Point-of-care ultrasound in diagnosis, follow-up and treatment of neonatal peripheral intravenous extravasation injuries

Background Neonatal intravenous extravasations can cause significant cutaneous injury due to unique features of neonatal skin. Paucity of data exists on optimal grading and treatment of extravasation. Description of post-injury internal tissue damage, correlation with external signs of trauma and a post-treatment tissue changes have not been characterized in the literature.

Objectives To illustrate the utility of Point-of-Care Ultrasound (POC-US) as a guiding tool to the area of the greatest internal damage caused by intravenous extravasation and therefore potentially improve treatment accuracy and efficacy. Secondary objective is to attempt to semi-quantitatively describe severity staging instrument based on the POC-US imaging. Finally, to depict tissue-level morphological changes in the skin after hyaluronidase is given. 

Design Descriptive study of 10 neonates who had intravenous extravasations treated with hyaluronidase is described in detail.  3 POC-US exams were done. First, as soon as possible after injury occurred but before hyaluronidase treatment, second exam 3-6h after hyaluronidase was given and final exam approximately 24-30h later. The assessment of the extravasation changes was semi-quantitative. Treatment was administered according to the unit’s protocol. Images of POC-US will be provided along with site images.

Results We studied 10 neonates, all with stage 3/4 extravasations pre and post extravasation treatment. US confirmed extravasations in all babies, provided clarity on degree of injury and precise location of greatest infusate pockets, guided treatment and afforded a visual into tissue changes during this process as well as provided images depicting improvement after treatment with hyaluronidase.

Conclusion IV Extravasation is a common occurrence in the neonatal ICU.  Visual staging does not always correlate well with internal location of fluid, degree of tissue damage and potential harm. POC-US localized greatest infusate pocket, characterized injured tissue and detailed changes post-treatment. We suggest POC-US is an excellent modality to assist in extravasation management/ follow-up care.