Infusions Nurses Society (INS) definitions:
Infiltration: Inadvertent administration of a non-vesicant solution or medication into surrounding tissue; rated by a standard tool or definition.
Extravasation: Inadvertent infiltration of vesicant solution or medication into surrounding tissue; rated by a standard tool or definition.
Vesicant: An agent capable of causing tissue damage when it escapes from the intended vascular pathway into surrounding tissue.
Phlebitis: Inflammation of a vein; may be accompanied by pain/tenderness, erythema, edema, purulence, and/or palpable venous cord; rated by a standard scale or definition.
Thrombophlebitis: Inflammation of the vein in conjunction with formation of a blood clot (thrombus).
Infiltration and extravasation are both common complications that results in fluids and/or medications inadvertently being infused into the surrounding tissues of a vessel in which a vascular access device is located. These complications can occur when:
- A catheter is not inserted correctly into the vein, or the vein has damage.
- The lining of the vein had been damaged and swells, preventing the infusate from flowing forward; instead, the infusions stop or leaks out the surrounding tissue.
- A clot forms within the vein or around the cannula, causing infusate to seep into surrounding tissue or the vein to tear and infusate to leak out. Phlebitis or thrombophlebitis can also result.
- The cannula punctures or erodes through the opposite wall of the vein. This can also be accompanied by phlebitis or thrombophlebitis.
- The catheter was pulled out of the vein during patient movement or because there was not an adequate length of catheter in the vein.
Most infiltrations do not cause serious tissue damage, but it can be uncomfortable for a patient. Infiltration may occur if an IV is improperly placed, piercing through a vein, or if it is placed in an improper location where a patient flexes or moves regularly, which may dislodge the IV from its original location. A patient with infiltration may experience symptoms such as redness, swelling and discomfort around the site.
The most serious complications occur with extravasation of highly irritating solutions. Extravasation of a vesicant can cause tissue necrosis and damage. Common symptoms and signs of extravasation include pain, stinging or burning sensations, and edema around the intravenous (IV) injection site. In some severe cases, it may cause tissue dysfunction or physical defects. Some examples of therapies that are vesicants include: chemotherapy, high osmolarity medication, 50% dextrose, calcium chloride, dopamine, phenytoin, etc.
The risks of both complications can be reduced through careful selection of the most appropriate vascular access device, insertion site, and through establishment of VAD patency prior to and during infusion therapy. The extent of injury from infiltration and extravasation depends on how quickly staff intervenes and how much fluid leaks into tissues. By detecting and treating infiltrations and extravasations early, a trained staff may prevent nerve damage and tissue sloughing.
The Infusion Nurses Society Practice Recommendations for Infiltration and Extravasation:
- Select the most appropriate VAD and insertion site to reduce the risk of infiltration/extravasation.
- Recognize the difference among vesicant, non-vesicant, irritant solutions, and medications. Each organization should be consensus on what medication is vesicant and irritant based on their internal formularies.
- Evaluate the presence of factors associated with infiltration/extravasation. In the presence of factors that may cause or increase the risk of infiltration/extravasation, increase the frequency of monitoring, and consider alternative vascular access options.
- Identifying patient specific factors associated with an increased risk of infiltration and extravasation including but are not limited to:
- Patients who have altered sensation around the VAD and/or who have difficulty communicating the onset of pain, tightness, or other discomfort.
- Patients with altered mental status or cognition.
- Age-related changes to vasculature, skin, and subcutaneous tissue.
- Diseases that produce changes in vasculature or impaired circulation.
- Difficulty with peripheral venous access related to history of multiple venipunctures and obesity.
- Access the risk of mechanical causes of infiltration/extravasation, which include: catheter placement in an area of flexion; catheter size; insertion technique and inserter experience; improper needle placement/needle dislodgement of an implanted vascular access port; partial dislodgement of VAD, including 1 or more lumen exit sites of a multi-lumen, staggered tip CVAD; inadequate securement; normal body movement; vein thrombosis or stenosis proximal to the insertion site and tip location, limiting blood flow.
- Limit the extent of injury through early detection of signs and symptoms of infiltration/extravasation.
Immediately stop the infusion upon identification of infiltration/extravasation injury and initiate appropriate intervention.
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Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice. J Infus Nurs. 2021;44(suppl 1):S1S2-S224. Doi:10.1097/NAN.0000000000000396
Moureau, N. L. (2019). Vessel health and preservation: The right approach for vascular access. Springer International Publishing.
Rosenthal, Kelli RN, BC, ANP, APRN, BC, CRNI, MS Reducing the risks of infiltration and extravasation, Nursing: Fall 2007 – Volume 37 – Issue – p 4,6-8