Peripheral Intravenous Catheter Extravasation Wound Care Guidelines

Abstract

The hospital peripheral intravenous (PIV) infiltration and extravasation protocol was developed in 2005 and outlined clear guidelines for treatment, assessment, and documentation requirements. The care of infiltration/extravasation wounds primarily resulting from Stage 3–4 infiltrations was identified as being inconsistent. In the hospitalized neonatal patient with a PIV extravasation, what is the best practice for managing extravasation wounds to minimize tissue damage and optimize wound healing? An evidence-based practice project team composed of nurses representing the neonatal intensive care unit, infant medical–surgical unit, surgical services, and WOCN was developed. The Johns Hopkins Nursing Evidence-Based Practice model was used. Literature search and evidence appraisal were completed for the past 15 years. Expert opinion evidence was provided by the WOCN team member. One neonatal clinical practice guideline addressing intravenous infiltration was found (Association, 2007Association of Women's Health, Obstetric and Neonatal Nurses Evidence based clinical practice guideline: Intravenous infiltration.in: 2nd ed. Neonatal skin care guidelines. Author, Washington, DC2007: 53-74Google Scholar) representing Level I evidence. The extravasation wound care section of this guideline was supported by Level IV and V evidence. Several additional studies were reviewed with similar evidence levels. Using the Oncology Nursing Society's evidence classification schema, the body of evidence was determined to be “interventions recommended for practice and/or likely to be effective.” An evidence-based standard of practice with algorithm was developed to guide wound care for three potential wound types: (a) closed with blister, (b) open and dry, and (c) open and moist/exudate. This algorithm was pilot tested in the neonatal intensive care unit. Based on nurses' feedback, small changes were made to the guideline during the pilot test. The practice standard will be reviewed by the Clinical Practice Council for potential hospital-wide implementation.