Intravenous (IV) infusion, a process for administering medication and fluid for various medical conditions, is often performed on pediatric patients in the hospital. 1 All patients may be at risk for suffering an infiltration injury, but the pediatric population, which includes neonates, infants, and children, are especially at risk because of their small and weaker blood vessels, immature skin, lack of subdermal fat, and constant movement. 1 – 3 Infiltration is defined as an inadvertent delivery of nonvesicant fluid or medication into surrounding tissue with the potential to harm the patient. 4 (S150) The resulting harm may include blistering of the skin, necrosis, pain, and infection. 5 If a vesicant fluid or medication has been infused into the surrounding tissue space, it is called extravasation. 4 (S149) Vesicant fluids can be composed of, but not limited to, calcium, potassium, parenteral nutrition, acyclovir, and a variety of other substances. 5, 6 These infiltrations of vesicant and nonvesicant fluids can cause considerable damage to tissue and, in extreme cases, may result in compartment syndrome. 5 Other factors that contribute to the severity of an infiltration injury include the osmolality of the infusing agent, duration of the exposure, pH of the solution, possible chemical irritation, and the mechanical pressure that has leaked into the tissue space, causing structural damage. 7
What is the solution for IV infiltration?
Your clinician will likely do the following:
- Stop the infusion
- Remove the IV
- Mark the outline affected area with a marker
- Photograph the affected area
- Apply a hot or cold compress based on the type of IV fluid infiltrated
- Elevate the extremity
- Inject medication into the subcutaneous tissue
What to do for infiltrated IV?
- Select an appropriate I.V. site, avoiding areas of flexion.
- Use proper venipuncture technique.
- Follow your facility policy for securing the I.V. catheter.
- Observe the I.V. site frequently.
- Advise the patient to report any swelling or tenderness at the I.V. site.
How to prevent IV infiltration?
- Stop the I.V. ...
- Estimate the amount of extravasated solution and notify the prescriber.
- Administer the appropriate antidote according to your facility's protocol.
- Elevate the extremity.
- Perform frequent assessments of sensation, motor function, and circulation of the affected extremity.
How to prevent infiltration IV?
stop IV therapy administration immediately by disconnecting IV tube from cannula Infiltration is the accumulation of fluid in the IV surrounding tissue caused by the needle puncturing the vein wall or by eventual needle misplacement. Stabilising chosen vein extremity and taping cannula firmly to the skin can help prevent infiltration.
How does IV infiltration reduce swelling?
How is it treated?Elevate the site as much as possible to help reduce swelling.Apply a warm or cold compress (depending on the fluid) for 30 minutes every 2-3 hours to help reduce swelling and discomfort.Medication-If recommended, medicine for extravasations is given within 24 hours for best effect.
Why would a patient need IV therapy?
Doctors and nurses use IV therapy to administer anesthesia, pain medications, antibiotics, fluids, and other vital fluids. During surgery, having an IV in place allows providers to deliver emergency drugs quickly and efficiently when they are needed.
What is the purpose of extravasation?
Extravasation occurs when a vesicant drug leaks out of the vein and into the surrounding tissue. When this happens, a person will likely experience serious tissue damage, including ulceration and tissue death, if they do not receive treatment in time.
What to do if an IV infiltrates?
In addition to following your facility policy for IV therapy, frequent assessment of the IV site can help to prevent many of the complications associated with IV infiltration. If you are concerned an IV is infiltrated, follow your facility policy and as a general guideline, discontinue the site and relocate the IV.
Where is IV therapy indicated?
IV fluid therapy indications IV fluid therapy is used to maintain homeostasis when enteral intake is insufficient (eg, when a patient is “nil by mouth” or has reduced absorption), and to replace any additional losses.
What is IV infiltration?
IV infiltrations and extravasations occur when fluid leaks out of the vein into surrounding soft tissue. Common signs include inflammation, tightness of the skin, and pain around the IV site. IV infiltration is a common complication of intravenous (IV) therapy.
Is IV infiltration serious?
In extreme cases, IV infiltration may even result in death. If you have been injured or a loved one has died following untreated IV infiltration, you may have legal options that can help you recover damages for medical expenses and personal pain and suffering.
Is extravasation an adverse event?
Extravasation injury is a well-known adverse event that occurs when offending drugs escape from the veins or intravenous catheters into subcutaneous tissues.
What skin complications are associated with extravasation?
Proper monitoring and immediate intervention will go a long way in minimizing the morbidity associated with these injuries. However, if there is a delay in recognition and treatment, it can lead to complications like skin necrosis, gangrene, extensive soft tissue defects and contractures.
Can IV infiltration cause infection?
Minor complications can become more serious. For example, cellulitis is a bacterial infection, and if it occurs at a break in skin, it can be a complication of IV infiltration. Symptoms include fever, pain, redness, and warmth. The bacteria can spread through the body and are potentially dangerous.
What can the nurse do to help protect the patient from infiltration of IV medication?
What can the nurse do to help protect the patient from infiltration of IV medication? Use the most proximal insertion port on the existing primary tubing. Ensure that the syringe has been securely loaded into the mini–infusion pump. Set the pump to deliver the medication over the prescribed time period.
How can IV extravasation be prevented?
Preventing extravasationKnow your hospital's policy about the use of antidotes for vesicants. ... Make sure you know the antidote and other recommended treatment for the vesicant drug you're giving.Ensure that the drug has been properly diluted before injection or infusion.More items...
Return to The Emergency Department If
1. You develop a fever more than 101º F. 2. Your symptoms get worse. 3. You have thick or bloody drainage from the IV site.
Contact Your Healthcare Provider If
1. You develop a new burning or stinging feeling near your infiltration site. 2. You have questions or concerns about your condition or care.
Manage Your Infiltration Site
1. Use cold or heat packs as directed. Your healthcare provider will tell you which to use according to the type of infiltrated fluid. 2. Rest and...
Follow Up With Your Healthcare Provider in 1 Day Or as Directed
You may need to follow up weekly so that your healthcare provider can check your wound. He may refer you to a plastic surgeon or wound care special...
What to do if IV infiltration has occurred?
Management. If you suspect that the IV infiltration has occurred, the first and most important thing that you should do is discontinue the IV line. You might be reluctant to remove the IV catheter, especially if you have had difficulties in inserting it in the first place, due to the poor vein structure.
What is a warm compress?
Warm compress. Infiltration occurring over time, reduced quantities of solutions that are not caustic. Isotonic solutions with normal pH. It is not recommended to elevate the affected limb of the patient, as this can lead to intense pain.
What causes the gap between the cells of the vein wall to widen?
The restriction of the blood flow in the area near the IV site (due to thrombosis or other factors) An inflammatory process – this can lead to the widening of the gap between the cells of the vein wall, leading in the end to leakage.
How deep is pitting tissue edema?
Edema – over 6 inches (gross – in any direction) Deep pitting tissue edema can also be present in certain patients. The blood circulation in the area can be impaired. The pain can range from moderate to severe. Infiltration of: vesicant, irritant or blood product.
What is the skin around the IV site?
The skin around the IV site is blanche and cool. The dressing applied over the IV site is either damp or wet. The infusion has reduced its speed or it has stopped altogether. If the solution container is lowered, there is no backflow of blood into the IV tubing.
What is the best antidote for IV infiltration?
One of the most recommended antidotes to be administered is represented by hyaluronidase, which has fluid reabsorption as one of its main properties. In case of a gross IV infiltration, surgical intervention might be necessary to avoid the appearance of life-threatening symptoms.
Can you use cold compresses on hypotonic fluid?
In case of fluids that are hypotonic or isotonic, you may choose the application of warm or cold compresses, according to the comfort of the patient. If the fluids have infiltrated into the surrounding tissues, the administration on an antidote might be necessary.
WHAT YOU NEED TO KNOW
An infiltrated IV (intravenous) catheter happens when the catheter goes through or comes out of your vein. The IV fluid then leaks into the surrounding tissue. This may cause pain, swelling, and skin that is cool to the touch. Some IV medicines can cause your skin and tissue to die (necrosis) if they leak into your tissues.
Contact your healthcare provider if
You develop a new burning or stinging feeling near your infiltration site.
Manage your infiltration site
Use cold or heat packs as directed. Your healthcare provider will tell you which to use according to the type of infiltrated fluid.
Follow up with your healthcare provider in 1 day or as directed
You may need to follow up weekly so that your healthcare provider can check your wound. He may refer you to a plastic surgeon or wound care specialist. Write down your questions so you remember to ask them during your visit.
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
What are the complications of IV?
IV Complications can be mild to life threatening and include: Infiltration. Phlebitis. Hematoma. Extravasation (extravascular infiltration of IV fluid or medication) Air Embolism.
What is infiltration in IV?
What infiltration is it’s the leaking of the fluid outside of the IV into the soft tissue of the patient’s extremity. For example, what happens is your patient’s arm or leg or whatever it is maybe swollen, maybe tender, and it could also be cold because of all the fluid that’s accumulated.
What is the term for leaking blood into the soft tissue?
Hematoma: leaking of blood outside of the vessel into that soft tissue space. 4. Extravasation: leaking of a caustic substance outside of the vessel into the soft tissue space. 5. Air embolism: injection of air into the blood vessel. The first one is infiltration.
What is the term for the occurrence of blood at the site of an IV?
Hematoma. Occurrence of blood at the site of the IV. Typically, happens because of passing through both sides of the vessel during insertion or poor application of pressure after removal. Discontinue the IV and apply a pressure bandage. Extravasation. Infiltration of irritating or caustic fluid or medication outside a blood vessel.
What are the symptoms of an air embolism?
Prime all lines per facility policy. Symptoms of an air embolism may include. Dyspnea. Chest pain. Stroke symptoms. Hypotension.
Why is it important to write questions?
Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later. Recite: Cover the note-taking column with a sheet of paper.
Why is my IV fluid red?
Inflammation of the tissue because of the IV fluid or inserting an IV. The area can appear red and swollen. Treatment includes warm compresses, elevation of the site and occasional non-steroidal anti-inflammatories (only if the IV is still patent) Antibiotics typically aren’t needed.
What is the difference between infiltration and extravasation?
Infiltration – if the fluid is a non-vesicant (does not irritate tissue), it is called an infiltration. Extravasation – if the fluid is a vesicant (a fluid that irritates tissue), it is called an extravasation.
What is it called when a fluid leaks?
Extravasation – if the fluid is a vesicant (a fluid that irritates tissue), it is called an extravasation. Tissue damage from these fluids may or may not be seen at the time the leak occurs, and may take weeks or months to develop.
What is a child's wound ostomy care practitioner?
Children’s Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. They are available during business hours for follow-up outpatient visits. Appointments can be scheduled by calling 651-220-6530.
How to stop a child from pulling an IV?
Be careful when moving your child to prevent the IV from being bumped, tugged, or dislodged. Do not allow your child to pull on the IV. Use distraction to take your child’s mind off of it. Ask Child Life for activities your child can do.
What is peripheral IV?
What is a peripheral IV device? A peripheral IV is a catheter (a very thin, flexible tube) that is inserted into a small vein in the scalp, hand, arm, leg or foot. This is done to give fluids or medicines directly into the bloodstream. The IV is secured with tape or a type of dressing.
What is it called when an IV solution is administered outside of the vein?
When an IV solution or medication that will not cause tissue ischemia or necrosis is inadvertently administered outside of the vein, this infusion therapy complication is called an infiltration .
What happens when an IV catheter is dislodged?
When this happens, IV solutions and medications which are meant to infuse through the vein now leak into the tissue surrounding the vein. The leakage of this fluid into the tissue surrounding the vein is called ...
What is the purpose of a vasopressor?
Vasopressors are most often used when treating critically ill patients to help maintain an adequate blood pressure through the vasoconstriction of the blood vessels.
What is the name of the IV diuretic that is used to treat necrotic tissue?
Furosemide (Lasix) – IV diuretic. When skin and underlying tissue necrosis develops, a surgeon may need to cut out (debride) the necrotic (dead) tissue in order for healing to occur. If a large area needs to be debrided, a skin graft may be necessary to close the wound.
Who is Valarie Haisley?
Valarie Haisley is a certified wound care nurse expert working with Med League. Contact Valarie to discuss your cases involving wound care and/or infusion therapy complications. Med League provides highly-qualified IV therapy experts as well as wound care experts who can review your case.
Can IV extravasation cause amputation?
Although rare, IV extravasation injuries may lead to amputation; these most serious complications usually occur when treatment is delayed. Approximately 90% of hospitalized patients require infusion therapy, and 1 in 3 peripheral IV catheters will experience a complication. 1,2.
Is vesicant a basic or acidic substance?
Vesicants are extremely acidic or basic (pH less than 5 or greater than 9), hyperosmolar (extremely concentrated), or vasoconstrictive (cause the blood vessels to constrict). Many chemotherapy drugs are vesicants.
What type of compress is used for infiltration?
Check your institution's policy regarding which type of compress (warm or cold) should be applied. Generally speaking, if the infiltration solution was isotonic, a warm compress is used to alleviate discomfort and help absorb the infiltration by increasing circulation to the affected area. Click to see full answer.
How to tell if an IV is infected?
Also, how do you tell if an IV is infiltrated? The signs and symptoms of infiltration include: 1 Inflammation at or near the insertion site with swollen, taut skin with pain. 2 Blanching and coolness of skin around IV site. 3 Damp or wet dressing. 4 Slowed or stopped infusion. 5 No backflow of blood into IV tubing on lowering the solution container.
How to reduce swelling in arm?
This will help decrease swelling and pain. Prop your arm on pillows or blankets to keep it elevated comfortably . Do not use soaps, lotion, or creams on the area unless directed by your healthcare provider.
Definition
- The IV infiltration can be defined as a complication of the intravenous therapy, with the administered medication infiltrating into the surrounding tissues. The leakage of the IV-administered fluids is clearly unintended, the condition being often presented as extravasation. The IV infiltration most commonly occurs when the IV catheter is dislodged...
Signs and Symptoms
- These are the most common signs and symptoms of the IV infiltration: 1. Inflammation at or near the site of insertion 2. The skin is taut and swollen 3. Intense pain is experienced by the patient 4. The skin around the IV site is blanche and cool 5. The dressing applied over the IV site is either damp or wet 6. The infusion has reduced its speed or it has stopped altogether 7. If the solution …
Grading
- In the clinical practice, the IV infiltration can be graded into five different categories: Zero 1. No symptoms First grade 1. Skin appearance – blanche skin 2. Edema – under 1 inch (in any direction) 3. The skin is cool upon touch 4. The patient can be with or without pain Second grade 1. Skin appearance – blanche skin 2. Edema – between 1 and 6 inches (in any direction) 3. The s…
Treatment
- The most common treatment measures in case of complications such as IV infiltration consist of: Application of compresses(absorb the excess fluid, calm the pain, reduce the inflammation) 1. Cold compress 1.1. Recent infiltration 1.2. Hypertonic solution 1.3. Solution with increased pH 2. Warm compress 2.1. Infiltration occurring over time, reduced quantities of solutions that are no…
Prevention
- In order to prevent complications such as the IV infiltration, it is important that one follows the standard policy for the insertion of an intravenous catheter. If you are at the start of your nursing career, it is for the best that you practice the venipuncture skills on patients who do not suffer from chronic medical conditions and are well-hydrated. As you gain more experience, you can m…
Management
- If you suspect that the IV infiltration has occurred, the first and most important thing that you should do is discontinue the IV line. You might be reluctant to remove the IV catheter, especially if you have had difficulties in inserting it in the first place, due to the poor vein structure. However, you must not think about yourself but about the patient and how much discomfort and pain the I…