Prevention and Early Detection of Intravenous Infiltration and Extravasation

Intravenous infiltration and extravasation instances are dreaded complications of IV therapy.

Intravenous Infiltration and Extravasation Cases

Infiltration is the accidental infusion of a non-vesicant solution into the tissue. An extravasation (pronounced ex-trav-a-sa shun) is an accidental infusion of a vesicant solution into the tissue. The vesicant is typically a caustic medication or a concentrated intravenous solution.

Early detection of infiltration or extravasation is certainly the responsibility of any medical professional who administers intravenous fluids.

For example, an anesthesiologist monitors an intravenous site during an operation, as do rescue squad members who start IVs and give fluids. Nurses monitor intravenous sites more than do any other professional.

You know as a legal nurse consultant that significant damages can result from an intravenous infiltration and extravasation. The analysis of these nursing malpractice cases often centers around the standard of care for preventing these outcomes. The analysis of liability is often not clear cut, in part because the standard of care may not be well delineated.

For example, consider the phrase often found in policies: (the nurse should provide) “frequent monitoring of an intravenous site.” What is the definition of frequent monitoring? A medical facility’s policy may not provide a specific time frame.

Many hospital policies state the site should only be checked once a shift. The definition of a shift may have changed from what used to be an 8-hour shift to a 12-hour shift.

What length shift does the hospital’s policy refer to? Does the nurse recognize that the frequency of site checks should increase if the patient is receiving a caustic medication? If the nurse administers potassium chloride for a four-hour infusion and only checks the site at the beginning and at the end of the infusion, the patient could sustain significant damage if the whole infusion went into the tissue.

Assessment of an intravenous site is the responsibility of registered nurses. A hospital that reduces the number of registered nurses, which increases the number of patients the registered nurse is assigned to, contributes to the risks of infiltration and extravasation.

It is very difficult for the registered nurses to take care of a large number of patients. Even though it takes seconds to assess an intravenous site, a nurse may be tied up with responsibilities that interfere with site assessment.

A devastating injury can occur if an intravenous infiltration and extravasation is not detected for six to eight hours.

Early Signs of Intravenous Infiltration and Extravasation

Prevention of infiltration and extravasation depends on early detection of the same symptom: swelling. Picture the IV catheter or the plastic tube sitting in the vein. For infiltration or extravasation to occur, the needle must slip out of the vein. Now it’s punctured a hole in the vein and the medication is now going into the surrounding tissue.

Obviously the main thing the nursing staff will see is immediate swelling. The intravenous fluid will collect under the tissue and it will get bigger and bigger and bigger as the amount of fluid inside the tissue increases.

In addition to assessing for swelling, the nursing standard of care requires checking for coolness at the site. The nurse has to touch around the IV catheter to check the temperature of the skin around the IV site. If the IV fluid goes into tissue, the site will be cool to the touch because the IV fluids that were infusing are not body temperature. Therefore, the two main symptoms medical professionals should look for are swelling and coolness.

Both infiltration and extravasation begin with swelling and coolness. Suppose an attorney asks a defendant nurse, “How can you tell the difference between an infiltration and extravasation if you’re looking for only coolness and swelling?” The answer should be, “It depends on what the nurse is infusing. The nurse has to recognize whether the solution contains a vesicant (caustic medication) because that increases the risks. Early action may reduce the damages associated with infiltration and extravasation.

Patricia Iyer MSN RN LNCCC is president of The Pat Iyer Group. This material is extracted from Analyzing Falls, Pressure Sores and IV Therapy Cases