What is the recommended treatment for intravenous (IV) infiltration on the dorsal surface of the hand resulting in a small bruise, also known as ecchymosis, with no other symptoms?

From the Guidelines

For a small bruise from an IV infiltration on the back of the hand with no other complications, the recommended treatment is simple supportive care, as outlined in the most recent guidelines 1. The treatment approach should focus on reducing swelling and pain, and promoting absorption of the infiltrated fluid.

• Apply a cold compress or ice pack wrapped in a cloth to the area for 15-20 minutes every 1-2 hours during the first 24-48 hours to reduce swelling and pain, as suggested by general principles of managing minor injuries 1.
• After 48 hours, switch to warm compresses for the same duration to help with absorption of the infiltrated fluid.
• Elevate the hand above heart level when possible to minimize swelling.
• Over-the-counter pain relievers like acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 200-400mg every 6-8 hours can help manage discomfort if needed. Most minor infiltrations resolve on their own within a few days to a week, according to the clinical practice guidelines for vascular access 1. The bruising occurs because the IV fluid has leaked into surrounding tissue, causing minor damage to small blood vessels. This type of minor infiltration typically heals without complications, but if you notice increasing pain, redness, warmth, swelling, or if the bruise doesn't improve within a week, seek medical attention as these could indicate infection or other complications, as emphasized in the guidelines 1.

From the Research

IV Infiltration Treatment

• For minor IV infiltrations, such as the one described, treatment is often limited to elevation and observation 2.
• In some cases, wound care may be performed by nursing staff, but this is not always necessary 2.
• The use of medication, such as hyaluronidase, phentolamine, or nitroglycerin ointment, may be considered in some cases, but this is typically reserved for more severe infiltrations 3.
• The majority of IV infiltrations can be managed with minimal intervention, and invasive procedures are rarely necessary 2.

Complications and Outcomes

• The risk of complications, such as infection, necrosis, or ulceration, is relatively low, even in cases where the infiltration is not promptly treated 4.
• In most cases, IV infiltrations do not result in long-term defects or functional impairment 4.
• The management of IV infiltrations can often be handled by primary care teams, with specialist consultation reserved for more complex cases 4.

Nursing Interventions

• Early recognition and intervention are critical in preventing serious complications from IV infiltrations 5.
• Nursing interventions, such as elevation, observation, and wound care, can help to minimize the risk of complications and promote healing 5, 2.