Infiltration

Infiltration refers to the leaking of IV fluid or medication into the tissue surrounding a vascular access device. This may be caused by improper placement of PIV, dislodgment of the catheter, damage to the patient vessel, or patient movement.

Signs and symptoms

• Swelling, discomfort, burning, and/or tightness at, near, or proximal to the insertion site
• Leakage from the insertion site
• Cool skin, redness, and/or blanching at the PIV site
• Decreased flow rate (gravity) or high-pressure/distal-occlusion alarms (infusion device)

• Select an appropriate site for PIV cannulation, avoiding areas of flexion.
• Use proper venipuncture technique and follow facility policy for securing PIV catheter.
• Establish catheter patency prior to initiating any intravenous administration.
• Observe the PIV site frequently and advise the patient to report any swelling/tenderness at the site.

• Upon first sign of infiltration, stop the infusion and remove the device.
• Check patient pulse, capillary refill time, and elevate the limb.
• A warm or cool compress may be applied, depending on the infiltrated solution.
• Perform venipuncture in a different location (proximal to the previous site, or in the contralateral arm) and restart the infusion as ordered, after changing the IV tubing (per facility protocol).
• Check the site frequently, then document findings and interventions.

Extravasation

• Discomfort, burning, pruritis, and/or tightness near PIV site
• Leakage from the PIV site
• Cool skin, redness, and/or blanching at/above the PIV site
• Blistering and/or skin sloughing surrounding PIV site
• Vesicant extravasation may lead to delayed manifestations of ulceration, eschar, and necrosis.

• Select an appropriate site for PIV cannulation, avoiding small and/or fragile veins, and avoiding areas of flexion.
• Avoid placing PIVs in extremities with preexisting edema or known neurological impairment.
• Establish catheter patency prior to initiating any intravenous administration.
• Be aware of vesicant medications. Examples include vancomycin, amiodarone, antineoplastic drugs (such as doxorubicin, vinblastine, and vincristine), hydroxyzine, promethazine, digoxin, and dopamine.
• Follow facility policy regarding vesicant administration via PIV. Institutional policy may require use of a central vascular access device (CVAD) for vesicant medications.
• Give vesicant drugs last, when multiple drugs are ordered, and strictly adhere to administration guidelines and techniques.

• Upon first sign of extravasation, stop the infusion, estimate the amount of extravasated solution and notify the prescriber.
• Do not immediately remove the PIV. Use it to attempt to aspirate fluid from the extravasated area and/or to administer an antidote (as with specific vasopressors).
• Administer the appropriate antidote according to facility protocol, if appropriate and as ordered.
• Elevate the extremity and perform frequent assessments of sensation, motor function, and circulation.
• Record the extravasation site, patient symptoms, estimated amount of extravasated solution, and treatment.
• Follow the manufacturer recommendations to apply either cold or warm compresses to the affected area.
• Perform venipuncture in a different location (proximal to the previous site, or in the contralateral arm) and restart the infusion as ordered, after changing IV tubing (per facility protocol). 
• Continue to check the site frequently, then document findings and interventions..