What is the treatment for an infiltration of the hand?

Treatment of Hand Infiltration

Immediately stop the infusion, remove the catheter if still in place, elevate the hand above heart level, and apply ice to minimize tissue damage and pain. 1

Immediate Management Steps

Stop and Assess

• Discontinue the infusion immediately upon recognizing signs of infiltration (pain, swelling, discoloration) 1
• Remove the catheter carefully to prevent further tissue trauma 1
• Assess the severity: document the extent of swelling, presence of skin changes, neurovascular status, and hand function 2, 3

Initial Interventions

• Apply ice immediately to the infiltrated area to decrease pain, reduce swelling size, and potentially decrease bleeding time, especially if heparin was administered 1
• Elevate the hand above heart level to promote venous and lymphatic drainage 4
• Do not apply pressure to the infiltration site initially, as this may worsen tissue damage 1

Critical Assessment for Compartment Syndrome

Monitor closely for signs of compartment syndrome, which can develop even days after infiltration and represents a surgical emergency requiring immediate fasciotomy 2, 3:

• Progressive pain out of proportion to clinical findings 2
• Tense swelling of hand compartments 2
• Intrinsic minus hand posturing (clawed fingers) 2
• Numbness or paresthesias 2
• Pain with passive finger extension 2

Women over age 50 are at highest risk for major complications from hand infiltrations, including compartment syndrome, skin necrosis, and nerve compression 3

Subsequent Management Based on Severity

Minor Infiltrations

• Rest the access site for at least one dialysis treatment (or 24-48 hours in non-dialysis patients) before attempting re-cannulation 1
• If re-access is necessary before healing, cannulate above (proximal to) the infiltration site, never through or below it 1
• Continue elevation and ice application for 24-48 hours 4

Major Infiltrations Requiring Intervention

Seek immediate surgical consultation if any of the following develop 2, 3:

• Skin necrosis or bullous eruption 2, 3
• Large hematoma causing mass effect or vascular compression 3
• Signs of compartment syndrome (see above) 2
• Nerve compression symptoms (numbness, weakness, paresthesias) 3
• Infiltration of chemotherapeutic agents or other vesicants 3

Special Considerations for Anticoagulated Patients

• Patients on anticoagulation are at high risk for large hematomas requiring surgical evacuation 3
• In some cases with post-heparin infiltration, leaving the needle in place temporarily while cannulating another site may be appropriate to allow the needle tract (not the vessel) to clot properly 1
• Apply direct compression to bleeding sites without occluding distal venous outflow 4

Follow-Up Protocol

• Reassess within 48-72 hours to ensure resolution and detect delayed complications 4
• Document infiltration in patient record to guide future access site selection 1
• If swelling persists beyond 2 weeks, investigate for central venous stenosis or thrombosis with duplex ultrasound 4
• Educate patient on warning signs requiring immediate return: increasing pain, skin color changes, numbness, or inability to move fingers 2, 3

Common Pitfalls to Avoid

• Never apply pressure before completely removing the needle, as this can worsen vessel wall damage 1
• Do not dismiss persistent swelling as benign—it may indicate compartment syndrome developing days after the initial injury 2
• Avoid re-cannulating the same site or distal to the infiltration until complete healing occurs 1
• Do not underestimate infiltrations in elderly women, who have disproportionately high rates of major complications requiring surgical intervention 3