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Looking Into Infiltration and Extravasation

Infiltration and Extravasation are two IV complications that can be difficult to immediately detect and can lead to adverse patient outcomes. Extravasation is best defined as the accidental administration of a vesicant fluid or solution into the surrounding tissue. Infiltration is defined as the accidental administration of a non-vesicant fluid or medication into the surrounding tissues.

In both situations, the amount of tissue damage depends on the type of drug or fluid being infused and the amount of time that it remains in the tissue area before being discovered. Tissue damage can range in severity from mild instances to tissue necrosis requiring surgical intervention.

There are a variety of reasons why infiltration or extravasation may happen in some patients. These include:

• Selecting an Improper Site (Inserting into an area of flexion)

• Traumatic insertions that have caused damage to the internal lining of the vessel.

• Inadequate securement of the IV device (catheter tip penetrates the catheter wall or the catheter slips out of the vessel)

• Improper device utilization for a specific treatment

• Obstructions to blood flow around or through the catheter

Patients with small sclerosed veins (diabetes or atherosclerosis) are at an increased risk of infiltration or extravasation. Additionally, children and the elderly and patients who are unable to communicate effectively with staff are at an increased risk. Without a doubt, prevention is the ideal strategy in regards to infiltration and extravasation. Several prevention oriented strategies are:

• Accept that these complications can occur and educate staff, patients and family on the early identification of signs and symptoms.

• Respond quickly whenever patients complain of pain at the insertion site.

• Monitor patients with IVs regularly – employ a standardized method for visually inspecting an insertion.

• Work to prevent the infusion site from extraneous movements.

• Avoid inserting IVs in areas of flexion.

• Have a policy and process in place for handling different types of infiltrations or extravasations.

Despite our best efforts, infiltration and extravasation can still occur. As active health care providers it is our goal to be prepared for these situations by being knowledgeable of the most recent evidence based guidelines for handling these sorts of situations. Facilities should actively encourage learning opportunities for providers and hands on learning programs. However, this should not limit nursing professionals. There is a huge variety of nursing CEU programs online that focus on intravenous insertions and complications – although those are by no means substitutes for hands on learning, they are options for nurses seeking to learn more about the subject.