Intravenous infiltration or IV infiltration, in short, is the condition of diffusion or accumulation of an IV-administered medicine into the surrounding tissues.
It is a complication of the intravenous therapy, in which the administered fluid or the infiltrate is unintentionally delivered to the nearby tissues or cells. It mostly occurs when IV catheter is dislodged from its intended place, causing the fluids to diffuse in the neighboring cells or tissues.
Lets read more about this.
Table of Contents
Infiltration vs. Extravasation
The terms infiltration and extravasation are often used interchangeably. However, they differ slightly in theory. While the theoretical definition of infiltration is the inadvertent administration of a non-vesicant or a non-irritating fluid or medication into the nearby cells or tissues, extravasation is the inadvertent administration of a vesicant fluid or solution into the neighboring tissue.
Hence, extravasation can be serious in the sense that it can cause tissue damage and inflammation. Some IV medicines can even cause necrosis or death of the cells or tissues.
How Is IV Infiltration Caused?
Infiltration occurs when the intravenous (IV)catheter crosses the vein boundary and comes out of it, causing the liquid to diffuse to the surrounding region. This situation of leakage of non-vesicant fluid into the subcutaneous tissues can be caused by some factors such as:
- Puncture of distal vein during the insertion of intravenous catheter
- Restriction of blood flow in the region around the IV site
- Movement of the arm in which the catheter is inserted, leading to erosion of the vein wall
- Improper cannula size
- Dislodgement of catheter from the vein due to inappropriate venous site for puncture
- Puncture of the vein wall by mechanical friction from catheter
- Excessive delivery rate of the fluid
- Inflammation which causes the gap between cells of the vein wall to increase, leading to leakage
- Inadequately secured catheter
- Distraction during administration of the drug
- Unfamiliar administrator
- Large catheter relative to the size of the vein
- Clot formation above the catheter site
- Inappropriate needle length
- Development of thrombus at the tip of catheter
Signs And Symptoms Of IV Infiltration
The signs and symptoms of IV infiltration are as follows:
a. Swelling and tightening of the skin
b. Inflammation at the site of insertion
c. Dampness in the dressing applied to the IV site
d. Upon lowering the container containing the solution, there is no backflow of blood into the IV tube
e. Blanched and cool skin around the IV site
f. Reduced or no infusion
g. Intense pain around the area
h. Numbness or tingling
Grading Of IV Infiltration
In medical terms, IV infiltration can be graded into five categories based on its extent-
1. Grade Zero
In this type, there are no symptoms.
2. Grade One
- Edema: Less than 1 inch in any direction
- Skin appearance: Blanched skin
- Pain: It can be with or without pain
- Skin on examination: The skin is cool to touch
3. Grade Two
- Edema: 1-6 inches in any direction
- Skin appearance: Blanched skin
- Pain: It can be with or without pain
- Skin on examination: The skin is cool to touch
4. Grade Three
- Edema: More than 6 inches gross, in any direction
- Skin appearance: Blanched and translucent skin
- Pain: Patient experiences mild to moderate pain
- Skin on examination: The skin is cool to touch
There can be numbness sometimes
5. Grade Four
Edema: More than 6 inches gross, in any direction
Skin appearance: Blanched and translucent skin along with skin tightening and leaking
Pain: Patient experiences moderate to severe pain
Skin on examination: The skin is cool to touch
There can be discolored or bruised skin, along with inflammation. Also, deep pitting tissue edema can be seen in some cases. Also, the blood circulation in the area can also be impaired.
IV Infiltration Complications
IV infiltration is quite a frequent occurrence in patients undergoing IV therapy. However, most of the cases are not serious as it does not cause any long-term effects. But in some cases, it can develop into a more dangerous complication with serious long-term effects.
Here are the complications that are often caused by infiltration:
i. Hematoma
During IV therapy, in case of puncture of a distal vein during the insertion of an intravenous catheter, there can be leakage of blood into the surrounding tissues along with infiltration of fluid. This condition is called hematoma.
Also, if pressure is not applied to the IV site during the removal of the catheter, this condition can occur. It can be controlled by applying pressure in the area and can be resolved in 2 weeks.
ii. Cellulitis
A bacterial infection occurring in the deep layers of the skin due to IV infiltration or a cut in the uppermost layer of skin is termed as cellulitis. It is usually seen as a complication of infiltration.
The symptoms include fever, pain and warm skin near the infected area. It is a very dangerous condition as it tends to spread throughout the body. It is important that you immediately consult a doctor if you notice the symptoms of cellulitis.
iii. Nerve Damage
Whenever IV infiltration takes place, it results in leakage of fluid in the tissues of the neighboring region. Therefore, there is a possibility of the fluid causing damage to the affected nerves, like the nerves in the arm or hand.
This can seriously affect the functionality of the hand or cause tingling sensations and numbness. Although it is a very rare complication, it is a possibility that is to be kept in mind by the patients undergoing IV therapy.
IV. Infiltration vs. Phlebitis
Phlebitis is a condition in which the vein experiences inflammation due to the pH of the IV solution being administered. It is also characterized by redness along the vein, elevated skin temperature, puffy skin, and pain.
In most cases, infiltration is not very harmful as it mostly presents only minor complications.
On the other hand, phlebitis is a major complication that can be a side effect of infiltration.
It can also occur due to vein trauma at the time of insertion, use of an inappropriate catheter size for the vein, or due to prolonged use of the same IV site.
Older patients are highly susceptible to phlebitis., while infiltration is quite a common possibility for any patient.
Home Remedies For IV Infiltration
The first thing that is to be done is to discontinue the IV line as soon as the diffusion has occurred. The sooner this is done, the better it would be as it would stop any further tissue damage. The catheter should preferably be left in place to administer the antidote.
The antidote is used to neutralize or inactivate the infused medication. It also increases the systemic absorption of the medication. However, the antidote should be only administered by an experienced medical practitioner.
Application of compresses is a very effective way to reduce the pain and inflammation and to absorb the excess fluid.
The warm compress or cold compress are used depending upon the type of IV solution. Depending on the situation, a cold or a warm compress is preferred.
a. Cold Compress
It is known that a cold compress works well if the infiltration is recent and the solution was hypertonic or had a high pH value.
b. Warm Compress
A warm compress can be applied if the small amount of non-caustic solution is diffused over a period. It is also the preferred technique if the solution is isotonic with a normal pH value.
Also, some say that elevating the affected part can be helpful, but no such link between elevation and relief has been verified. In fact, it is observed that elevation causes more pain. Hence, it should be avoided.
P.S. In cases of tissue damage or necrosis, it is required that you consult a plastic surgeon.
Management
It is important that the first signs and symptoms of infiltration or extravasation be identified at an early stage. This would prevent any serious adverse effects, and proper intervention would ensure that least harm is done to the patient.
For this, appropriate guidelines need to be followed to minimize the complications associated with it.
Now, as specified above, the first step in managing the situation is to immediately discontinue the IV line. This is to ensure that least harm is done to the tissues surrounding the area.
Next step is to preferably place a new catheter if the position of the catheter is responsible for the diffusion. The new catheter must be used to deliver the antidote to minimize the damage done to the area and to nullify the solution.
Hyaluronidase is one of the most recommended antidotes, which has the property of fluid re-absorption.
Effective ways of managing IV infiltration are cold or warm compress as described in the treatment section. Identify the type of drug (vesicant or non-vesicant) and (hypertonic or isotonic) to identify which type of compress would be needed.
If a patient is suffering from gross IV, surgical intervention might be necessary so that major life-threatening symptoms can be avoided. Surgical intervention would mostly include decompression in the area along with additional fasciotomy.
Further management includes pain relief prescription and administration of analgesia.
Also, the after-care management is as important as the treatment itself.
The causes of the infiltration should be identified, and the treatment should be in lines with the cause. After the treatment, the follow-up routine needs to be adhered to, to ensure that no further damage has been caused. This will ensure proper recovery and minimal damage.
How To Prevent IV Infiltration
As in any other complication, even in this case prevention is the best measure. Here are some of the preventions that can be followed to avoid the occurrence these complications:
- Educate your friends and family about the signs and symptoms of infiltration and extravasation so that early diagnosis is possible.
- Avoid excessive movement of the IV site.
- Monitor IV site at regular intervals, especially during infusion.
- Ensure that the catheter is properly secured.
- Try to avoid flexion areas to insert the catheter
- Patients must know what kinds of medications or solutions are being infused
- Beginners should practice venipuncture skills on well-hydrated patients who don’t suffer from chronic medical conditions
- It is better to avoid insertion of the catheter in areas where there is a lot of movements like hand, wrist or the antecubital fossa
- It is recommended that the point of access be the forearm, which has a lot of veins. Also, the bones protect the catheter from excessive movement
- Medical conditions like diabetes or chronic hypertension might change the integrity of the vein wall. Hence, these conditions must be kept in mind before going for the insertion
Final Talk
In short, IV infiltration is a serious medical emergency and needs proper medical care, diagnosis, treatment and an after-care routine. It might be dangerous or even life-threatening if not treated well.
Medical practitioners or the administers of the medicines must make sure that they are not distracted while inserting the catheter. Also, all the preventions should be followed so that the risk factors are minimized.
It is crucial that the patients are aware of the solutions being infused so that they can identify the signs and symptoms at an early stage and any major complications can be avoided.
Lastly, everyone must remember that it is not wise to ignore the pain or any irregularity that occurs post the insertion. Anything that causes discomfort should be immediately reported to the doctor. This will ensure proper safety and save you from any serious harm later.
