Forewarned is forearmed: extravasation as a risk in pediatric infusion therapy. A literature review and clinical cases

Extravasation is the unintentional entry of drugs into the intervascular space. Depending on the substance, it can lead to tissue necrosis associated with certain complications. Extravasation is reported in up to 46% of children, especially newborns; soft tissue necrosis develops in 4% of those affected, leading to the formation of cicatricial contractures, deformities, and subsequent restriction, and in some cases even to loss of limb function. Currently, there are no guidelines for the management of extravasation injuries in children. In our paper, we highlighted the latest literature using PubMed and Google Scholar resources, as well as our own clinical experience in providing care to patients with adverse events as a result of extravasation. The lack of randomized controlled trials for the treatment of children with extravasation complications and the reluctance of health professionals to report this condition in the medical records alter the evidence-based statistics. Depending on the substance, the volume of fluid injected, and the extent of damage to the surrounding tissues, treatment options can be varied, including surgical and non-surgical methods. Non-surgical therapies include the injections of antidotes, hyaluronidase, or vasodilators, and the procedures for draining and lavage of the lesion. Each clinical case requires an individualized approach, and the care provided should be both sufficient and timely to reduce the frequency of severe complications with disabling outcomes.