Peripheral IV infiltration and extravasation events (PIVIEs) are among the most common — and underreported — complications in healthcare. While IVs are standard practice, the damage they can cause when something goes wrong is anything but routine.
The question is: Do you know your data?
And just as importantly: Are you grading your PIVIEs?
If not, your organization could be missing critical opportunities to improve patient outcomes, reduce avoidable harm, track trends to take action, and ultimately reduce risk.
Routine IV Assessments are Not Enough
The current standard of care for identifying infiltrations and extravasations relies on clinicians performing routine physical IV assessments in accordance with facility protocols. These assessments typically follow the “Touch, Look, Compare” methodology, where clinicians evaluate the IV site to ensure it is soft, warm, pain-free, and dry, then compare it to an unaffected extremity for signs of swelling. This form of assessment is subjective, and this approach presents several challenges. Staffing shortages, exacerbated by the COVID-19 pandemic, can lead to less frequent assessments. Newer nurses are also less trained, experienced nurses are retiring, and clinical skill sets are eroding over time. Additionally, IV sites may not always be visible, and some patients may be unable to communicate pain or discomfort effectively.
Start with the Basics
Is your institution putting a stake in the ground and documenting if there are complications with IVs? If they are documenting, are they reporting all levels of infiltration and extravasation events? If not, this is step one to gathering data. Begin by putting this process in place.
Why Grading PIVIEs Matters
PIVIEs vary widely in severity. That’s why both infiltrations (leakage of non-vesicant fluid into tissue) and extravasations (leakage of vesicants or irritants) should be assessed using a standardized grading scale. Without grading, it’s impossible to:
- Benchmark severity across patients or units
- Accurately report outcomes
- Inform process improvement or product selection
- Prevent the most serious injuries from happening again
Common Grading Scales: 1–4 Severity and the IEGS Swelling Scale
1–4 Infiltration/Extravasation Grading Scale (INS standard):
IEGS Swelling Scale (Infusion Nurses Society):
- Designed to offer more detailed, anatomical-based quantification of swelling.
- Useful especially in pediatrics or research where more nuanced measurement is critical.
- Grades swelling based on circumference and anatomical spread (e.g., <2 cm vs. entire limb involvement).
Both scales help quantify tissue injury and guide appropriate clinical response — but only if they are used consistently. Note that both systems are subjective in nature and may have their own downfalls such as a vesicant can create blistering before significant swelling occurs in the limb.
The Role of Continuous Monitoring in Reducing High-Grade Injuries
One of the most effective ways to shift the scale from harm to safety is early detection. That’s where continuous monitoring with ivWatch becomes essential.
ivWatch consists of a patient monitor and sensors that use a predictive algorithm to detect tissue changes around the IV site in real-time — alerting clinicians before visible symptoms appear. This means clinicians are no longer limited to intermittent visual or tactile checks – subjective can become objective when clinician routine assessments are combined with technology.
What this means for grading your data:
- Events that may have become Grade 3 or 4 level injuries can now be caught earlier and documented as Grade 1 or 2
- The overall severity profile of your PIVIE data improves
- Patient harm is reduced, and downstream consequences like tissue necrosis, surgical intervention, or extended length of stays are avoided
How to Start Documenting, Grading, and Improving
- Start with the basics: Change behavior and ensure all infiltrations and extravasations are recorded.
- Standardize: Choose a grading system (INS or IEGS) and train staff on how to use it.
- Document: Build grading into your EMR or daily IV site assessment documentation.
- Track: Review the frequency and severity of events by unit, clinician, and device type.
- Invest: Deploy tools like ivWatch to reduce missed detections and help downgrade the harm scale.
Final Thought: If You Don’t Grade It, You Can’t Improve It
Unreported or ungraded PIVIEs are lost learning opportunities. By actively grading infiltrations and extravasations — and integrating technology like ivWatch — hospitals can not only reduce IV-related harm but also shift the entire risk profile of vascular access care.
Make your data count. Document infiltration and extravasation events, no matter the severity level. Grade your PIVIEs. And let ivWatch help you keep the 3s and 4s from happening in the first place. These injuries are avoidable.