From the Guidelines
To treat swelling from IV infiltration, immediately stop the IV infusion and remove the catheter, and apply cold compresses to the affected area for 20-30 minutes every 1-2 hours during the first 24 hours to reduce swelling and pain by causing vasoconstriction, as recommended by the most recent guidelines 1. The management of IV infiltration should prioritize reducing swelling, pain, and the risk of further complications.
- Stop the IV infusion and remove the catheter to prevent further fluid leakage into the tissue.
- Apply cold compresses to the affected area for 20-30 minutes every 1-2 hours during the first 24 hours to reduce swelling and pain by causing vasoconstriction, as this is a common practice in managing infiltrations 1.
- After 24 hours, switch to warm compresses to promote circulation and absorption of the infiltrated fluid.
- Elevate the affected limb above heart level when possible to reduce swelling through gravity. For pain management, consider using acetaminophen (325-650 mg every 4-6 hours) or ibuprofen (400-600 mg every 6-8 hours) if not contraindicated, as these can help alleviate pain and discomfort associated with the infiltration 1. In cases of infiltration with vesicant medications, specific antidotes may be needed, such as hyaluronidase (150-200 units subcutaneously) to help disperse certain infiltrated medications, or sodium thiosulfate for anthracycline extravasation. It is essential to document the infiltration site, appearance, and interventions taken to monitor the patient's progress and adjust the treatment plan as needed. Most infiltrations resolve within 24-48 hours with these measures, but severe cases involving large volumes or irritating medications may require surgical consultation, especially if there are signs of compartment syndrome (severe pain, pallor, paresthesia, pulselessness, or paralysis) 1.
From the Research
Treatment of Patient Swelling from IV Infiltration
- The management of IV infiltrations can be done through various methods, including elevation and observation, wound care, and in some cases, incision, aspiration, or antidote injection 2.
- A study found that 91% of IV infiltration injuries were treated with only elevation and observation, while 7% required wound care and 2% required incision, aspiration, or antidote injection 2.
- The use of nursing staff, wound care teams, and primary physicians with limited specialist consultation can be effective in managing IV infiltration injuries 3.
- Early recognition and intervention are crucial in preventing serious complications from IV infiltration, such as superficial soft tissue infection, necrosis or eschar formation, and ulceration or full-thickness wound formation 3, 4.
- The Infusion Nurses Society's national standards of practice require that a nurse who administers IV medication or fluid know its adverse effects and appropriate interventions to take before starting the infusion, including the use of heat and cold therapy 4.
Prevention of Complications
- Patients with vascular disease do not experience worse outcomes compared with healthy individuals 3.
- The risk of compartment syndrome is low, and most complications can be monitored and managed by a primary team 3, 5.
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as intravenous diclofenac can provide good pain relief for patients with postoperative pain, but further research is needed to fully understand its effects 6.
Special Considerations
- Patients at highest risk of developing compartment syndrome requiring surgery from IV infiltration are likely to have barriers to communication, such as young age or impaired mental state 5.
- The management of IV infiltration injuries should take into account the type of substance infiltrated, with noncytotoxic, radiographic contrast, and known vesicants being the most common 2.