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[pic] PROFOMA FOR REGISTRATION OF SUBJECTS FOR
DISERTATION
MS.CHINGAKHAM BABITA DEVI
FIRST YEAR M.SC NURSING
CHILD HEALTH NURSING
YEAR 2009 -11
PADMASHREE COLLEGE OF NURSING
GURUKRUPA LAYOUT, NAGARBHAVI,
BANGALORE-560072
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR
DISSERTATION
|1 |NAME OF THE CANDIDATE AND ADDRESS |MS. CHINGAKHAM BABITA DEVI |
| | |I YEAR M. Sc NURSING |
| | |PADMASHREE COLLEGE OF NURSING,GURUKRUPA LAY OUT |
| | |NAGARBHAVI, BANGALORE-560072 |
|2 |NAME OF THE INSTITUTE |Padmashree College Of Nursing Bangalore |
|3 |COURSE OF THE SYUDY AND SUBJECT |IST Year M. Sc. Nursing |
| | |(Child Health Nursing) |
|4 | DATE OF ADMISSION |10/06/2009 |
|5 |TITLE OF THE STUDY | Assess The Knowledge And Practice Of Staff Nurses On Prevention |
| | |And Management Of Extravasation Among Infant Receiving Intra |
| | |Venous Therapy In Selected Hospitals Of Bangalore. |
6.BRIEF RESUME OF THE INTENDED WORK
6.1. INTRODUCTION:
“Infiltration and extravasations are complications that can occur during intravenous therapy administered via either peripheral or central venous access devices. Both can result in problems with the sifting of future venous access devices, nerve damage, infection and tissue necrosis. Extravasations injuries occur as a result of leakage of Intra Venous (I.V) fluid from a vein into the surrounding tissue. Extravasations is defined as the leakage of solutions from the vein. This may cause damage to surrounding tissue during intravenous fluid administration, newborn and infant are the one, most common occurring extravasations complication.
The pediatric patient is at greater risk for potential complication related to IV therapy and should be monitored at least every 2 hourly and more frequently, depending on the patients age and size, or type of therapy. When an infant infiltration or extravasation is present, the infusion slows or stops, and child usually complains of tenderness or pain at the site. The infant or younger child however may not be specific in identifying their pain, therefore the only visible sign of discomfort may be generalized crying and irritability. The nurse must remove all the tape used to secure the site and visually evaluate and touch the skin in order to assess for redness, drainage ,hardness, or inflammation.1
In 2006 the Infusion Nurses Society's national standards of practice require that a nurse who administers IV medication or fluid know its adverse effects and appropriate interventions to take before starting the infusion. A serious complication is the inadvertent administration of a solution into the tissue surrounding the IV catheter. Both infiltration and extravasation can have serious consequences: the patient may need surgical intervention resulting in large scars, experience limitation of function, or even require amputation. These outcomes can be prevented by using appropriate nursing interventions during IV catheter insertion and early recognition and intervention upon the first signs and symptoms of infiltration and extravasation. Nursing interventions include early recognition, prevention, and treatment. 2
Extravasations or inadvertent infiltration of fluids into subcutaneous tissue from peripheral intravenous (IV) devices is a common adverse event in newborns. Although fluids occasionally extravasate from central venous lines, the complication is much more common from peripheral catheters, which are used widely in sick neonates. Injury to the skin, even in a very immature neonate, results in inflammatory response and heals by scar formation. Tissue necrosis from extravasations injury could result in partial or complete skin loss, infection, and nerve and tendon damage, with the potential risk of permanent cosmetic and functional impairment.3
Extravation of IV Fluids into the subcutaneous tissues is a common occurrence. Reports estimate that up to 11% of children receiving intravenous fluids occuring extravasation. In such cases the effects are mild and resolve spontaneous, but in a few serious complication may develop. These include full thickness skin loss and muscle and tendon necrosis leading to permanent disability.4
Sick and preterm neonates are particularly vulnerable to extravasation injury but many of these injuries could be prevented if a 'hyper-vigilant' approach to monitoring of the intravenous access is adopted. A number of barriers exist that may prevent rigorous and continuous monitoring of intravenous access sites in neonatal units. Several themes were identified in the literature as supporting quality nursing practice in this area, including: staffing and skill mix, preceptorship of newly qualified staff, continuing professional development, record keeping and communication. These themes are explored and recommendations made to help reduce the incidence of extravasation injury.5
An Experimental Study to evaluate an evidence-based wound protocol for intravenous extravasation injuries in neonates. Among 10 neonate, Nine newborns with intravenous extravasations injuries. Birth weight: 582–4,404 gm, gestational age: 24–40 weeks. Five wounds were colonized with coagulase-negative Staphylococcus species, two with diphtheroids, three with Enterococcus. Rates of wound healing ranged from one to six weeks.6
Peripheral intravenous fluid extravasation is a common occurrence among neonatal intensive care unit patients. Fifteen high-risk neonates, averaging less than 35 weeks' gestation and less than 1,500 g birth weight, with full-thickness extravasation injuries were successfully treated non-operatively by a topical fibrinolysin/deoxyribonuclease ointment. All wounds healed without delaying hospital discharge, and no significant scar contractures -were observed in patients followed up to 16 months after injury.7
On an annual of emergency report cases of severe complications from intraosseous infusions. One child was a sudden infant death syndrome patient who developed severe tissue necrosis after intraosseous placement. The second child was a near drowning who developed a compartment syndrome requiring fasciotomy. Extravasation is a potentially major complication that resulted in these limb-threatening events. Intraosseous infusion remains an important resuscitation modality, but great care must be taken to avoid these results. Strategies for avoiding extravasation are discussed.8
“Extravasation is the complication that can occur during intravenous therapy.. The nurse is the key to reducing the risk of extravasation, through her knowledge and skill in cannulation and the intravenous administration of drugs. The nurse must also be able to recognize the early signs and symptoms of extravasation and act promptly and effectively to limit tissue damage. Finally, accurate documentation of the event is vital to facilitate patient care and in case of litigation.9
6.2 NEED FOR THE STUDY:
Extravasation occur as a result of inadvertent leakage of vesicant fluid from a vein or cannula into the surrounding soft tissue . The reported incidence of extravasation injury in neonates and children is 0.1% to15% and occurs most frequently in neonates of less than 26-27 weeks’ gestation given the fragility and small caliber of the peripheral veins. To prevent and manage this type of skin injury, experts recommend using sterile transparent dressings to secure intravenous lines to allow for at least hourly site inspections. If necrotic tissue is present, surgical consultation should be obtained, coupled with use of autolytic debridement.10
Children's and Women's Services, University of Iowa Hospitals and Clinics, Children's Hospital of Iowa, Iowa City, USA. Provides a guidelines for iv. infiltrations in pediatric patients. A large Midwestern tertiary care center used a multidisciplinary approach to develop an intravenous infiltration/extravasation guideline for pediatric patients, ages 0-18 years old, using the Iowa Model for research utilization. This infiltration clinical practice guideline included a site appearance staging tool, decision algorithm, research-based antidotes, and standard of care. The goal of the guideline was to prevent or minimize adverse occurrences for paediatric patients at risk for intravenous infiltrations. Quality assessment and improvement tracking suggested that there was an increased consistency in use of practice guideline interventions for and reporting of the infiltration event, a reduction in adverse patient outcomes and potential cost savings.11
In 2004 a survey conducted at United Kingdom, on Extravasation injuries on regional neonatal intensive care units, reported the incidence of extravasation injury resulting in skin necrosis to be approximately 4%, determined a prevalence of 38 per 1000 neonates who sustained an extravasation injury that caused skin necrosis. Most injuries occurred in infants of 26 weeks gestation or less, with parenteral nutrition infused through intravenous cannulae. Common treatments were exposing wounds to the air, infiltration with hyaluronidase and saline, and occlusive dressings. 12
Intravenously administered drugs with potentially devastating consequences should be given only by personnel highly knowledgeable regarding the side effects and skilled in intravenous cannulation. A strict protocol should be followed. The earliest signs heralding extravasation should be recognized and infusion discontinued immediately. If extravasation occurs, prompt surgical consultation is necessary. Injection into the volar wrist, dorsum of the hand, and antecubital fossa should always be avoided. 13
Extravascular escape of intravenously administered phenytoin can result in serious local soft tissue complications. Injury can range from simple phlebitis to chemical cellulitis or, in extreme cases, frank tissue necrosis that necessitates amputation. The histopathologic findings include extensive necrosis and sloughing of epidermis, widespread necrosis of dermis, subcutaneous tissue, muscles and nerves, and extensive thrombotic occlusion of vessel lumens. Results of elastic tissue stains reveal that the thrombosed vessels are exclusively veins and venules. 14
A case of cutaneous bullous eruptions in the hand resulting from extravasation of mannitol infusion was reported., In which it caused swelling and multiple cutaneous bullous eruptions in the hand and forearm . The possible mechanisms relevant to extravasation and its tissue damage are prevent by Selecting proper intravenous infusion site, using pliable catheters and frequent inspection are important steps for prevention of extravasation.15
Peripheral intravenous infusion of fluids and drugs is daily routine in hospitals. Extravasation of intravenously infused agents is one of the iatrogenic complications frequently encountered in hospital. It is found that 1,800 extravasations out of 16,380 administrations of intravenous fluid (11%) in children.1 Most of these extravasations cause no serious injury and require no treatment. But some severer extravasation accidents will cause injuries including soft-tissue necrosis. Agents that may cause tissue necrosis include chemotherapeutic drugs, hyperalimentation preparations, intralipid, 10% dextrose, dopamine, various antibiotics including chloramphenicol, cephalothin, gentamycin, oxacillin, and nafcillin.15
A descriptive study on a variety of preventative measures and administration of antidotes or other emergency treatment techniques, intravenous (IV) extravasation produces serious wounding and may lead to permanent long-term damage. Extravasation of IV fluids in the subcutaneous space may lead to blistering, necrosis, and damage to the underlying structures. Preterm newborns are at increased risk for extensive wounding owing to fragile vessels, thin epidermis, and limited subcutaneous tissue overriding common sites for placement of peripheral IV cannulas. When prevention techniques fail, immediate recognition of the extravasation, prompt intervention, and initiation of wound care are important nursing interventions to limit tissue damage. A review of the current evidence regarding immediate care of IV extravasations and subsequent wound care is presented and highlights the need for scientific research to guide practice.16
From above findings of literature, the researcher realized that the nurses should have adequate knowledge regarding the I.V. infusion and their Prevention and Management of Extravasation so that this will reduce the evidence of deformity due to the leakage of fluid from the vein or the cannula.
6.3 STATEMENT OF THE PROBLEM:
A Study To Assess The Knowledge And Practice Of Staff Nurses On Prevention And Management Of Extravasation Among Infant Receiving Intra Venous Therapy In Selected Hospitals Of Bangalore.
6.4 OBJECTIVES OF THE STUDY:
← To assess the existing knowledge of staff nurses on prevention and management of extravasation.
← To assess the practices of staff nurses on prevention and management of extravasation.
← To associate the knowledge and practice of staff nurses on prevention and management of extravasation.
← To correlate knowledge and practices of staff nurses on prevention and management of extravasation.
6.5 OPERATIONAL DEFINITION:
Knowledge
It refers to the awareness and understanding of staff nurses on prevention and management of extravasation which occure due to the leakage of fluid from the vein / cannula of infant receiving I.V. therapy.
Practice
It refers to the staff nurses practices towards the prevention and management of extravasation, occurs due to the leakage of I.V. fluid administration among infants..
Extravasation
It refers to the leakage of Chemotherapeutic Agents such as Acyclovir, Aminophylline, Calcium, Chlordiazepoxide , Diazepam, Digoxin, Dobutamine, Epinephrine, Vincristine, Mannitol, Nafcillin, Norepinephrine, Penicillin, Phenytoin, Vancomycin and Non-Chemotherapeutic Agents such as Actinomycin D, Dactinomycin, Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Mitomycin, Vinblastine, Flucloxacillin, Vinorelbine or medication from the vein / cannula of infant receiving I.V.Therapy.
Prevention : It refers to the knowledge of nursing action measures designed to reduce the I.V. Therapy complication as extravasation which cause blistering, necrosis, swelling and damage to the underlying structures.
Management : It refers to an action, manner, or practice of handling or control of extravasation.
Staff nurses:
Refers to the nurses those who are registered in Karnataka Nursing Council and have the Diploma or Degree certificate and who are providing care for the infants receiving I.V. Therapy in pediatric unit.
Infants:
It refers to the child whose age is from birth to one year and those who are receiving I.V. therapy.
I.V. Therapy:
It refers to the solution which includes Chemotherapeutic, Non Chemotherapeutic agent and medication administered to the infant intravenously.
6.6 ASSUMPTIONS:
* Staff nurses may have knowledge on prevention and management of extravasation to some extent.
* The level of knowledge by staff nurses on prevention and management of extravasation can be increase in their practice after the provision of information pamphlet.
* Nurses play an important role as a care giver to individual, community and society.
6.7 HYPOTHESIS:
H1 : There will be a significant correlation between knowledge and practice of staff nurses on prevention and management of extravasation.
H2 : There will be a significant association of knowledge and practice of staff nurses on prevention and management of extravasation with their selected demographic variable.
6.8 REVIEW OF LITERATURE:
A review of literature related research and theory on a topic has become a standard and virtually essential activity of scientific research projects “Literature review is a critical summary of research on a topic of interest, often prepared to put a research problem in contact or as the basis for an implementation project .”Review of literature was undertaken to gain in depth knowledge on various aspect of the problem under this study.
In this study the relevant literature reviewed has been organized and presented under the following headings:
* Literature related to Management of Extravasation due to I.V. Fliud administration.
* Literature related to Prevention of Extravasation from I.V. Fluid administration
* Literature related to complication related to I.V. Fluid administration.
Literature related to Management of Extravasation due to I.V. Fliud administration.
A comparative study was conducted on 10 premature infant in that five premature infants with wounds of hyperalimentation fluid extravasation managed by the antibacterial ointment (Terramycin ophthalmic ointment) and sesame oil and a anti inflammatory herbal mixture. The method of dressing was application of a thick layer of this mixture covered by vaseline and wet gauze renewed at an interval of 8-12 hr after irrigating the wounds thoroughly with normal saline. 30 days dressing done. The wounds had healed completely. They conclude that this therapy may be considered for an alternative treatment and warrants clinical trials for the confirmation of the local management of extravasation injury.17
A retrospective review on management of Extravasation at Australian hospital. Various agents include calcium, potassium, bicarbonate, hypertonic dextrose, cytotoxic drugs and antibiotics, causing tissue necrosis after intravenous infusions have extravasated. Age ranged from 17 days to 60 years. Two patients received their injuries from solutions containing isotonic dextrose/saline. The other seven patients received injuries from a variety of solutions including calcium gluconate (1), parenteral nutrition (1), sodium bicarbonate (1), immunoglobulin (1), gentamicin and penicillin(1), flucloxacillin (1), and the chemotherapeutic agents epirubicin and cyclophosphamide (1). Four patients were managed by delayed debridement and split skin grafting, while five were treated non-operatively. Management of extravasation injuries should be conservative if possible. Prevention of these injuries with the education of both medical and nursing staff remains the ultimate aim.18
A comprehensive review of clinical treatments of Anthracycline extravasation was done on extravasation of antineoplastic agents, In his experience using local clysis with a saline-hyaluronidase solution for treatment of 148 extravasations, 80% of which were from doxorubicin, and no other details were given. Patients were only treated if seen within the first hour after extravasation. Twelve to thirty-eight ml of a 150 units per 1,000 ml saline was used. The extremity was then elevated and observed without further treatment. None of the patients suffered full thickness skin loss or permanent loss of motion of any joint. None required skin grafting. A benefit of hyaluronidase-saline clysis has not been documented. 19
A Descriptive Study was done to evaluate the time and type of treatment following extravasation from intravenous infusion and the sequelae of the injuries. The study was done at hospital with 12 patients and the period of study was between May 2003 and January 2007. Immediate treatment following extravasation and discontinuation of the infusion was done. Eleven patients developed skin necrosis of varying severities. Morbidity is increased by delay in recognition and treatment of the extravasation. A protocol for the treatment of extravasation is recommended.20
An Experimental study on Emergency treatment of accidental infusion leakage in the newborn. In this Infusion leakage in the paediatric population of the intensive-care unit is known to cause skin necrosis and significant scarring around tendons, nerves and joints, extending the length of hospital stay. A series of report of 14 newborn children affected by accidental infusion leakage, and their early treatment with Gault's procedure: saline flushout and liposuction. The results were good: no skin impairment in 11 cases and 3 cases of skin necrosis healed spontaneously. Recommended Early treatment of toxic infusion to avoid skin necrosis at the site of extravasation and should be employed as early as possible in order to dilute and remove the toxin from the subcutaneous tissue.21
A Retrospective Study was done on Extravasational side effects of cytotoxic drugs,12 patients with extravasation of cytotoxic drugs. Study was done in the department of plastic surgery of a medical college. We managed 12 cases referred to our department with extravasation of cytotoxic drugs. Mitomycin C was used in seven cases (58.33%), vincristine in two cases (16.66%), 5-Florouracil in another two cases while doxorubicin was responsible for extravasational side effects in one case (8.33%). The size of necrosis ranged from 3.75 cm(2) to 25 cm(2) with average size of 9.6 cm(2). In terms of the area involved, the dorsum of the hand was involved in five cases (41.66%), the wrist in another five cases (41.66%), and the cubital fossa in the remaining two cases (16.66%). All cases were treated with daily debridement of necrotic tissue, saline dressing, and split skin grafting. Extravasation of cytotoxic drugs further increases the suffering of cancer patients. This catastrophe can only be avoided by vigilance and immediate application of antidotes.22
Literature related to Prevention of Extravasation from I.V. Fluid administration.
An update on prevention and management on Infiltration and extravasation. They are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. Consequences range from local irritation to amputation. While immediate action using appropriate measures can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures. However, timely surgical intervention, when necessary, can prevent more serious adverse outcomes. Clinicians should be prepared to act promptly when an event occurs. Thorough incident documentation helps determine whether infusion care meets the standard of practice and is a keystone to medico legal defense.23
Literature related to complication related to I.V. Fluid administration.
A Study report describes an unusual presentation and complication of extravasation of intravenous fluid in an infant who presented with a large hypopigmented skin lesion distant from the site of intravenous cannulation. The infusion was immediately discontinued and an alternate intravenous site secured. A chest radiograph revealed that the catheter was not in the external jugular vein site, and a large fluid collection was apparent over the right lateral chest wall. The hypopigmented skin lesion disappeared within 48 h, and the infant remained stable. This article serves to alert the physician to consider the extravasation of intravenous fluid as a potential cause of acute development of skin hypopigmentation in an at-risk patient. 24
A Retrospective chart review was done to identify variables associated with extravasation and resulting tissue damage in neonates with peripheral intravascular therapy.25 neonates were the sample and in between 2003-2004 study has done. Charts of 15 female and 10 male infants, were reviewed. As a result extravasation was not significantly related to age, weight, or sex. The most common intravenous medications were total parenteral nutrition (19) and calcium (18). The sites of the infiltrate were the arm 16, foot 5, and scalp 3 .Stages 0 (absence of redness, pain, swelling; & flushes)11 and 4 (severe swelling; blanching, pain, skin breakdown, etc.) 6 were the most common stages. The site of the infiltrate was measured and care described in only 9 neonates.2
A Closed Claims Analysis was done to assess liability associated with peripheral vascular catheters. Serious complications after peripheral IV and arterial vascular cannulations. Complications related to IV catheters were categorized as to type of complication. The most common complications were skin slough (28%), swelling/infection (17%), nerve damage (17%), fasciotomy scars (16%), and air embolism (8%). Approximately half of these complications (55%) occurred after extravasation of drugs or fluids. Compared with other claims, IV claims involved a larger proportion of cardiac surgery (25% vs 2% for other, P < 0.001) and smaller proportion of emergency procedures (8% vs 22% for other, P < 0.001),which resulted from extravasation of drugs or fluid.26
A study was done to assess the Intra-abdominal extravasation complicating parenteral nutrition in infants. Two infants receiving total parenteral nutrition via a central venous catheter positioned in the inferior vena cava developed an acute abdomen secondary to extravasation of the infusate. The presence of an associated abdominal mass necessitated a laparotomy in one patient. Both infants recovered completely after the catheter had been removed. 27
A descriptive study on peripheral intravenous extravasation. Tissue extravasation resulting from (IV) infiltration can occur as a complication of neonatal intensive care with varying degrees of morbidity. Serious extravasation can result in pain, infection, disfigurement, prolonged hospitalization, increased hospital costs, and possible litigation. Although most infiltrates resolve spontaneously after the IV catheter is removed, IV extravasations and tissue sloughing do occur in NICU patients. The goal in managing tissue damage after IV extravasation is to improve tissue perfusion and prevent progression of tissue necrosis. This article presents an initial approach to nursing care for peripheral IV infiltrations to guide clinicians in management of this complication.28
A Prospective Controlled Study to assesses the improvement in outcome for newborn infants by decreasing major complications associated with intravenous fluid therapy by using an in-line filter, of iv. lines. In this 88 infants were randomly assigned to receive either filtered or non-filtered infusions via a central catheter. Main outcome measures such as bacteraemia, phlebitis, extravasation, thrombosis, septicaemia and necrosis were all scored. Bacterial cultures of the filters showed a contamination rate on the upstream surface of 15/109 filters (14%). The mean costs of disposables were less in the filter group, showing a reduction from ±31.17 to ±23.79. The use of this in-line filter leads to a significant decrease in major complications and subst antial cost savings.29
7. MATERIAL AND METHODS:
7.1 Source Of Data:
Data will be collected from staff nurses working in pediatric unit who are providing care to the infant receiving I.V. Therapy.
7.2 METHOD OF DATA COLLECTION:
i )Research design
Non-experimental descriptive correlational design
ii) Research variables
Dependent variable
The knowledge and practice of staff nurses on prevention and management of extravasation.
Independent variable:
The infant who are receiving I.V. Therapy.
Demographic variables
The demographic variables of the staff nurses such as age, sex, designation, qualification, working experience in ward and previous exposure to any information.
iii) Setting
The setting will be the pediatric unit of the selected hospitals of Bangalore.
iv) Population
In this study the target population is the staff nurses working in the pediatric unit of selected hospital of Bangalore.
v) Sample
The staff nurses who are fulfilling the inclusion criteria will be the sample. Sample size will be 60.
vi) Criteria for sample selection
Inclusion criteria: the study includes those who are
- Staff nurses who are registered in Karnataka nursing council working in the pediatric unit with diploma or degree certificate in selected hospital Bangalore.
-Willing to participate in the study.
- Both male and female nurses
Exclusion criteria: study excludes those who are
- On night duty during the time of data collection.
- Already undergone I.V. Therapy training program.
vii) Sampling technique.
Purposive Sampling technique will be used in this study.
viii) Tools for data collection.
← Section A: A self administered structure questionnaire to assess the demographic data such as age, sex, designation, qualification, working experience in ward and previous exposure to any information.
← Section B: A Self administered questionnaire to assess the knowledge of staff nurses on prevention and management of extravasation.
← Section C: A self administered Structure questionnaire to assess the practice of staff nurses on prevention and management of extravasation.
xi) Method of Data Collection:
After obtaining formal permission from the concerned authority and getting informed consent from the subject, the investigator will administer the self administere structured questionnaire to assess the knowledge and practice of staff nurses on prevention and management of extravasation. Duration of the study : 4 weeks.
x) PLAN FOR DATA ANALYSIS:
The data will be analyzed using descriptive and inferential statistics.
Descriptive statistics:
Frequency, percentage, mean, standard deviation will be used to describe the knowledge and practices of staff nurses on prevention and management of extravasation within the selected demographic variable.
Inferential statistics:
1. Co-rrelational coefficient will be used to determine the co-rrelation between knowledge and practice of staff nurses on prevention and management of extravasation.
2. Chi-Square test will be used to determine the association of knowledge and practice of staff nurses on prevention and management of extravasation with demographic variable.
xi) Projected Outcome:
After the study the investigator will assess the level of existing knowledge for the practiced of prevention and management of extravasation by the staff nurses, An information pamphlet to be provided which will help in improving their knowledge and they will follow proper practice during care of the infant.
7.3 Does The Study Require Any Investigation Or Intervention To The Patients Or Other Human Beings Or Animals?
Yes, the study will require minimum investigation on staff nurses in the form of self administer Structured questionnaire on prevention and management of extravasation . No other investigation which cause any harm will be done for the subject.
7.4 Has Ethical Permission Clearance Obtained From Your Institution?
Yes, permission will be obtained from the concerned authority in selected hospital.
8. LIST OF REFERANCES:
1. Dianne L. Josephson. Extravasation and Intrafiltration. Principles and Practice, Intravenous infusion therapy for nurses ,2004 ,page, no,476 .
2. Lynn Hadaway , Milner, GA, USA, Infiltration and extravasation., Am J Nurs. 2007 Oct;107(10):15.
3. Ramasethu. Prevention and management of Extravasation injury in neonates.American Academy of pediatrics 2004,Vol.5 No.11 e491.Available from
4. Dar Burd, G.Santis, TM Milward. Severe extravasation injury. British Medical Journal, Volume 290 ,25 May 1985 , page no. 1579
5. Tong R . Preventing extravasation injuries in neonates. Paediatric Nursing, 2007 Oct;19(8):page no 22-5.
6. Doris Sawatzky-Dickson, RN, MN, Karen Bodnaryk, RN, BN. Neonatal Intravenous Extravasation Injuries: Evaluation of a Wound Care Protocol. The Journal of Neonatal Nursing, Volume 25, Number 1 / January/February 2006. Also Available from http: //neonatalnetwork .
7. Falcone, PhilipA, Barrall, DavidT, Jeyarajah, RohanB.S, ectal. Nonoperative Management of Full-thickness Intravenous Extravasation Injuries in Premature Neonates Using Enzymatic Debridement. Annals of Plastic Surgery,Feb 1989 vol.22 No.2. Also available from
8. C. Simmons, N. Johnson, R. Perkin, D. van Stralen , Intraosseous Extravasation Complication Annals of Emergency Medicine, Volume 23, Issue 2, Pages 363-366 .Also available from .
9. Dougherty, L. IV Therapy Extravasation-and-infiltration. British Journal of Nursing. 17(14), p.896-901. Also available from therapy-extravasation.
10. Mona Mylene Baharestani. Extravasation injuries. Scottsdale Wound Management Guide, VOLUME: 53 Issue Number:6
11. Montgomery LA, Hanrahan K, Kottman K, Otto A, Barrett T, Hermiston B. Guideline for i.v. infiltrations in pediatric patients. Pediatr Nursing.1999 Mar-Apr;25(2):167-9, 173-80
12. C E Wilkins, A J B Emmerson. Extravasation injuries on regional neonatal units. Archives of Disease in Childhood - Fetal and Neonatal Edition 2004;89:F274-F275
13. Linder RM, Upton J. Prevention of extravasation injuries secondary to doxorubicin. Postgrad Med.1985 Mar;77(4):105-9,112-114
14. A. Hayes, T. Chesney. Necrosis of the hand after extravasation of intravenously administered phenytoin . Journal of the American Academy of Dermatology. 28(2):360-363
15. Kow-Aung Chang, Bruno Jawan, Hsiang-Ning Luk, Si-Tun Fung, Ju-Hao Lee, Bullous Eruptions Caused by extravasation of Mannito. China Medical College Hospital, Taichung, Taiwan. acta anaesthesiols in 39:195-198, 2001.
16. R. Clifton-Koeppel’s. Wound Care After Peripheral Intravenous Extravasation .Newborn and Infant Nursing Reviews. Volume 6 (4):202-211
17. Ky Young Cho, Soo Jung Lee, Jin Sik Burm, and Eun Ae Park. Successful Combined Treatment with Total Parenteral Nutrition Fluid Extravasation Injuries in Preterm Infants, Korea. J Korean Med Sci. 2007 June; 22(3): 588–594.
18. Kumar RJ, Pegg SP, Kimble RM. Management of extravasation injuries. Royal Clinic Children's Hospital, Australia. ANZ J Surg. 2002 Sep;72(9):684.
19. W Langer, Maxwell Sehested, Peter Buhl Jensen, Heckler. Copenhagen University Hospital Anthracycline extravasation: a comprehensive review of experimental and clinical treatments. Volume 95, Numero 3,maggio-giugno 2009.Also available from
20. Rose RE, Felix R, Crawford-Sykes A, Venugopal R, Wharfe G, Arscott G. Extravasation injuries. West Indian Med J. 2008 Jan;57(1):40-7.
21. D. Casanova, J. Bardot, G. Magalon. Emergency treatment of accidental infusion leakage in the newborn: British Journal of Plastic Surgery, 54, ( 5), :396-399.
22. Thakur JS, Chauhan CG, Diwana VK, Chauhan DC, Thakur A. Extravasational side effects of cytotoxic drugs: A preventable catastrophe. Indian J Plast Surg. 2008 Jul;41(2):145-50
23. Doellman, Darcy , Hadaway, Lynn MEd; Bowe-Geddes, Leigh Ann ; Franklin, Michelle , LeDonne, Jack, Papke-O'Donnell, Lorelei ,et al. Infiltration and Extravasation: Update on Prevention and Management. Journal of Infusion Nursing, July/August 2009 – Volume 32,-Issue 4 – page no 203-211
24. Kam-Lun Ellis Hon,Chun-Mo Chow,Albert Li and Alexander K. C. Leung. A large hypopigmented skin lesion following extravasation of intravenous fluid. Journal of Advances in Therapy, Volume 24, Number 5 / September, 2007, Pages 983-986.
25. Mc Cullen, Kim L.; Pieper, Barbara, A Retrospective Chart Review of Risk Factors for Extravasation Among Neonates Receiving Peripheral Intravascular Fluids. Journal of Wound, Ostomy and Continence Nursing: March/April 2006 - Volume 33 - Issue 2 - p 133-139
26. Sanjay M. Bhananker, Derek W. Liau, Preetma K. Kooner, Karen L. Posner, Robert A. Caplan, and Karen B. Domino. Liability Related to Peripheral Venous and Arterial Catheterization: A Closed Claims Analysis. 2009 doi.10.1213/ane.0b013e31818f87c8 International Anaesthesia Research Society. Also available at
27. S. Nour, J. W. Puntis, M. D. Stringer. Intra-abdominal extravasation complicating parenteral nutrition in infants. Archives of Disease in Childhood - Fetal and Neonatal Edition 1995;72:F207. Also available at
28. Janet L. Thigpen, RNC, MN. Peripheral Intravenous Extravasation: Nursing Procedure for Initial Treatment. The Journal of Neonatal Nursing. Neonatal Network publication, Volume 26, Number 6 / November/December 2007,page no 379-384.
29. RA van Lingen , W Baerts , ACM Marquering, GJHM Ruijs. The use of in-line intravenous filters in sick newborn infants. Acta Paediatrica 2009,Volume 93 Issue 5, Pages 658 – 662
9. Signature of the candidate :
10. Remarks of the guide : Since infants are more prone to develop venous infiltration during the I.V therapy, proper observation by the staff nurses is mandatory to prevent complication like necrosis and nerve damage. This study is appropriate to update the nurse’s knowledge and the effort taken by the investigator can be encouraged.
11.1 Name and designation of :
Guide : Mrs. Arockia Mary, Assoc. prof
11.2 Signature :
11.3 Head of the department : Mrs. Arockia Mary, Assoc. prof
11.4 Signature :
11.5 Remarks of the principal : This study is relevant, feasible and appropriate
for the specialty chosen.
11.6 Signature :
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