Neonatal Extravasation: An Overview and Algorithm for Evidence-based Treatment

The peripheral intravenous (PIV) catheter is the most used vascular access device for the administration of medications in hospitalized neonates, however 95% of PIV catheters are removed due to complications. Infiltration and extravasation are one of the most destructive complications to the neonate's fragile skin. This article reviews multiple aspects of infiltration and extravasation injury. First, starting at the cellular level the role of vesicants in vascular injury and its role triggering inflammation will be discussed, followed by a comprehensive review of vesicants and their mechanism of injury, by pH, osmolality or chemical composition, then an overview of the NICU nurses knowledge and actions to prevent infiltration and ending with the use of an evidence-based algorithm that was developed at one children's hospital to minimize injury caused by extravasations through targeted, prompt treatment.