Do you have experience on lipid extravasation in preterms? Emergency interventions? Prognosis?

We connect both electrolyte/aminoacids/glucose and lipids to the same line.

If the we have extravasation of the TPN we take the infusion and canula away, but we do no emergency interventions besides that.

I come to think of two preterms with skin necrosis after TPN extravasation; one necrosis was located on the volar side of the hand and this child finally had surgery to cover the skin necrosis. The other child had a smaller necrosis on the foot which resolved without specific treatment.

Would be interested to hear more experience about this issue!

Extravasation of TPN is a problem in our unit. We try to use central lines (longlines) but sometimes it is not possible to have a central line. When we experience extravasated lipids we take out the i.v. line and try to press out as much of the lipids that is possible. Necrosis is a problem and sometimes we have to use skin transplants because of necrosis, but it is only few infants.

Jes Reinholdt

Rigshospitalet

Copenhagen

We inject saline in 0.1ml increments around the infiltrate to dilute the infusant. We have had good success with this. We have also used Wydase in the past.