Understanding IV Infiltration: A Comprehensive Overview
Intravenous (IV) therapy is a common medical procedure, but it is not without its risks. Infiltration, the most frequent complication, occurs when non-vesicant fluid or medication leaks into the surrounding tissue instead of flowing into the vein. While typically less severe than extravasation, which involves caustic substances, infiltration can still cause significant discomfort, delay treatment, and, in severe cases, lead to tissue damage or nerve compression. An in-depth understanding of the factors that contribute to this event is crucial for both patients and healthcare providers.
Patient-Specific Risk Factors
Several characteristics inherent to the patient can increase their susceptibility to IV infiltration.
Age
- Pediatric patients: Infants and young children have smaller, more delicate veins that are challenging to cannulate and are more prone to damage. Their restlessness and lack of understanding may also increase the risk of accidental dislodgment.
- Geriatric patients: Older adults often have fragile, thin-walled veins due to the natural aging process and loss of supportive subcutaneous tissue. This makes them more susceptible to vein rupture during insertion or during the infusion.
Vein Characteristics
- Fragile veins: Conditions like chronic steroid use or frequent IV therapy can cause veins to become brittle and porous, increasing the likelihood of leakage.
- Underlying medical conditions: Patients with diabetes, chronic kidney disease, or hypertension may have compromised vascular health, which affects vein integrity.
Patient Behavior
- Restlessness or agitation: Uncooperative or confused patients, or those with impaired cognitive function, are more likely to inadvertently pull, bump, or move the IV catheter, causing it to dislodge.
- Excessive movement: Placement in an area of high flexion, such as the wrist or elbow, increases the chance of the catheter bending or slipping out of the vein with normal patient movement.
Procedural and Equipment-Related Risk Factors
Proper technique and equipment selection are paramount to preventing infiltration. Mistakes in these areas are a major contributor to catheter failure.
Insertion Technique
- Incorrect angle of insertion: Inserting the catheter at an improper angle can cause it to puncture through the opposite wall of the vein, a common cause of immediate infiltration.
- Multiple insertion attempts: Repeated attempts to cannulate the same vein increase the trauma to the vein wall and the surrounding tissue, raising the risk of future infiltration.
Equipment and Securement
- Catheter size: Using a catheter that is too large for the patient's vein can cause vein irritation and trauma. The Infusion Nurses Society (INS) and other guidelines recommend using the smallest gauge catheter appropriate for the therapy.
- Inadequate catheter securement: A poorly secured IV catheter can shift easily with patient movement. Proper stabilization using dressings or specialized devices is essential to prevent dislodgment.
- Prolonged dwell time: Leaving a peripheral IV in the same location for too long increases the risk of phlebitis and infiltration. Guidelines often recommend rotation every 72-96 hours.
Medication-Related Risk Factors
The type of solution being infused can directly impact the likelihood of infiltration.
- Hyperosmolar solutions: Solutions with a high concentration of solutes, such as 10% dextrose or total parenteral nutrition (TPN), can be irritating to veins and cause osmotic fluid shifts that lead to infiltration.
- Vesicant and irritant medications: While not strictly infiltration, the leakage of vesicant (tissue-damaging) or irritant drugs can cause severe extravasation, which begins as an infiltration event. Examples include certain chemotherapies, antibiotics like vancomycin, and high-concentration electrolytes.
- High infusion rate: Infusing fluid too quickly can overwhelm a fragile vein, causing it to rupture or allowing fluid to leak out of the insertion site.
Comparison Table: Infiltration vs. Extravasation
| Feature | Infiltration | Extravasation |
|---|---|---|
| Infiltrated Substance | Non-vesicant (non-irritating) fluids and medications, such as normal saline. | Vesicant (irritating or damaging) drugs, such as certain chemotherapy or electrolyte solutions. |
| Potential Severity | Generally less severe, often resolves with intervention. Can cause mild swelling and discomfort. | Potentially severe, leading to tissue necrosis, blistering, and permanent damage. |
| Symptoms | Swelling, coolness, pallor, tight skin, and slowed IV flow. | Symptoms of infiltration, plus burning, stinging, redness, and blistering. |
| Management | Stop infusion, remove IV, elevate limb, and apply compresses. | Stop infusion, aspirate fluid, notify prescriber, may require antidote and surgical consult. |
Nursing Assessment and Prevention Strategies
Preventing IV infiltration relies on meticulous technique and continuous monitoring.
- Select the right site: Choose a vein in the forearm rather than areas of flexion like the hand or wrist, as the forearm bones act as a natural splint.
- Use the smallest gauge catheter: A smaller gauge catheter minimizes vein trauma and allows for better hemodilution of the infusate.
- Ensure proper securement: Stabilize the catheter and tubing firmly to prevent movement that could cause dislodgement.
- Regular site monitoring: Visually inspect and palpate the IV site frequently. For high-risk patients or vesicant infusions, assess hourly.
- Patient education: Teach patients to report any pain, swelling, or discomfort at the IV site immediately.
For more detailed, evidence-based recommendations, consult the guidelines published by the Infusion Nurses Society (INS).
Conclusion
Identifying the numerous risk factors associated with IV infiltration is the first step toward effective prevention. By addressing patient-specific vulnerabilities, adhering to best practices for insertion and securement, and considering the properties of infused medications, healthcare providers can significantly reduce the incidence of this common complication. Patient education and diligent site monitoring are essential components of a proactive strategy, ensuring safer and more comfortable intravenous therapy for all patients.
