Contributed by
Cincinnati Children's Hospital
Neil Johnson MD.
History
Since 2011 CCHMC has used the "Red-Yellow-Green" for categorizing risk of injury if medication is extravasated subcutaneously
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Question
What are the criteria used to determine medications in the RED list?
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Correct answer
pH<5 or >9; Osmolarity > 950 milliosmoles; Vasoactive or chemotherapy medication
Discussion
In 2009, at the beginning of the CCHMC Vascular Access safety and improvement initiative, it became obvious that the Infusion Nurses Society (INS) four part highly descriptive PIV extravasation grading system was not suitable for data driven injury prevention and patient safety research. In particular, the INS grading system stated that "infiltration / extravasation of a VESICANT (what we now call a "RED medication") automatically required a Grade 4 designation. The BIG problem was that the INS did not define what a "vesicant" (RED) medication was! So we set about developing a CCHMC data driven listing of medications with a high risk of skin / tissue damage if extravasated. This initiative was led by Darcy Doellman RN, Neil Johnson MD and Barb Tofini RN with important contributions by John Hingl ( Pharmacy leadership_
An 18 month project was undertaken and resulted in a 2013 peer review publication
Criteria for inclusion in the RED list included:
1) pH<5 or >9
2) Osmolarity >950 milli Osmoles
3) Vasoactive medications (for example epinephrine)
4) Chemotherapy medications
5) Strong published evidence of severe harm
The listing has been modified over the years by consensus and is now an internationally recognized standard.
CCHMC published our work in 2013. The INS convened an expert group, including some of the authors of our paper, and published their own listing of "RED" and YELLOW" medications in 2017, adopting our ideas and with a red listing very similar to ours. They acknowledged our prior contributions but only in the fine print and references....
Differential diagnosis
None
Additional images
References
- Clark E, Giambra BK, Hingl J, Doellman D, Tofani B, Johnson N. Reducing Risk of Harm From Extravasation: A 3-Tiered Evidence-Based List of Pediatric Peripheral Intravenous Infusates. J Infus Nurs. 2013;36(1):37-45.
- https://chatgpt.com/?utm_source=microsoft&utm_medium=paid_search&utm_campaign=MSFT_C_SEM_BBR_Core_CHT_BAU_ACQ_PER_MIX_ALL_NAMER_US_EN_110625&c_id=570612897&c_agid=1181976989897641&c_crid=&c_kwid=kwd-73874005954345:loc-190&c_ims=&c_pms=91867&c_nw=o&c_dvc=c&msclkid=43b238ed81001417ed7052dc5edc1c83