The use of hyaluronidase in the treatment of intravenous extravasation injuries

Abstract

Intravenous extravasation injuries are a major cause of morbidity in the pediatric population. A variety of commonly used drugs and intravenous fluids have been shown to cause injury, particularly when infants are infused subcutaneously. Optimal management of intravenous extravasations remains controversial. The enzyme hyaluronidase degrades hyaluronic acid, a constituent of the normal interstitial barrier; by degrading interstitial bonds, it can increase the distribution and absorption of locally injected substances. To test the hypothesis that hyaluronidase might prevent skin injury associated with extravasations, a reliable skin injury model in immature pigs was created using subcutaneous CaCl2 injections. Hyaluronidase, in a concentration of 150 U/mL injected subcutaneously in a circumferential fashion immediately following the injection of CaCl2, significantly reduced the area of necrosis (P less than .01). As a control for the diluent volume administered with the hyaluronidase injection, the effect of a circumferential injection of 1.0 mL normal saline was compared with a similar injection of 1.0 mL normal saline with 150 units of hyaluronidase. Again, the area of skin necrosis following injection with hyaluronidase was statistically smaller (P less than .01). We have created a reliable skin injury model using immature porcine skin, which resembles human skin. Our data using this model suggest that the use of hyaluronidase may decrease the morbidity associated with intravenous extravasation injuries.