The administration of intravenous therapy (IV) is so commonplace these days it’s easy to forget that the potential for harm is high on the list for untoward outcomes. As a healthcare professional, it is important to know the difference between infiltration and extravasation.
IV infiltration is one of the most common problems that can occur when fluid infuses into the tissues surrounding the venipuncture site. This sometimes happens when the tip of the catheter slips out of the vein, the catheter passes through the wall of the vein, or the blood vessel wall allows part of the fluid to infuse into the surrounding tissue.
In addition to following your facility policy for IV therapy, frequent assessment of the IV site can help to prevent many of the complications associated with IV infiltration. If you are concerned an IV is infiltrated, follow your facility policy and as a general guideline, discontinue the site and relocate the IV.
Comparison of the IV site with the same area on the opposite extremity can also be helpful in determining whether an infiltration has occurred. If the assessment of the involved extremity is inconclusive, the application of pressure on the vein, about two inches above the insertion site (and above the tip of the cannula) with a finger or tourniquet, will decrease or stop the flow of fluid if the cannula is still in the vein. If an infiltration is present, the rate will remain unchanged. If the infusion continues despite the obstruction applied, an infiltration has occurred.
If the infiltration is severe, you may consider the application of a compress in addition to elevating the affected limb. Check your institution’s policy regarding which type of compress (warm or cold) should be applied. Generally speaking, if the infiltration solution was isotonic, a warm compress is used to alleviate discomfort and help absorb the infiltration by increasing circulation to the affected area. However, sloughing can occur from the application of a warm compress to an area infiltrated with certain medications such as potassium chloride. In certain situations, a cold compress is recommended.
An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. Vesicants can cause tissue destruction and / or blistering. Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. Extravasation can result in tissue sloughing, pain, loss of mobility in the extremity and infection. The treatment for extravasation will vary depending on the antidote for the infiltrated medication and your facility policy.