Page 140 - Hospital Authority Convention 2017

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2017

F4.1 Clinical Safety and Quality Service II 16:15 Room 421

Prevention of Neonatal Extravasation Injuries: The Experience of a Neonatal Unit in Hong Kong
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Chan KM 1,2 , Chau JPC , Fung GPG , Chan SY , Chan YF , Chan HB 3
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Nursing Services Division, United Christian Hospital, The Nethersole School of Nursing, The Chinese University of Hong Kong,
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Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong
Introduction
Extravasation injury (EI) develops when intravenous fluid leaks into the surrounding tissue. It is a serious injury of patient
receiving intravenous therapy and medication. Extravasation injury remains the most common iatrogenic complication in
high-risk patients resulting in pain, skin necrosis, nerve damage, scarring, or even permanent contracture.
Neonates who are unable to verbalise pain, with blood vessels of smaller size, and less mature skin are particularly at risk
of this iatrogenic complication. Due to the potential risks and harms of extravasation, an evidence-based clinical practice
guideline (CPG) was developed and implemented to prevent this iatrogenic complication.
Objectives
(1) To prevent neonatal peripheral intravenous EI in a local neonatal unit; (2) to improve nurses’ knowledge and practices on
prevention and management of neonatal peripheral intravenous EI.
Tuesday, 16 May An evidence-based CPG on prevention and management of neonatal peripheral intravenous EI was developed and
Methodology

implemented using multi-faceted training strategies. Incidence of neonatal peripheral intravenous EI was evaluated with
an observation period of 143 days before and after CPG implementation respectively. Nurses’ knowledge and practice on
prevention and management of neonatal peripheral intravenous EI were evaluated immediately before and six months after
completion of multi-faceted training.
Results
213 neonates participated in the study with 104 and 109 neonates recruited in control and intervention groups respectively.
Data was analysed using independent t-tests. Both groups were homogenous with no significant difference in demographics
(p>0.01). There were significantly fewer neonates in the intervention group with peripheral intravenous EI (p=0.012). Incidence
of peripheral intravenous EI per 1,000 days in the control and intervention groups were 14.04 and 2.904 respectively.

53 nurses completed the study. Results of paired t-tests indicated that the mean scores of both nurses’ knowledge and
practice in post-test were significantly higher than pre-test (p< 0.01).

Conclusion
Implementation of CPG can significantly reduce the number of neonates with peripheral intravenous EI. Nurses’ knowledge
and practice on prevention and management of neonatal EI were significantly improved. CPG will be disseminated to staff in
the neonatal unit for routine use after the study.

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