IV Infiltration and Extravasation Causes and Prevention
IV Infiltration Prevention and Management describes infiltrations and extravasations, common causes, and best practices to prevent and mitigate the risk of these complications from occurring. Infiltration is a common complication of IV therapy and refers to the leakage of medication into surrounding tissues rather than the vein while extravasation refers specifically to when a vesicant is leaking. Infiltrations and Extravasations complications can be prevented in a variety of ways, most of them tracing back to the insertion of the vascular access line. Read to find out about the consequences of infiltration and how Vascular Wellness’ Vascular Access clinicians help prevent this outcome.
What is IV Infiltration?
What are the Most Common Causes of Infiltration?
IV Infiltration is leakage of a medication or solution from the catheter and into the surrounding tissues instead of the vein. It accounts for around 23% of IV catheter failures, making it the most common cause of malfunction. The Most Common Causes of infiltration are physical, such as dislodgment of the needle or catheter, improper securement of the needle, incorrect insertion of the catheter, and patient activity that may jostle or dislodge the needle. Other common causes can include fragile or porous veins (i.e., the vein may be too weak to handle an infusion and burst) and blood clots proximal to the area of IV insertion, blocking blood flow and forcing fluid into the surrounding tissues.
Hematoma caused by Midline Infiltration
Proper insertion of catheter using Ultrasound Guidance
IV Infiltration and Extravasation Causes and Prevention:
What are the Signs and Symptoms of Infiltration?
The Signs and Symptoms of Infiltration can present in a variety of ways depending on the location of the IV, the medication administered, and the patient’s past medical history. However, in most cases, the area around the IV becomes cool, swollen, and painful. Usually, the IV must be discontinued, and the clinician should elevate the arm and apply a warm or cool compress, depending on the medication administered. With certain vesicants, warm compress is best practice to help the vesicant move through the body and away from the acute tissue area to prevent additional damage. In cases where the patient only has one IV, this may disrupt care and nurses will temporarily be unable to administer regularly scheduled medications or have venous access in the event of an emergency until new vascular access is achieved. Finally, one of the most common complications of infiltration are soft tissue infections, which can quickly spread through the bloodstream to other parts of the body and extend hospital stays. Preventing infections is a top priority in healthcare settings, where patients’ immune systems may be compromised due to their diagnoses or medications.
What is the Difference Between Infiltration and Extravasation?
The difference between Infiltration and Extravasation is that extravasation refers specifically to the leakage of a vesicant, which is a medication that can cause permanent tissue or nerve damage if it is not treated quickly. Common examples of vesicants include chemotherapy agents, vasopressors (medications that constrict blood vessels), and antibiotics that are known to be harsh on the veins such as vancomycin. In the case of extravasation, the treating physician must be notified immediately, and, depending on the situation, an antidote or other appropriate medications should be given. Time is vital in these situations, as signs and symptoms may take multiple days to appear.
Symptoms of extravasation are similar to infiltration, but also include numbness, tingling, and formation of blisters and ulcers around the IV site. The infiltration extravasation may also progress to form eschar (a layer of dark, crusted, and dead tissue) or skin necrosis (death). If these complications aren’t treated quickly enough, the damage to the nerves and tendons may result in neurological deficits and joint stiffness. Although rare, this may even result in compartment syndrome, which is characterized by increased pressure in a confined area due to swelling and/or eschar formation. Due to the seriousness of these potential issues, both prevention and fast identification are vital to the treatment of extravasation.
Extravasation caused by Vancomycin in PIV
PIV Extravasation after Debridement
Extravasation Healing
after Wound Vac
IV Infiltration and Extravasation Causes and Prevention:
How does Vascular Wellness Reduce the Risk of Infiltration and Extravasation?
Vascular Wellness Vascular Access Clinicians work to reduce the risk of infiltration and extravasation in many ways. The most common causes of IV infiltration are improper placement and securement of the catheter, and preventing this complication starts with the expertise level of the vascular access nurse placing the line. In addition, we focus on the following risk mitigation steps:
Extensive Training. Our nurse clinicians are Vascular Access Board Certified (VA-BC), insured, skill-verified semiannually, and salaried W2 employees to ensure consistent, quality services at the patient’s bedside every time. They leverage our aggregate and diverse experience across hundreds of thousands of lines placed with an exceptional 98% success rate and 0% insertion related infection rate.
Ultrasound Guidance and Needle Visualization. This ensures the needle goes into the patient one time, and one time only, which actively prevents one of the risk factors for infiltration – frequent cannula insertion – by ensuring the catheter positioning is correct throughout the entire procedure.
Advanced Technology. In addition to ultrasound guidance for placement of all lines, we use ECG Tip Confirmation Technology to ensure proper placement of PICC lines, often eliminating the need for X-ray confirmation and enabling the vascular access to be used immediately with confidence.
Superior Supplies. We only use top-rated, hospital preferred supplies from Becton Dickinson (BD), formerly Bard. Superior supplies help mitigate the risk of infiltration from bad placement, clotting, infections, and other adverse events.
IV Infiltration Prevention and Management is vital to reducing the prevalence of this serious and potentially life-threatening complication. By both taking preventative measures ahead of time and ensuring quick identification and action when infiltration occurs, clinicians can support better outcomes for their patients. This demonstrates the importance of employing skilled Vascular Access Clinicians like the ones at Vascular Wellness; we take every measure to decrease the risk of infiltration and extravasation through our extensive training, reliable supplies, and ultrasound visualization.
Want to know how our clinicians address Infiltration and Extravasation Prevention and Management in the field?
Learn about how our clinicians addressed a complicated extravasation case in the field:
Fracture and Extravasation Complicates Vascular Access→
Curious about radiopharmaceutical extravasations?
Learn more about why preventing extravasations is vital in the field of nuclear medicine:
Why is Proper Vascular Access Critical to Nuclear Medicine?→
Want to learn more about how Vascular Wellness Vascular Access Services helps mitigate the risk of IV complications? Read our Vascular Access Patient Cases below…
Fracture and Extravasation Complicates Vascular Access
Clotted Fistula Requires Urgent Vas-Cath
Vascular Access Patient Cases:
Clinical Cases from the Front Lines of Vascular Access Care
We place the right line at the right time, the first time.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.
