Of the two billion IVs administered globally every year, up to half will fail. The healthcare system’s age-old standard of monitoring IVs, to “wait and see” if an IV injury occurs, is broken, ineffective, and poses serious risks to patient safety. Infiltration and extravasation-related injuries occurring across every patient population – from neonates to geriatrics – can be severe, including medication dosing errors, skin necrosis, skin staining, nerve damage, and amputation.
For decades, clinicians have been taught to rely on the ability to flush an IV and look for blood return as a gold standard to assess patient IVs for infiltrations and extravasations, but some IVs are leaking into the tissue even when the IV catheter is still placed inside the vein, giving a good flush and producing a blood return.
Understanding the common ways IVs infiltrate will change the way you assess IV sites and monitor your patient IVs.
There are five primary ways a patient’s IV can fail, these first two are most commonly what people think of when they hear the term infiltration. These are easier to detect quickly due to the lack of blood return and inability to obtain a good flush:
When the catheter punctures through the opposing vein wall, fluid is infused directly into the subcutaneous tissue.
When the catheter backs out of the vein, the infusing fluid or medication leaks into the patient’s subcutaneous tissue. This can sometimes be caused by an incorrectly sized catheter.
Signs and symptoms often develop quicker in these instances because the fluid is now infusing directly into the subcutaneous tissue. Since the catheter is no longer in the vein you are unable to see a blood return upon assessment. Depending on where the catheter has dislodged, you might still be able to flush, but it wouldn’t be as easy, and it would most likely be uncomfortable to your patient as that fluid would not be entering the vein but instead the patient’s tissue. Often you are not able to flush at all due to resistance or pain.
Not all types of infiltrations are as easy to assess. There are common ways that fluid can infiltrate the tissue while the IV catheter still sits within the vein, allowing blood return and a good flush:
When fluid leaks at the insertion site of the catheter, it pools in the surrounding tissue. This can be from an obstruction or constriction in the vein, or veins becoming more fragile over time.
Even when the catheter is secured inside the vein, if it has punctured through the opposing vein wall—typically due to multiple insertions, IV placement, or movement—infusing fluid will leak directly into the patient’s subcutaneous tissue.
With certain medications damage can happen to the vein wall, causing increased space between cells, where fluid can leak out into the surrounding tissue.
It’s time to move away from the “wait and see” mindset with IV injuries and embrace a proactive, comprehensive approach. Real-time IV monitoring is changing the way clinicians monitor IVs and offers an alternative to these unreliable methods by detecting infiltrations and extravasations when they begin. There are simply no longer any excuses for IV injuries.
When you can’t rely on a flush, ivWatch technology is there to be a second set of eyes by continuously monitoring your patient’s IV site, alerting you to IV infiltrations at their earliest stages, typically before signs and symptoms are able to be seen.
If you need a resource for your team download The Causes Tool.