![]() ![]() Hyaluronidase is an enzyme that helps absorb and dispense extravasated irritants, which has shown to reduce the severity of tissue damage. 16 Subcutaneous injection of hyaluronidase is one of the pharmaceutical treatments of IV extravasation. 16 Treatments vary among each unit protocol including immediate line removal, limb elevation, saline washout, and thermal compress. ![]() 15 Extravasation can lead to tissue necrosis, infection, limb disfigurement, and functional loss. 9 Infiltration rate among neonates is 57% to 70% and tissue damage from extravasation occurs in 11% to 25%. Approximately 95% of PIV catheters are removed before the completion of therapy generally due to complications such as infiltration, infection, clotting, or other problems. 14 This is an extremely short period compared with the length of nutritional supplementation and medication needed in most NICU neonates. One study (n = 72) among the neonatal population showed that the average length of time a PIV catheter was in place before complications required removal was 30 hours, 13 while another larger study (n = 250) among the neonatal population showed 37 hours to be the average length of time. 9 Despite the high rate of use and long history, PIV catheter still has a poor track record. 1, 10– 12 Most NICU nurses are competent at inserting a PIV catheter, which is usually placed in the extremities or the scalp. 9 A PIV catheter is easier to place than a central catheter, but it does not last as long and can often take multiple attempts to be successfully placed. The most widely used vascular access device in the NICU is a PIV catheter, which is commonly a 22- or 24-gauge Teflon radiopaque over the needle catheter. 6 Peripherally inserted central catheter-related cases of CLABSI and pericardial effusion had been directly linked to neonatal death. 5 Peripherally inserted central catheter can be associated with complications including central line-associated bloodstream infection (CLABSI), phlebitis, infiltration, occlusion, catheter leakage leading to pleural effusion and peritonitis, cardiac arrhythmia, pericardial effusion, and cardiac tamponade. Peripherally inserted central catheter requires additionally trained nurses for insertion and radiographs to confirm correct placement. It is intended for long-term nutrition and medication therapies as it can remain in place for months at a time. 4 To be considered centrally placed, the tip of the PICC should be in the superior or inferior vena cava 5 (Figure (Figure1). 3Ī PICC is an intravenous catheter that is inserted peripherally and threads into the central venous circulation and is made of silicone, polyurethane, or polyethylene. 2 The neonatal extended dwell peripheral intravenous (EPIV) catheter is a new device that became available in recent years and seems to have advantages over the PIV catheter and PICC, but comparative effectiveness studies have not been reported from the NICU population. However, both devices have well-known limitations and risks. 1 The 2 most commonly used neonatal vascular access devices are peripheral intravenous (PIV) catheter and peripherally inserted central catheter (PICC). Establishing vascular access is challenging in NICU neonates due to their small and extremely fragile veins. The majority of NICU neonates require vascular access during their stay for prolonged nutritional support and medications. Vascular access is often needed in neonatal intensive care unit (NICU) neonates. ![]()
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