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CLINICIAN-RELATED RISKS
RECOGNIZING INFILTRATION IN
OUR PATIENTS
WHAT IS IV
INFILTRATION?
Displacement of non-vesicant, or irritant medications or
fluids into surrounding tissues
F Aldesleukin (interleukin-2)
F Ifosfamide
F Bleomycin
Displacement of vesicant medications into surrounding
tissues is known as extravasation
F Antibiotics
F Lactated Ringers
F Dilantin
F Cytotoxic (chemotherapy drugs), and non-cytotoxic
drugs (Digoxin, Diazepam, TPN)
F DNA binding (Anthryacycline Antibiotics)
F Non-DNA binding (Alkylators, antitumor antibiotics)
DEVICE-RELATED RISKS
Metal needles, large-gauge catheters
F Smaller is better!
Inadequately secured IV needle or catheter
F Use a transparent dressing!
F Crisscross tape after the transparent dressing
is applied
Undesirable IV site location
F Avoid areas of flexion
F Avoid hard, cordlike veins
F Avoid veins of the hand
F Avoid the antecubital fossa
F Veins of the forearm are preferred
PATIENT-RELATED
RISKS
Pre-existing
medical conditions
Age
F
F
Pediatrics
Geriatrics
Communication
barrier
Fragile veins
Source: (Sauerland, C., Engelking, C., Wickham, R., & Corbi, D., 2006)
Chemotherapy patients
Diabetics
Hypovolemia
Cultural groups
F Asian Culture
F
F
F
Source: (Sauerland, C., Engelking, C., Wickham, R., & Corbi, D., 2006)
Infiltration
Blanched skin
F Swelling
Possible numbness
F Redness
Circulatory impairment
F Edema
Skin tight and leaking
F Pain
INS Infiltration Scale
F Grade 0: No symptoms
F Grade 1: Skin blanched; edema <1 in any direction;
cool to touch; may have pain
F Grade 2: (same as Grade 1) to include edema 1-6
in any direction
F Grade 3: Skin blanched; translucent; gross edema
>6 in any direction; cool to touch; mild to moderate
pain; possible numbness
F Grade 4: Typically considered extravasation; skin
discolored, bruised, swollen; circulatory impairment;
moderate to severe pain;
Sources: (Dougherty, L., 2008); (Schulmeister, L., 2009); (Sauerland, C., Engelking, C.,
Wickham, R., & Corbi, D., 2006); (Schummer, W., et. al., 2005)
RECOGNIZING EXTRAVASATION IN
OUR PATIENTS
Typically classified as Grade 4 on INS Infiltration Scale
Degree of injury is proportionate to:
Amount of drug infused
Location of peripheral IV site
Concentration of the drug
F All of which can lead to:
Ulceration within days or weeks
Severe, continuous pain
Tissue damage and possible
impairment of affected limb
F
F
PREVENTING EXTRAVASATION
F
F
F
F
F
F
F
F
F
F
Hourly assessments
Cover site with
transparent dressing
Stabilize equipment
Proper site selection
Use smallest gauge
plastic cannula possible
Prepare and organize
material prior to insertion
Vesicant education for
all nurses
Pharmacy
involvement
Interdisciplinary
approach
IVT (Intravenous
Therapy) Teams
The Journal
of Clinical
Innovations
suggests IVT
Teams reduce
the occurrences
of complications
associated with
peripheral IVs.
Evidence is limited pertaining to the Cost
effectiveness of implementing such teams.
Based on the academic review and appraisal
of a multitude of articles, case studies and
random clinical trials, it is our suggestion
that hospitals conduct an independent study
to determine the effectiveness of IVT Teams
in relation to cost.
POLICY CHANGES
12. Infiltration/Extravasation
Remove catheter.
Warm/Cool compresses:
a. Warm compresses:
i. All chemotherapy agents
STANDARD OF PRACTICE
STANDARD NUMBER: 1624,320
STANDARD TITLE: Peripheral Intravenous Therapy
REGULATORY STANDARD:
EFFECTIVE DATE: 05/06
REVISION DATE: 11/2008, 6/2010, 08/2010, 9,2011
ii. Dopamine
b. Cool compresses
i. All hypertonic solutions and antibiotics
refer to 1624.140 Extravasation
STATEMENT:
c. For drug specific detail,
Peripheral intravenous (IV) therapy will be provided based on physician order in a safe,
Management policy
aseptic manner for short-term vascular access and fluid administration.