Nursing Interventions for the Prevention and Management of Extravasation in Pediatric Patients: A Systematic Review

Background: Extravasation of intravenous fluids and medications is a frequent yet preventable complication in pediatrics, often leading to pain, tissue injury, and long-term sequel. Nurses are central to prevention, early recognition, and initial management, given their frontline role in IV therapy. Despite this, evidence remains fragmented and practice is heterogeneous. The aim of this review was to identify and synthesize nursing interventions for the prevention and management of extravasation in pediatric patients. Method: A systematic review was conducted on studies published from January ۲۰۲۰ to August ۱۳, ۲۰۲۵. Databases included PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane, and CINAHL. Search strategies combined MeSH and free-text terms for extravasation, infiltration, IV complications, pediatrics, neonates, children, nursing care, prevention, and management. Eligible studies were English, free full text, and clinical studies/implementation reports addressing prevention, detection, or management in pediatric patients. Two reviewers independently screened, extracted data, and appraised risk of bias. Results: ۱. Prevention Risk assessment tools: Validated pediatric instruments (e.g., Intravenous Infiltration and Extravasation Risk Assessment Tool - IIERAT). Identification of high-risk patients: Preterm and low-birthweight infants; children receiving vesicant, irritant, or hyperosmolar solutions. Prevention bundles: Safe site selection (avoiding active limbs), minimizing cannula dwell time, appropriate cannula size, considering central access for vesicants, and monitoring infusion pressures. Nurse education: Structured training with lectures, simulation, and protocols improves vigilance and reduces complications. Monitoring: Hourly site checks, documentation, infusion pump alarms, and involving parents in observation. Technology-assisted detection: Point-of-care ultrasound (POCUS) and optical/near-infrared sensors facilitate earlier recognition compared to inspection alone. ۲. Management Immediate actions: Stop infusion, aspirate residual drug via cannula, elevate the limb, and apply warm or cold compresses depending on the drug type. Pain control: Ensuring comfort through appropriate analgesia. Pharmacologic interventions: Nurses play a key role in preparing and administering prescribed agents such as hyaluronidase, phentolamine, or topical nitroglycerin. Adjunctive techniques: Flush-out method, applying advanced dressings (hydrocolloid, hydrogel, hydrocellular foam), and supporting wound care. Emerging biologic therapies: Monitoring and applying biologic therapies (amniotic membrane, fish skin, active leptospermum honey, platelet-rich plasma) under medical guidance. Surgical management: Providing perioperative support, wound care, and family education following surgical interventions (Debridement or reconstruction for severe tissue necrosis). Conclusion: Current evidence highlights the central role of nurses in minimizing extravasation-related harm in pediatrics. Strengthening standardized protocols, continuous education, and careful monitoring, alongside future studies, will support safe, evidence-based integration of emerging interventions and biologic therapies.

کلیدواژه ها:

Extravasation ، Infusion Therapy ، Pediatrics