Ten little fingers, ten little toes: Scar management of neonatal extravasation injuries

Simone West

Melbourne Children’s Hand Therapy a member of the Children’s Private Medical Group, 48 Flemington Road, Parkville VIC 3052, reception@cpmgmelbourne.com.au   

Small in size, big in challenge, are problematic scars resultant from Grade 4 extravasation burns related to peripheral cannulas. An extravasation injury is a type of chemical burn, associated with leakage of a vesicant solution into tissue other than the vein for which it was intended. Hyperosmolar agents, such as > 10% dextrose, are examples of vesicant solutions associated with neonatal extravasation burns. Characteristics of Grade 4 extravasation injuries are erythema, blistering, tissue necrosis and ulceration.

Long-term effects of Grade 4 extravasation injuries are dependent upon multiple factors such as anatomical location of a cannula insertion site; concentration, amount and type of vesicant; time to recognition of initial injury; skill of health professionals; and history of wound healing. In addition, intrinsic factors associated with the health and wellbeing of the neonate play an integral factor in outcome. Degree of tissue damage and time taken to heal, via primary or secondary intention, are core determinants utilised by allied health professionals to design scar management programs focussed upon minimisation of potential impact of problematic scar upon childhood development. Digital function, glide of dorsal based tissue, muscle length and efficiency and non-impeded joint movement, are prime considerations that require long-term monitoring and a dynamic approach to care.

This presentation illustrates considerations and management strategies, employed by allied health professionals, in their concomitant roles of burn therapist and developmental clinician, supporting the transition of a neonate into childhood.

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