Treatment of Infiltration in Vascular Access
For any size infiltration, apply ice for at least 10 minutes and avoid maximizing blood pump speed. 1
Management Based on Severity
Small Infiltration
- Apply ice for a minimum of 10 minutes to help decrease pain, reduce the size of infiltration, and potentially decrease bleeding time 1
- Refrain from maximizing blood pump speed to prevent further damage 1
- Monitor closely for signs and symptoms of worsening infiltration 1
Moderate Infiltration
- Withdraw the needle and hold manual pressure over the infiltration site 1
- Apply ice for at least 10 minutes 1
- If infiltration occurs after heparin administration, take care to properly clot the needle tract without clotting the fistula 1
- In some cases, leaving the needle in place and cannulating another site may be appropriate 1
Large Infiltration
- Withdraw the needle and apply manual pressure 1
- Apply ice for at least 10 minutes 1
- Determine if dialysis is necessary that day 1
- If dialysis is required:
- Consider resting the fistula for at least one treatment if possible 1
Assessment After Infiltration
- Perform close assessment of the site, the AV access, and the adjacent extremity 1
- Measure the extent of swelling 1
- Assess the presence of flow in the AV access both proximal and distal to the hematoma 1
- Evaluate circulation to the associated extremity 1
- Monitor for potential complications such as hematoma formation 1
Complications of Infiltration
- Hematoma development can vary from small diffuse areas to large firm masses that may compress vessels 1
- Significant hematomas can lead to:
- A single infiltration injury before successful cannulation is associated with 56% lower odds of overall AVF maturation 1
Prevention of Further Damage
- Use ultrasound guidance to help determine direction of flow and proper needle placement in select patients when performed by trained operators 1
- For future cannulations, select a site above the infiltration if the fistula must be used 1
- If the patient has a catheter in place, consider restarting fistula use with one needle and gradually advancing to two needles, larger needle size, and greater blood flow rates as the access allows 1
- Ensure proper needle removal technique to prevent post-dialysis infiltrations 1
- Apply gauze dressing over the needle site without applying pressure initially
- Remove the needle at approximately the same angle as insertion
- Only apply pressure after the needle is completely removed
Common Pitfalls to Avoid
- Lifting up on the needle after it is in the vein, which can cause infiltration 1
- Improper needle flip or taping procedures that may lead to infiltration 1
- Using too steep an angle during needle removal, which may cause the needle's cutting edge to puncture the vein wall 1
- Applying pressure to the puncture site before the needle is completely removed 1
- Failing to recognize early signs of infiltration, which can lead to more extensive damage 1, 2