Infiltration and extravasation care

Article Translations: (Spanish) (Somali)

What is a peripheral IV device?

A peripheral IV is a catheter (a very thin, flexible tube) that is inserted into a small vein in the scalp, hand, arm, leg or foot. This is done to give fluids or medicines directly into the bloodstream. The IV is secured with tape or a type of dressing. Additionally, tape and an arm board may also be used to help secure the IV. 

What is an infiltration or extravasation?

Sometimes, the fluid or medicine leaks into the tissue around the vein. The difference between an infiltration and extravasation is the type of medicine or fluid that is leaked.

• Infiltration – if the fluid is a non-vesicant (does not irritate tissue), it is called an infiltration.
• Extravasation – if the fluid is a vesicant (a fluid that irritates tissue), it is called an extravasation.

Tissue damage from these fluids may or may not be seen at the time the leak occurs, and may take weeks or months to develop.

How does this happen?

• Catheters can become clogged over time
• Catheters can come out unexpectedly
• IV fluids can leak out of the vein or artery because of irritation

What are signs of an infiltration/extravasation?

• Redness around the site
• Swelling, puffy or hard skin around the site
• Blanching (lighter skin around the IV site)
• Pain or tenderness around the site
• IV not working
• Cool skin temperature around the IV site or of the scalp, hand, arm, leg or foot near the site

What happens after an infiltration/extravasation?

• The site will be assessed and evaluated
• Depending on severity, additional health team members (such as a pharmacist or advanced practice nurse specializing in skin care) may be consulted to discuss treatment options
• The IV will be removed
• The site will be checked hourly until it returns to normal

How is it treated?

Some possible treatments are:

• Elevating the site as much as possible to help reduce swelling.
• Apply a warm or cold compress (depending on the fluid) for 30 minutes every 2-3 hours to help reduce swelling and discomfort. After 24 hours, a warm compress may be applied.
• Medication-If recommended, medicine for infiltrations or extravasations is given as soon as possible for the best effect. In some cases, it may still be given several hours after the event with direction by your child’s care team.  
  

The most common medicine is hyaluronidase (Wydase®) and it is given in small amounts just under the skin.

What can I do to help prevent an infiltration/extravasation?

• Let your child’s health care team know if your child has had multiple attempts to place an IV in the past.
• If the IV dressing becomes loose, let the nurse know so it can be changed or appropriately reinforced.
• Be careful when moving your child to prevent the IV from being bumped, tugged, or dislodged.
• Do not allow your child to pull on the IV. Use distraction to take your child’s mind off of it. Ask Child Life for activities your child can do.
• If an immobilizer or soft tie is needed to help protect the IV site, leave it on.
• Keep IV site visible so the nurse can perform assessments every hour (for example, do not cover site with bedding when sleeping). If you are concerned that the IV site looks different or if your child is complaining of pain at the site, let the nurse know.

What else do I need to know?

Depending on the severity of the infiltration/extravasation, you may be instructed to monitor the affected area after discharge.

Call your clinic if the affected area is getting worse, such as:

• Increased swelling
• Blistering
• Skin opening up

Go to the Emergency Room right away if your child has any of the following:

• Temperature higher than 101.5° F
• Hand, arm, leg, or foot near the removed IV site changes color (blue-purple).
• Hand, arm, leg, or foot near the removed IV site changes temperature (becomes cold).
• Hand, arm, leg, or foot near the removed IV site becomes swollen and firm and cannot move fingers or toes.

Additional resources

Children’s Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. They are available during business hours for follow-up outpatient visits. Appointments can be scheduled by calling 651-220-6530.

Questions?

This information is not specific to your child, but provides general information. If you have questions, please call your provider or clinic.

Last reviewed 10/2023

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