What is the management for IV (intravenous) infiltration?

Management of IV Infiltration

When IV infiltration occurs, immediately stop the infusion, attempt to aspirate residual fluid, remove the IV catheter, and apply appropriate thermal compresses based on the type of infiltrated solution. 1

Immediate Management Steps

1. Stop the infusion immediately when infiltration is suspected 1, 2
2. Leave the IV catheter in place initially to attempt aspiration 1
3. Aspirate any residual drug/fluid from the IV line and surrounding tissue 1, 2
4. Remove the IV catheter after aspiration attempt 1
5. Apply appropriate thermal compresses:
   • Cold compresses for vesicant medications (anthracyclines, mitomycin C)
   • Warm compresses for irritants, vinca alkaloids, epipodophyllotoxins, and taxanes 1
6. Document the incident thoroughly, including:
   • Patient identification
   • Date and time of infiltration
   • Name of drug/fluid and diluent used
   • Signs and symptoms reported by patient
   • Description of the IV access
   • Extravasation area and approximate amount of infiltrated solution
   • Management steps with time and date 1

Assessment and Monitoring

1. Evaluate the severity of infiltration by assessing:

   • Pain at the site
   • Swelling and bruising
   • Discoloration
   • Temperature of the affected area
   • Potential compression of vessels 3

2. Regular monitoring:

   • Daily or every 2 days during the first week
   • Then weekly until complete resolution
   • Monitor for progressive inflammation, redness, edema, pain, blistering, and potential necrosis 1

Specific Treatments Based on Infiltrated Agent

For Vesicant Medications (e.g., chemotherapy agents)

1. Anthracycline extravasation:

   • Administer dexrazoxane IV in a 3-day schedule (1000, and 500 mg/m²) starting within 6 hours 1

2. Vinca alkaloid extravasation:

   • Inject hyaluronidase 1-6 ml of 150 U/ml solution 1

3. Vasoconstrictor extravasation:

   • Inject phentolamine 0.1-0.2 mg/kg (up to 10 mg) diluted in 10 ml of 0.9% sodium chloride intradermally 1

For Non-Vesicant Infiltrations

Most non-vesicant infiltrations can be managed conservatively with:

• Elevation of the affected limb
• Thermal compresses
• Pain management as needed 4

Follow-up Care

1. Surgical consultation if:

   • Unresolved tissue necrosis develops
   • Pain persists for more than 10 days
   • Full-thickness wounds form 1, 4

2. Wound care for any resulting skin breakdown or ulceration 4

Prognosis

• Approximately 95% of IV infiltrations resolve without long-term functional deficits 1
• Only about 5.1% result in any long-term defects 4
• Surgical emergencies from IV infiltration are rare 1, 4

Prevention Strategies

1. Proper IV site selection:

   • In adults, use upper extremities instead of lower extremities 3
   • In pediatric patients, hand, dorsum of foot, or scalp can be used 3

2. Regular site assessment:

   • Evaluate catheter insertion site daily 3
   • Palpate through dressing to discern tenderness
   • Visually inspect if using transparent dressing 3

3. Patient education:

   • Instruct patients to report any pain or burning during infusion 1

4. Staff training:

   • Ensure proper cannulation technique
   • Recognize early signs of infiltration 2

Common Pitfalls to Avoid

• Delayed recognition of early signs of infiltration
• Applying pressure to the extravasation site
• Delaying antidote administration for vesicant drugs
• Inadequate follow-up monitoring 1
• Using steel needles for administration of fluids that might cause tissue necrosis if extravasation occurs 3

By following these guidelines, most IV infiltrations can be managed effectively with minimal long-term consequences, while preventing more serious complications such as tissue necrosis or functional impairment.