the cultures start coming back negative.

[dawngloves, BSN, RN]

We have a standing order for Wydase and also do IV checks q hour. But I understand that a lot can happen in one hour. I don't see infiltrates often enough to know how it'll look later. But I would think that Plastics should be consulted.

[dawngloves, BSN, RN]

Most of ours, do, too, but I can't believe that EVERYBODY always uses PICC lines for all their fluids. When we first get a baby, say a 32 weeker, we will use peripheral more often than not. The plan is to start feeds and advance quick enough that the IV is only needed a couple of days. Other times, if a baby is septic and the PICC culture comes back positive, we are forced to pull the line and not allowed to insert another one until the cultures start coming back negative.

A PICC for every baby sounds great in therory, but unless a 32 weeker is going to be NPO and on 14 days of abx, we'll just use a peripheral line too.

[cathys01]

I have had two IV infiltrates in my 18 months in the NICU (within two weeks of each other - about a year ago). Both were on chronic babies getting TPN/Lipids. Both went bad within 1 hour (we do q1hr IV checks). Our docs do Wydase for TPN infiltrates. I think it's important to let the doc know *immediately* when an infiltrate is noted. I've never seen anyone do warm compresses for infiltration, but maybe that's just my unit?

[Gompers, BSN, RN]

I'm a bit nervous now that the original poster deleted her questions, even though they're already quoted in my post...

[lovemyjob]

The other day I came on and had a PIV infiltrated upon first check (we RARELY do PIV's. ur 32 weekers usually have a uvc until their ability to tolerate feeds is determined..then the need for a PICC is determined.) The docs injected it with hydrocortisone. I was told they no longer made wydase. They hand looked great the next day. Man do I HATE PIV's.

[BittyBabyGrower, MSN, RN]

I didn't think they made Wydase anymore. We have a protocol for NS injections SC around the infiltrated site to dilute out the TPN. No warm compresses...it will make the tissue absorb the TPN more readily and the calcium is what makes the worst of the infiltrate.

We have had a few really bad ones...now plastics has us use Tegagel with an occlusive dressing over it. You change it when it starts to get dry. It will look nasty under the dressing for a while, but the infiltrates heal much better this way. I've seen them down to fascia before....yuck!

[Gompers, BSN, RN]

I didn't think they made Wydase anymore. We have a protocol for NS injections SC around the infiltrated site to dilute out the TPN. No warm compresses...it will make the tissue absorb the TPN more readily and the calcium is what makes the worst of the infiltrate.

We have had a few really bad ones...now plastics has us use Tegagel with an occlusive dressing over it. You change it when it starts to get dry. It will look nasty under the dressing for a while, but the infiltrates heal much better this way. I've seen them down to fascia before....yuck!

They did stop making it, but either we have a stash of it down in pharmacy or someone else is now making it or something similar. We just used it last week.

I'll have to ask about Tegagel, that sounds interesting!

We don't use warm compresses much anymore, either. We'll elevate the IV site to help decrease the swelling. If the IV site actually has obvious tissue damage, we'll use bacitricin on the site covered with Telfa and then gauze, and use a velcro posey band to hold it on the site, or sometimes a length of stockinette. If there is a burn, like from Bicarb, we'll use Silvadene instead. We have plastics come up and see all the infiltrates that go beyond a little swelling, and follow their suggestions.

[lovemyjob]

The infiltrate we used hydrocort on was only running D12.5 1/4 NS, but the doc said if it had Ca+ in it we wouldnt be able to use it. Not sure what we do when it is TPN...