LETTER TO EDITOR
Year : 2017 | Volume
| Issue : 4 | Page : 498-499
Intravenous burn following accidental warm saline infusion
Vandna Bharti, Raghavendra Vagyannavar, Mohammad Hashim
Department of Anaesthesiology and Critical Care, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
Room No 336, New P. G Hostel, SGPGIMS Campus, Rae Bareli Road, Lucknow - 226 014. Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|Date of Web Publication||22-Sep-2017|
|How to cite this article:|
Bharti V, Vagyannavar R, Hashim M. Intravenous burn following accidental warm saline infusion. Saudi J Anaesth 2017;11:498-9
Inadvertent hypothermia is common in patients undergoing surgical procedures. Hypothermia within the perioperative period may have many undesired physiological effects that are associated with postoperative morbidity. Infusion of warm fluid is effective in keeping patients nearly normothermic and preventing perioperative complications.
A 46-year-old female diagnosed with carcinoma esophagus was posted for feeding jejunostomy on an elective basis. She was shifted to the operation theater and was induced uneventfully. 45 min into the procedure, it was observed that her temperature had fallen to 34°C. She was immediately warmed by the use of a warming blanket and by the infusion of warm intravenous fluids. During this period, bottle of too warm saline was inadvertently attached to the intravenous line placed in her left wrist. It was observed in 10 min time that the forearm bearing this intravenous line had sustained superficial burns in the form of redness due to the high temperature of the saline infusion. The bottle was immediately replaced by a bottle of saline at room temperature. Topical lignocaine jelly was applied to the burnt area. Later, in the postanesthesia care unit, it was observed that a blister had developed approximately 4 cm proximal to the insertion of the intravenous cannula with erythema along the course of the vein in the forearm [Figure 1]. The intravenous cannula was removed. Topical heparin ointment was applied locally.
Adverse consequences due to perioperative hypothermia include myocardial ischemia, cardiac arrhythmias, coagulopathy, shivering, increased oxygen consumption during rewarming, alteration in drug metabolism, impaired offloading of oxygen from hemoglobin, and increased rate of wound infection. Administration of cold or inadequately warmed intravenous fluids leads to hypothermia, whereas administration of normothermic fluids may decrease both the incidence and complications of hypothermia. Infusion of adequately warmed fluids is mandatory in trauma patients requiring fluid resuscitation to minimize thermal stress and maintain thermal homeostasis.
There are different options for treating and/or preventing hypothermia within the adult perioperative environment. Use of microwave-heated crystalloid fluid has been recommended as one method of correcting hypothermia during resuscitation. Sieunarine and White reported a case of full-thickness burns and venous thrombosis after microwave-heated crystalloid was infused in the management of a ruptured aortic aneurysm. This case highlights the severity of the burn injury that can occur with infusion of heated fluids. Measuring the temperature of the fluid before the start of the infusion will avoid this complication.
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| References|| |
Xu HX, You ZJ, Zhang H, Li Z. Prevention of hypothermia by infusion of warm fluid during abdominal surgery. J Perianesth Nurs 2010;25:366-70.
Sieunarine K, White GH. Full-thickness burn and venous thrombosis following intravenous infusion of microwave-heated crystalloid fluids. Burns 1996;22:568-9.