Centre for Reviews and Dissemination, University of York, York, UK.
Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Health Technol Assess. 2018 Aug;22(46):1-112. doi: 10.3310/hta22460.
Extravasation injuries are caused by unintended leakages of fluids or medicines from intravenous lines, but there is no consensus on the best treatment approaches.
To identify which treatments may be best for treating extravasation injuries in infants and young children.
Scoping review and survey of practice.
Children aged < 18 years with extravasation injuries and NHS staff who treat children with extravasation injuries.
Any treatment for extravasation injury.
Wound healing time, infection, pain, scarring, functional impairment, requirement for surgery.
Twelve database searches were carried out in February 2017 without date restrictions, including MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus and EMBASE (Excerpta Medica dataBASE).
Scoping review - studies were screened in duplicate. Data were extracted by one researcher and checked by another. Studies were grouped by design, and then by intervention, with details summarised narratively and in tables. The survey questionnaire was distributed to NHS staff at neonatal units, paediatric intensive care units and principal oncology/haematology units. Summary results were presented narratively and in tables and figures.
The evidence identified in the scoping review mostly comprised small, retrospective, uncontrolled group studies or case reports. The studies covered a wide range of interventions including conservative management approaches, saline flush-out techniques (with or without prior hyaluronidase), hyaluronidase (without flush-out), artificial skin treatments, debridement and plastic surgery. Few studies graded injury severity and the results sections and outcomes reported in most studies were limited. There was heterogeneity across study populations in age, types of infusate, injury severity, location of injury and the time gaps between injury identification and subsequent treatment. Some of the better evidence related to studies of flush-out techniques. The NHS survey yielded 63 responses from hospital units across the UK. Results indicated that, although most units had a written protocol or guideline for treating extravasation injuries, only one-third of documents included a staging system for grading injury severity. In neonatal units, parenteral nutrition caused most extravasation injuries. In principal oncology/haematology units, most injuries were due to vesicant chemotherapies. The most frequently used interventions were elevation of the affected area and analgesics. Warm or cold compresses were rarely used. Saline flush-out treatments, either with or without hyaluronidase, were regularly used in about half of all neonatal units. Most responders thought a randomised controlled trial might be a viable future research design, though opinions varied greatly by setting.
Paucity of good-quality studies.
There is uncertainty about which treatments are most promising, particularly with respect to treating earlier-stage injuries. Saline flush-out techniques and conservative management approaches are commonly used and may be suitable for evaluation in trials.
Conventional randomised trials may be difficult to perform, although a randomised registry trial may be an appropriate alternative.
The National Institute for Health Research Health Technology Assessment programme.
外渗伤是由于静脉内的液体或药物意外泄漏引起的，但对于最佳治疗方法尚无共识。
确定哪些治疗方法可能最适合治疗婴儿和幼儿的外渗伤。
范围综述和实践调查。
年龄<18 岁的有外渗伤的儿童和治疗有外渗伤儿童的 NH S 工作人员。
任何用于治疗外渗伤的方法。
伤口愈合时间、感染、疼痛、瘢痕形成、功能障碍、手术需求。
2017 年 2 月进行了 12 次数据库检索，没有时间限制，包括 MEDLINE、CINAHL（护理与联合健康文献累积索引）和 EMBASE（医学文摘数据库）。
范围综述-研究由两名研究人员进行重复筛选。一名研究人员提取数据，另一名研究人员进行核对。研究按设计分组，然后按干预措施分组，详细信息以叙述和表格形式总结。问卷调查分发给新生儿病房、儿科重症监护病房和主要肿瘤/血液病房的 NH S 工作人员。总结结果以叙述和表格、图形形式呈现。
范围综述中确定的证据主要包括小型、回顾性、非对照的群组研究或病例报告。这些研究涵盖了广泛的干预措施，包括保守治疗方法、盐水冲洗技术（有或没有先前的透明质酸酶）、透明质酸酶（无冲洗）、人造皮肤治疗、清创和整形手术。很少有研究对损伤严重程度进行分级，大多数研究的结果部分和报告的结果都很有限。研究人群在年龄、输液类型、损伤严重程度、损伤部位和从损伤识别到后续治疗的时间间隔方面存在异质性。一些较好的证据与冲洗技术的研究有关。NH S 调查从英国各地的医院科室获得了 63 份回复。结果表明，尽管大多数科室都有治疗外渗伤的书面方案或指南，但只有三分之一的文件包括损伤严重程度的分期系统。在新生儿病房，肠外营养引起的外渗伤最多。在主要的肿瘤/血液病房，大多数损伤是由于腐蚀性化疗药物引起的。最常用的干预措施是抬高受影响的区域和使用止痛药。很少使用热敷或冷敷。在大约一半的新生儿病房中，经常使用盐水冲洗治疗，无论是否使用透明质酸酶。大多数受访者认为随机对照试验可能是一种可行的未来研究设计，但不同的环境下意见差异很大。
高质量研究较少。
对于哪种治疗方法最有前途，存在不确定性，特别是对于治疗早期损伤。盐水冲洗技术和保守治疗方法通常用于治疗，可能适合在试验中进行评估。
常规随机试验可能难以进行，尽管随机登记试验可能是一种合适的替代方法。
国家卫生研究院卫生技术评估计划。
