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Infiltration and extravasation care

Peripheral IV infiltration and extravasation

What is a peripheral intravenous (IV) device? A peripheral IV is a catheter (a very thin, flexible tube) that is inserted into a small vein in the arm, hand, 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.

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
  • Swelling
  • Blanching (lighter skin around the IV site)
  • Pain or tenderness
  • IV not flushing
  • Cool skin temperature around the IV 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 baseline

How is it treated?

Some possible treatments are:

  • Elevate 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.
  • Medication- If recommended, medicine for extravasations must be given within 24 hours to be most effective. The sooner it is given, the better it will work.

The most common medicine is hyaluronidase (Wydase®). It is given in small amounts just under the skin using very small needles. Numbing creams, such as EMLA or LMX, cannot be used because they prevent it from being absorbed properly.

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

  • If another IV is placed, 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 bedding off of the IV site.
  • If you are concerned that the IV might not be working, let the nurse

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 you have any of the following:

  • Your child develops a temperature higher than 101.5° F
  • Change in skin color (blue-purple) in the area away from IV site
  • Change in skin temperature (cold) in the area away from IV site
  • IV site in hand or arm becomes swollen and firm, cannot move fingers
  • IV site in foot becomes swollen and firm, cannot move toes

Additional resources

Children’s Skin Integrity 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 doctor or clinic.

Last reviewed 4/2016

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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