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Infiltration
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Infiltration refers to the leaking of IV fluid or medication into the tissue surrounding a vascular access device. This may be caused by improper placement of PIV, dislodgment of the catheter, damage to the patient vessel, or patient movement.
Signs and symptoms
- Swelling, discomfort, burning, and/or tightness at, near, or proximal to the insertion site
- Leakage from the insertion site
- Cool skin, redness, and/or blanching at the PIV site
- Decreased flow rate (gravity) or high-pressure/distal-occlusion alarms (infusion device)
Prevention
- Select an appropriate site for PIV cannulation, avoiding areas of flexion.
- Use proper venipuncture technique and follow facility policy for securing PIV catheter.
- Establish catheter patency prior to initiating any intravenous administration.
- Observe the PIV site frequently and advise the patient to report any swelling/tenderness at the site.
Management
- Upon first sign of infiltration, stop the infusion and remove the device.
- Check patient pulse, capillary refill time, and elevate the limb.
- A warm or cool compress may be applied, depending on the infiltrated solution.
- Perform venipuncture in a different location (proximal to the previous site, or in the contralateral arm) and restart the infusion as ordered, after changing the IV tubing (per facility protocol).
- Check the site frequently, then document findings and interventions.
Extravasation
Extravasation refers to the leaking of vesicant drugs into the tissue surrounding a vascular access device. Extravasation can cause severe local tissue damage, delayed healing, infection, tissue sloughing and necrosis, disfigurement, loss of function, and may result in amputation.
Signs and symptoms
Signs and symptoms usually manifest immediately but may be subtle at first and progress over days to weeks.
- Discomfort, burning, pruritis, and/or tightness near PIV site
- Leakage from the PIV site
- Cool skin, redness, and/or blanching at/above the PIV site
- Blistering and/or skin sloughing surrounding PIV site
- Vesicant extravasation may lead to delayed manifestations of ulceration, eschar, and necrosis.
Prevention
- Select an appropriate site for PIV cannulation, avoiding small and/or fragile veins, and avoiding areas of flexion.
- Avoid placing PIVs in extremities with preexisting edema or known neurological impairment.
- Establish catheter patency prior to initiating any intravenous administration.
- Be aware of vesicant medications. Examples include vancomycin, amiodarone, antineoplastic drugs (such as doxorubicin, vinblastine, and vincristine), hydroxyzine, promethazine, digoxin, and dopamine.
- Follow facility policy regarding vesicant administration via PIV. Institutional policy may require use of a central vascular access device (CVAD) for vesicant medications.
- Give vesicant drugs last, when multiple drugs are ordered, and strictly adhere to administration guidelines and techniques.
Management
- Upon first sign of extravasation, stop the infusion, estimate the amount of extravasated solution and notify the prescriber.
- Do not immediately remove the PIV. Use it to attempt to aspirate fluid from the extravasated area and/or to administer an antidote (as with specific vasopressors).
- Administer the appropriate antidote according to facility protocol, if appropriate and as ordered.
- Elevate the extremity and perform frequent assessments of sensation, motor function, and circulation.
- Record the extravasation site, patient symptoms, estimated amount of extravasated solution, and treatment.
- Follow the manufacturer recommendations to apply either cold or warm compresses to the affected area.
- Perform venipuncture in a different location (proximal to the previous site, or in the contralateral arm) and restart the infusion as ordered, after changing IV tubing (per facility protocol).
- Continue to check the site frequently, then document findings and interventions..