Cerebral Oximetry Probes-Associated Skin Burns in Pediatric Patients Mustafa Kemal Arslantas, MD, and Reyhan Arslantas, MD Cerebral oxygen monitoring continuously monitors cerebral oxygenation with a noninvasive technique based on near-infrared spectroscopy. In this report, we describe 2 children in whom skin burns followed the reuse of probes monitoring cerebral oxygenation with In Vivo Optical Spectroscopy. (A&A Case Reports 2014;2:11–2)
C
erebral oxygen monitoring continuously monitors cerebral oxygenation using a noninvasive technique based on near-infrared spectroscopy.1 In this report, we describe 2 children in whom skin burns occurred while the monitoring probes used to measure cerebral oxygenation with In Vivo Optical Spectroscopy (INVOS®, Covidien, Boulder, CO) were being used for the second time. A legal representative of the patient consented to publication.
CASE DESCRIPTION Case 1
A 50-day-old baby boy weighing 3 kg with left hypoplastic heart syndrome was receiving mechanical ventilation and an alprostadil infusion due to respiratory failure and pneumonia while receiving mechanical ventilation. Because there were no disposable electrodes available to monitor INVOS and due to the perceived urgency of the situation, electrodes used once previously were used. The nurse soon identified first-degree burns around the area surrounding the electrodes (Fig. 1). Cerebral oxygen monitoring was immediately terminated, and a medical dressing was applied to the burns. In addition, a paracetamol suppository was added to the treatment to provide analgesia. The patient’s burns healed in about a week without further complications.
Case 2
In a 5.5-month-old cyanotic baby boy weighing 4.3 kg, complete atrioventricular septal defect and double-outlet right ventricle were detected after complete echocardiographic examination. A pulmonary artery banding operation was From the Department of Anesthesiology, Marmara University Pendik Education and Research Hospital; and Department of Anesthesiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. Accepted for publication May 2, 2013. Funding: This study is funded by authors. The authors declare no conflicts of interest. Address correspondence to Mustafa Kemal Arslantas, MD, Department of Anesthesiology, Marmara University Pendik Education and Research Hospital, Camlik M. Yahya Kemal Beyatli C. No: 11–12, Pendik, Istanbul, Turkey. Address e-mail to [email protected]. Copyright © 2014 International Anesthesia Research Society DOI: 10.1097/ACC.0b013e31829e41b8
January 15, 2014 • Volume 2 • Number 2
decided on due to the presence of pulmonary hypertension. The patient was taken to the pediatric cardiovascular surgery intensive care unit where doctors, not aware of the first case, applied a previously used probe to the patient for cerebral oxygen monitoring. The probe was placed on the lateral side of the patient’s forehead. On noticing a burning odor, an intensive care unit nurse identified a first-degree burn around the right frontal region where the electrode was attached to this skin (Fig. 2). The cerebral monitoring was promptly terminated, and, as in the first case, medical dressing was applied to the burn and paracetamol suppository was added to the treatment for analgesia. The burn healed in about a week without further complications.
DISCUSSION
Cerebral oximetry is used to monitor changes in cerebral oxygen metabolism, and an INVOS device is suitable when used as a trend monitor. Although there were some studies conducted with INVOS cerebral oximeters, we were unable to locate reports of skin burns caused by electrodes. While the INVOS user’s manual reports that pressure sores can occur as a result of the application of tight bandages, skin burns are not mentioned as possible complications. Skin burns associated with the use of pulse oximeters using similar technology have been identified.2 The electrodes include a light-emitting diode (LED) as a light source. LEDs emitting infrared light may produce heat although it is a small amount. The electrodes also include a thin protective gel layer over the optical windows to prevent skin injury because of the heat produced. This protective layer may become thinner, and the isolation barrier between LED and skin may be interrupted if electrodes are used more than once. The infants’ susceptibility to injury as a result of their low cardiac output, poor peripheral circulation, and poor heat dissemination may also have contributed to the formation of skin burns. E REFERENCES 1. Fischer GW. Recent advances in application of cerebral oximetry in adult cardiovascular surgery. Semin Cardiothorac Vasc Anesth 2008;12:60–9 2. Lin CW, Wang HZ, Hsieh KS. Pulse oximeter-associated toe injuries in a premature neonate: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1999;62:914–6
cases-anesthesia-analgesia.org
11
Cerebral Oximetry Probes-Associated Skin Burns
Figure 1. Case 1.
Figure 2. Case 2.
12 cases-anesthesia-analgesia.org
A & A case reports
C
erebral oxygen monitoring continuously monitors cerebral oxygenation using a noninvasive technique based on near-infrared spectroscopy.1 In this report, we describe 2 children in whom skin burns occurred while the monitoring probes used to measure cerebral oxygenation with In Vivo Optical Spectroscopy (INVOS®, Covidien, Boulder, CO) were being used for the second time. A legal representative of the patient consented to publication.
CASE DESCRIPTION Case 1
A 50-day-old baby boy weighing 3 kg with left hypoplastic heart syndrome was receiving mechanical ventilation and an alprostadil infusion due to respiratory failure and pneumonia while receiving mechanical ventilation. Because there were no disposable electrodes available to monitor INVOS and due to the perceived urgency of the situation, electrodes used once previously were used. The nurse soon identified first-degree burns around the area surrounding the electrodes (Fig. 1). Cerebral oxygen monitoring was immediately terminated, and a medical dressing was applied to the burns. In addition, a paracetamol suppository was added to the treatment to provide analgesia. The patient’s burns healed in about a week without further complications.
Case 2
In a 5.5-month-old cyanotic baby boy weighing 4.3 kg, complete atrioventricular septal defect and double-outlet right ventricle were detected after complete echocardiographic examination. A pulmonary artery banding operation was From the Department of Anesthesiology, Marmara University Pendik Education and Research Hospital; and Department of Anesthesiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. Accepted for publication May 2, 2013. Funding: This study is funded by authors. The authors declare no conflicts of interest. Address correspondence to Mustafa Kemal Arslantas, MD, Department of Anesthesiology, Marmara University Pendik Education and Research Hospital, Camlik M. Yahya Kemal Beyatli C. No: 11–12, Pendik, Istanbul, Turkey. Address e-mail to [email protected]. Copyright © 2014 International Anesthesia Research Society DOI: 10.1097/ACC.0b013e31829e41b8
January 15, 2014 • Volume 2 • Number 2
decided on due to the presence of pulmonary hypertension. The patient was taken to the pediatric cardiovascular surgery intensive care unit where doctors, not aware of the first case, applied a previously used probe to the patient for cerebral oxygen monitoring. The probe was placed on the lateral side of the patient’s forehead. On noticing a burning odor, an intensive care unit nurse identified a first-degree burn around the right frontal region where the electrode was attached to this skin (Fig. 2). The cerebral monitoring was promptly terminated, and, as in the first case, medical dressing was applied to the burn and paracetamol suppository was added to the treatment for analgesia. The burn healed in about a week without further complications.
DISCUSSION
Cerebral oximetry is used to monitor changes in cerebral oxygen metabolism, and an INVOS device is suitable when used as a trend monitor. Although there were some studies conducted with INVOS cerebral oximeters, we were unable to locate reports of skin burns caused by electrodes. While the INVOS user’s manual reports that pressure sores can occur as a result of the application of tight bandages, skin burns are not mentioned as possible complications. Skin burns associated with the use of pulse oximeters using similar technology have been identified.2 The electrodes include a light-emitting diode (LED) as a light source. LEDs emitting infrared light may produce heat although it is a small amount. The electrodes also include a thin protective gel layer over the optical windows to prevent skin injury because of the heat produced. This protective layer may become thinner, and the isolation barrier between LED and skin may be interrupted if electrodes are used more than once. The infants’ susceptibility to injury as a result of their low cardiac output, poor peripheral circulation, and poor heat dissemination may also have contributed to the formation of skin burns. E REFERENCES 1. Fischer GW. Recent advances in application of cerebral oximetry in adult cardiovascular surgery. Semin Cardiothorac Vasc Anesth 2008;12:60–9 2. Lin CW, Wang HZ, Hsieh KS. Pulse oximeter-associated toe injuries in a premature neonate: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1999;62:914–6
cases-anesthesia-analgesia.org
11
Cerebral Oximetry Probes-Associated Skin Burns
Figure 1. Case 1.
Figure 2. Case 2.
12 cases-anesthesia-analgesia.org
A & A case reports
