Neonatal Extravasation

Overview and Algorithm for Evidence-Based Treatment

Victoria Beall, BSN, CWOCN, RN; Brent Hall, PharmD; James T. Mulholland, BSN, RN; Sheila M. Gephart, PhD, RN


NAINR. 2013;13(4):189-195. 

In This Article

Abstract and Introduction


The peripheral intravenous (PIV) catheter is the most used vascular access device for the administration of medications in hospitalized neonates, however 95% of PIV catheters are removed due to complications. Infiltration and extravasation are one of the most destructive complications to the neonate's fragile skin. This article reviews multiple aspects of infiltration and extravasation injury. First, starting at the cellular level the role of vesicants in vascular injury and its role triggering inflammation will be discussed, followed by a comprehensive review of vesicants and their mechanism of injury, by pH, osmolality or chemical composition, then an overview of the NICU nurses knowledge and actions to prevent infiltration and ending with the use of an evidence-based algorithm that was developed at one children's hospital to minimize injury caused by extravasations through targeted, prompt treatment.


Many medications given to neonates have the potential to injure when an extravasation occurs. An extravasation is described by the Infusion Nurses Society (INS) as the inadvertent administration of a vesicant solution or medication into the surrounding tissues.[1] A vesicant is defined as a solution or medication that causes the formation of blisters leading to tissue necrosis and sloughing. Extravasation can result in varying degrees of localized tissue injury and can cause pain, infection, and partial to full thickness tissue loss involving muscles and nerves. If extravasation is severe and depending on the site, skin grafts, long hospitalization and high costs result. Not surprisingly, with disfigurement and loss of function, parents may try to recover payment for their loss by initiating lawsuits.[2,3]