Early Identification of Infiltration
Events – A Matter of Eyes or Device?


Intravenous vascular access is the most performed invasive procedure in clinical settings worldwide.1 The support and management of patient conditions relies tremendously upon stable vascular access for the administration of essential fluids, medications, nutrition, and blood products.2 Vascular access devices, either central or peripheral, play a vital role in patient outcomes.

The use of vascular access devices comes with significant risks and complications such as infections, thrombosis, occlusion, and peripheral intravenous infiltration/extravasation. Device failure frequently results in potential and significant patient harm or injury.2,3 Observational studies have found peripheral IV related complications as high as 75%.3,4

  • Introduce the “5 Rights” in vascular access and review the importance of properly administering these best practices during the patient assessment stage.
  • Review the differences in requirements and potential complications with central and peripheral vascular access.
  • Discuss infusion-related complications, both general and device-related, and the challenges of detecting infiltration events early.
  • Examine the differences between intermittent observational tools such as “Touch, Look, and Compare” techniques versus continuous monitoring tools for early infiltration/extravasation detection to reduce potential harm.
  • Analyze real world infiltration clinical data and evidence about the importance of early recognition to improve patient safety.

Watch the Recording

Roland van Rens Biography

Matheus (‘Roland’) van Rens has over twenty years of clinical experience in neonatal nursing and holds a MA in Advanced Nursing Practice (Ma ANP), awarded in 2005 from Erasmus University in the Netherlands. He has worked as an advanced neonatal nurse practitioner, performing complex vascular access procedures in this patient group, developed and delivered multi-professional education activities and carried out clinical research in Europe and more recently in the Middle East. Most recently he served as the Clinical Director of Nursing for the newborn intensive care unit (NICU) at Women’s Wellness and Research Center, Qatar.

His research engages with issues around improving neonatal care, most notably around the broad topic of vascular access, a topic on which he has been the primary investigator for several studies. With his international research collaborators and co-authors, he has presented at international conferences and published several referred journal articles concerning neonatal vascular access, infusion therapy and related technology.

Matheus is a member of the Dutch Sigma Theta Tau International chapter and has recently been nominated for the prestigious Janet Pettit award in recognition of his contributions to the field of neonatal vascular access care. Currently, he is preparing for his PhD study in the Netherlands.

Roland van Rens Published Clinical Resources

1.    van Rens MFPT, Reiss IK, Latour JM. Peripheral central catheter insertion: eyes or device? Pediatr Crit Care Med. 2012 Sep;13(5):607-8. doi: 10.1097/PCC.0b013e31824fbdc9. PMID: 22955466.
2.    van der Eijk AC, van Rens MFPT, Dankelman J, Smit BJ. A literature review on flow-rate variability in neonatal IV therapy. Paediatr Anaesth. 2013 Jan;23(1):9-21. doi: 10.1111/pan.12039. Epub 2012 Oct 12. PMID: 23057436.
3.    Legemaat MM, Jongerden IP, van Rens MFPT, Zielman M, van den Hoogen A. Effect of a vascular access team on central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit: a systematic review. Int J Nurs Stud. 2015 May;52(5):1003-10. doi: 10.1016/j.ijnurstu.2014.11.010. Epub 2014 Dec 2. PMID: 25526669.
4.    Legemaat M, Carr PJ, van Rens MFPT, van Dijk M, Poslawsky IE, van den Hoogen A. Peripheral intravenous cannulation: complication rates in the neonatal population: a multicenter observational study. J Vasc Access. 2016 Jul 12;17(4):360-5. doi: 10.5301/jva.5000558. Epub 2016 May 31. PMID: 27312758.
5.    van Rens, MFPT., Hugill, K., & Francia, A. V. (2019). A new approach for early recognition of peripheral intravenous (PIV) infiltration: A pilot appraisal of a sensor technology in a neonatal population. Vascular Access, 5(2), 38–41.
6.    Bayoumi MAA, van Rens MFPT, Chandra P, Francia ALV, D’Souza S, George M, Shahbal S, Elmalik EE, Cabanillas IJE. Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit. J Vasc Access. 2021 Mar;22(2):243-253. doi: 10.1177/1129729820928182. Epub 2020 Jun 30. PMID: 32602399; PMCID: PMC7983328.
7.    Hugill K, van Rens M. Inserting central lines via the peripheral circulation in neonates. Br J Nurs. 2020 Oct 22;29(19):S12-S18. doi: 10.12968/bjon.2020.29.19.S12. PMID: 33104432.
8.    van Rens M. Hugill K, Garcia K., Persistent left superior vena cava and the correct anatomical interpretation of a peripherally inserted central catheter tip position: a case report. Infant. 2021 May Vol. 17 Issue 3, p112-114. 3p
9.    van Rens MFPT, Hugill K, Mahmah MA, et al. Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study. BMJ Open 2021;11:e047788. doi:10.1136/bmjopen-2020-047788
10. van Rens M, Hugill K, Francia AL, Abdelwahab AH, Garcia KL. Treatment of a neonatal peripheral intravenous infiltration/extravasation (PIVIE) injury with hyaluronidase: a case report. Br J Nurs. 2022 Apr 21;31(8):S31-S36. doi: 10.12968/bjon.2022.31.8.S31. PMID: 35439074.
11. van Rens M, Hugill K, Gaffari MAK, et al Outcomes of establishing a neonatal peripheral vascular access team, Archives of Disease in Childhood – Fetal and Neonatal Edition Published Online First: 07 October 2021. doi: 10.1136/archdischild-2021-322764
12. van Rens M, Nimeri AMA, Spencer TR, Hugill K, Francia ALV, Olukade TO, Mahmah MA. Cyanoacrylate Securement in Neonatal PICC Use: A 4-Year Observational Study. Adv Neonatal Care. 2021 Nov 2. doi: 10.1097/ANC.0000000000000963. Epub ahead of print. PMID: 34743117.
13. van Rens, M.F.P.T., Paramban, R., Francia, A.L.V. et al. Evaluation of a diluted lipid emulsion solution as a lubricant for improved peripherally inserted central catheter guidewire removal in a neonatal population. BMC Pediatr 22, 71 (2022). https://doi.org/10.1186/s12887-022-03119-2
14. Bayoumi MAA, Elmalik EE, Ali H, D’Souza S, Furigay J, Romo A, Shyam S, Singh R, Koobar O, Al Shouli J, van Rens M, Abounahia FF, Gad A, Elbaba M and Lutfi S (2022) Neonatal Simulation Program: A 5 Years Educational Journey From Qatar. Front. Pediatr. 10:843147. doi: 10.3389/fped.2022.843147
15. Bayoumi MAA, van Rens R, Chandra P, et al Peripherally inserted central catheters versus non-tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study. BMJ Open 2022;12:e058866. doi: 10.1136/bmjopen-2021-058866
16. van Rens MFPT, Hugill K, Mahmah MA, Francia AL, van Loon FH. Effect of peripheral intravenous catheter type and material on therapy failure in a neonatal population. J Vasc Access. 2022 Feb 23:11297298221080071. doi: 10.1177/11297298221080071. Epub ahead of print. PMID: 35196909.
17. van Rens MFPT, Hugill K, Francia ALV, et al. Closed intravenous systems for central vascular access: A difference maker for CLABSI rates in neonates? The Journal of Vascular Access. April 2022. doi:10.1177/11297298221085480

Upcoming Events

Sept. 30 - Oct. 2

Minneapolis, Minnesota,
Booth 606

Live Booth Presenters:
Russ Nassof, JD
Former AVA Treasurer,
Secretary and Board Member

Eric Hamre, RN, BSN
Director of Clinical Services,

October 13-15

Philadelphia, Pennsylvania,
Booth 1149

Live Booth Presenters:
Roland van Rens
Director of Nursing, NICU
Eric Hamre, RN, BSN
Director of Clinical Services,

October 26


Speaker: Russ Nassof, JD
Former AVA Treasurer,
Secretary and Board Member
Part II:
A Solution for Increased Clinician Liability Post-COVID for Infiltration/Extravasation


1. Zingg W, Pittet D (2009) Peripheral venous catheters: an under-evaluated problem. Int J Antimicrob Agents 34(Suppl4): S38-42. https://doi.org/10.1016/S0924-8579(09)70565-5
2. Odom B, Lowe L, Yates C. Peripheral infiltration and extravasation injury methodology: a retrospective study. J Infus Nurs 2018;41(4):247-52. https://doi.org/10.1097/NAN.0000000000000287
3. van Rens MFPT, Hugill K, Mahmah MA, et al. Evaluation of unmodifiable and potentially modifiable factors affecting peripheral intravenous device-related complications in neonates: a retrospective observational study. BMJ Open 2021;11:e047788. https://doi.org/10.1136/bmjopen-2020-047788
4. Pettit J. Assessment of the infant with a peripheral intravenous device. Advances in neonatal care. 2003 Oct 1;3(5):230-40. https://doi.org/10.1016/j.adnc.2003.08.006