Peripheral line infiltrartion

johan john · May 1, 2008

I need immediate help for an iv infiltration with sodium bicarb.the baby is acase of early neonatal sepsis who is in severe metabolic acidosis, who is quiet unstable with severe thrombocytopenia.Central line insertion was failed and had a big blister from extravasation.Please help out .

Canu suggest the practice in your units for infiltration of Dopamine, calcium, and TPN?

dawngloves, BSN, RN · May 1, 2008

You should consult your unit policy on this.

We use Hyaluronidase for infiltrates.

Jolie, BSN · May 1, 2008

If the baby demonstrates evidence of tissue damage, s/he may need a plastics consult.

EricJRN, MSN, RN · May 1, 2008

We typically use hyaluronidase, but we would use phentolamine mesylate (Regitine here in the US) for dopamine infiltrations. A plastic surgery consult may help. Right now it sound like this baby has many other urgent concerns though.

NicuGal, MSN, RN · May 1, 2008

If it has just happened you can use Wydase, or NS injected in several increments around the area, but you will need a hospital policy for either to cover your butt. Unfortunatley, NAHCO3 leaves a nasty burn. We also use a hydrogel over bad infiltrates (your hospital wound team would know about this). If the baby is terribly septic the perfusion is bad and unfortunately this baby is most likely in for more infiltrates. It happens Just make sure to fill out an incident report.

elizabells, BSN, RN · May 4, 2008

Wydase and then bacitracin and Telfa. If it's really, really bad (like the surrounding skin gets necrotic) Plastics gives us Accuzyme for the wound borders. I know right now we're in a lawsuit over a TPN burn that supposedly should have been in a central line but wasn't, so the concentrations of everything were really high, and the kid has permanent loss of function to the affected limb.

And the poster above me is right - these kids get horrible infiltrates. I just had a patient die of MRSA that got into an infiltrated IV. She was an access nightmare - ended up with an IO, if you can believe it.

corks · May 9, 2008

Hydrallinase or normal saline flush outs whereby several needle pricks are made around the site and saline is used to flush. Actiform cool for a dressing-great for pain relief during dressing changes! May need plastics referral. Have seen bad ones with TPN and MGSO4. :cry:

Jolie, BSN · May 9, 2008

Have seen bad ones with TPN and MGSO4.

Just curious, why was a baby receiving mag sulfate?

corks · May 9, 2008

For PPHN.

elizabells, BSN, RN · May 9, 2008

For PPHN.

Huh. I've never heard of that. Something new to research tonight, yayyyy!

elizabells = giant nerd :)

Jolie, BSN · May 9, 2008

Huh. I've never heard of that. Something new to research tonight, yayyyy!
elizabells = giant nerd :)

I was thinking the same thing, elizabells.

Having been on Mag for preterm labor, I can vouch that it made me sick as a dog, with every possible side-effect. I would feel really bad for a poor baby on that stuff. I sure hope s/he was well medicated for pain/sedation!