Hyaluronidase For Treating Intravenous Extravasations.
Barbara J. Few
MCN Vol. 12 Jan/Feb 1987
Hyaluronidase For Treating Intravenous Extravasations.
Barbara J. Few
MCN Vol. 12 Jan/Feb 1987
Although IV therapy is common place in acute care pediatrics, it is not without risks. Up to 11 percent of intravenous lines have been reported to infiltrate in the pediatric patient population (1). If extravasation injuries result, they can lead to partial- or full-thickness skin loss. This sometimes requires longer and more frequent hospital stays, surgical debridement, skin grafting, or in some severe cases, amputation of the affected limb (2). If hyaluronidase is injected after an IV infiltration, however, tissue damage may be prevented or at least significantly reduced.
ACTION/USAGE.
Hyaluronidase is an enzyme that breaks down hyaluronic acid, a mucopolysaccharide that is a normal component of tissue "cement." It enhances the absorption of other injected substances by dispersing them over a large area. First introduced in the 1950s, hyaluronidase was used for hypodermoclysis in dehydrated infants and for local infiltration anesthesia. More recently, it has proved effective in treating IV extravasations. In these cases it acts to reduce the local concentration of a damaging agent and increase its rate of absorption, thereby decreasing tissue exposure (3,4).
DOSAGE/ADMINISTRATION/SIDE EFFECTS.
A positive outcome with the use of hyaluronidase depends above all on its timely administration. It is best given in a dose of 15 units/1 cc via the affected IV catheter before it is removed, to ensure the delivery of the drug to the same plane as the toxin. It may also be given subcutaneously around the periphery of an extravasation. In either case, the injury should be treated with hyaluronidase within one hour, even if damage to the surrounding tissues seems relatively minor.
(3). In a retrospective study of 31 patients with major extravasation injuries, researchers found that the depth and extent of full-thickness tissue loss was invariably worse than first predicted (2).
The only adverse reaction to the enzyme that has been reported was an allergic response to the hyaluronidase fraction of a local anesthetic. This reaction was well controlled, however, by IV diphenhydramine (5). No other adverse effects have been observed, even when animals were given up to 750,000 units of the drug (3).
REFERENCES
1. BROWN, A. S. AND OTHERS, Skin necrosis from extravasation of intravenous fluids in children. Plast. Reconstr. Surg. 64:145-156, Aug. 1979.
2. UPTON, J., AND OTHERS. Major intravenous extravasation Injuries. Am. J. Surg.13:497-506. Apr. 1979.
5. TAYLOR, I. S., AND POLLOWITZ, J. A. A little-known phenomenon: allergic reaction to hyaluronidase (letter). Ophthalmology 91:1003, Aug. 1984