Andrew: Education among nurses and doctors in general wards is limited, particularly regarding peripheral IVs. Many clinicians focus primarily on signs of infection around a peripheral cannula, because early infiltration can mimic phlebitis or cellulitis.

The initial signs of an infiltration can easily be mistaken for infection. We need to increase awareness of the potential risks associated with certain medications commonly used in general practice, especially those typically given in oncology.

For example, calcium chloride has an osmolarity over 2000, yet it is administered peripherally, and many clinicians are unaware of the serious risks involved. Similarly, many antibiotics are irritants that can damage veins.

Education and awareness are essential to ensure staff recognize these risks and can identify early signs of infiltration.

Sara: I would add that education is absolutely key. At my hospital, staff often haven’t been taught to assess how much of the catheter is actually in the vein or to consider the catheter-to-vein ratio, which ensures proper blood flow around the catheter.

Through my work with ultrasound-guided IVs in the ICU, I’ve observed that some clinicians assume ultrasound alone is sufficient. While it helps place IVs, it’s crucial to use appropriate equipment and catheter length for the vein being assessed.

For example, patients coming from the emergency department may have a standard 1.18-inch catheter placed in a deeper vein. That purchase with the vein is not there, and the catheter is not stabilized, meaning that before you even realize something is wrong, things have already happened under the surface because the vein is deeper and the catheter, unfortunately, has lost its purchase with the vein.

Understanding these technical details and the reasons extravasations occur is a critical first step. Education should focus not only on the medications being administered but also on using appropriate devices to administer them safely.

Donna: Education is certainly a significant component. Another key factor is integrating this information into the medication administration record. This ensures nurses know when they are administering a high-risk medication.

Staff can quickly reference the record, check policies, contact pharmacy if needed, and even access information about the appropriate antidote. This approach has been a major improvement in ensuring safe practice and enhancing awareness.

Melissa: From the patient perspective, early signs are critical. When the medication was administered through my IV, I felt burning, slight swelling, and a purplish discoloration. The swelling continued to worsen over several hours, eventually preventing me from moving my fingers.

That initial small swelling ultimately led to over 30 surgeries and ongoing nerve pain. This illustrates why education is so crucial. Early recognition of even minor changes can prevent severe outcomes.

Andrew: Nurses are trained to know that IV therapy should not be painful. Any pain during administration is a red flag. If a patient reports pain or swelling, the IV should be stopped immediately. Do not attempt to continue or “push through” to avoid resiting the cannula.

The patient’s voice is critical—they have the right to say, “Stop, this is painful.”

Sara: Administration practices vary across institutions. At our hospital, before removing an infiltrated catheter, staff attempt to aspirate remaining medication from the catheter. Some institutions also inject hyaluronidase through the affected catheter and surrounding tissue. Staff education focuses on following the policy carefully and using the appropriate technique.

Andrew: The UK’s NIVAS Toolkit emphasizes standardized recognition, reporting, and surveillance of infiltration and extravasation injuries. Many hospitals currently underreport these events, so true rates are unknown locally and nationally. Recognizing and reporting injuries consistently allows us to learn from them and improve practice. Standardized reporting, combined with practice improvements, is essential for reducing these injuries.

Melissa: When I first learned about ivWatch, I was worried it would make me relive my trauma. But seeing the videos and learning about how it helps babies and patients was eye-opening.

I realized there is a gap in foundational education for healthcare providers—from medical schools to catheter manufacturers—regarding IV safety. We need to address this foundation so that clinicians are trained in safe IV practices before ever caring for patients.

Sara: There’s a lot of focus on reportable events like CLABSI, CAUTI, and ventilator-associated pneumonia, which can overshadow daily practices like IV care. By reporting infiltration and extravasation events consistently, we can highlight their frequency and drive meaningful change. It’s about balancing focus on high-profile metrics with everyday care practices, ensuring all aspects of patient care receive appropriate attention.