An intravenous (IV) line is placed into almost every patient at the time of presentation to the hospital. The procedure is simple, a needle is placed into the patient’s vein so a plastic catheter can be slipped over the needle into the vein. The needle is then removed, and the plastic catheter is taped in place. IV’s are used to administer fluid, or medication. There are several available sizes of catheters from the very large (16 gauge) to the very small (24 gauge). The type of medication being administered determine the gauge of IV required. Commonly, fluid and medication is administered through a 20 gauge catheter.
IV sites need to be changed regularly, usually every 3 days, to ensure that an infection does not develop. IV sites need to be assessed regularly to make sure the site is still intact. If nothing is infusing into the site, it should be assessed once per shift. More frequent assessment, sometimes as often as every 15 minutes, is appropriate if medication is infusing into the site. Every healthcare facility that offers IV therapy has policies on the appropriate manner to insert an IV, and the appropriate manner to assess an IV site. Every nurse should be trained on these policies and comply with them. Unfortunately, this does not always occur. When it does not, an infiltration or an extravasation can result with devastating consequences.
The Infusion Nursing Standards of Practice define infiltration as “the inadvertent administration of nonvesicant medication or fluid into the surrounding tissue instead of into the intended vascular pathway.” These Standards define extravasation as “the inadvertent administration of vesicant medication or fluid into the surrounding tissue instead of into the intended vascular pathway.” A vesicant is “an agent capable of causing injury when it escapes from the intended vascular pathway into the surrounding tissue.”
Infiltration and extravasation occurs when the plastic cannula is no longer fully in the vein. This can occur from: 1) improper insertion into the vein; 2) damage to the lining of the vein which causes it to swell preventing forward flow of the infusate; 3) the presence or formation of a clot within the vein or around the cannula; or, 4) if the cannula punctures or erodes through the opposite wall of the vein.
The first symptom of an infiltration or extravasation is almost always pain at or near the IV site. If the problem is not addressed, redness and swelling usually develop. Sometimes the skin is noted to be cool near the IV site. Sometimes the patient feels numbness along the nerve path if it is affected by the infiltration. Sometimes fluid can actually be seen leaking from the site. These symptoms are caused by the infusion of the substance into the tissue around the vein (where it is not supposed to be) rather than into the vein (where it is supposed to be).
Some medications can cause tissue death if they are allowed to infuse into the tissue around the vein. This can cause large wounds as the tissue sloughs off, requiring surgical debridements and skin or muscle grafting to try and repair. Permanent injury can result from this type of extravasation. Sometimes, so much fluid is permitted to infiltrate into the tissue around the vein that circulation to the extremity is impaired. In this scenario, permanent nerve damage, loss of function, and even limb amputation can occur.
The best treatment for infiltration and extravasation is prevention. A patient depends on the nursing staff to adequately and timely assess the IV site and to ensure the IV fluid/medications are infusing properly into the vein. The extent of injury from infiltration or extravasation is usually related to how much of the fluid or medication has leaked into the tissues by the time it was detected. Early detection of infiltrations or extravasations may prevent nerve damage and/or tissue death. Failure to promptly detect infiltrations or extravasations can leave the patient with permanent disfigurement and loss of function
If you or a loved one has suffered an injury that required medical treatment as a result of an infiltrated or extravasated IV site, contact Wormington & Bollinger today. We serve those who have suffered preventable medical complications throughout the State of Texas. With a high level of success rate in the medical malpractice field, our experienced lawyers have helped people in Dallas, Fort Worth, Arlington and Plano among cities others all over Texas. We are committed to helping you investigate the cause of this injury, to determine who is responsible, and to lessen the financial burden it has imposed on you and your family.