[SoccerMomNC]

I had my first infiltrate today. We were doing a cardiac CT, #18 g inserted in the right AC. Everything's going OK, gave 2 doses of Lopressor, denied pain at IV site. Then injected and his arm blew up like a balloon!! I thought I was going to throw up! He said that it started hurting with the test dose, but he didn't think it was unusual. We immediately applied warm compresses and elevated the arm. To make things worse, this is the spouse of a nurse.
Question: besides reminding pt to tell you if IV site hurts, what else could've been done to prevent this?

[BigDog]

We stand out with pt and feel the site when injecting test dose.amazingly pts tell us everything feels "fine" while their arm is puffing up.

[dianah]

It was easier to know about infiltrations with the old, ionic contrast agents, as the pts c/o IV site burning as soon as the contrast began infiltrating!! There is much less pain with the new nonionic, iso- and low-osmolar contrast agents, so we're left to rely on objective signs of infiltration rather than subjective. Watch and keep fingers on the site when injecting, and then when you must step out of the room for scanning, keep your eyes glued to that site! I'm sure you already do these things.

A thought: is the IV required to be placed in the AC? I have found lovely, straight, superficial veins (accessory cephalic, cepahlic and medial anti-brachial) on the inside of the forearm. The IV isn't disturbed when the pt's arm is bent, and it's easier to tell (except on pts with large forearm) if the IV is infiltrating (you can see it balloon up immediately). Also, some pts (especially men) have a large GARDEN HOSE basilic vein on the backside of the forearm (I called it my "stand on your head to hit it" vein because I had to often be a contortionist to cannulate it) that ROLLS a lot but if you can hit it, it's a nice big one (and not often used, so it doesn't get scarred).

[DutchgirlRN]

When starting the IV do you push at least 20cc NS quick flush? I have found this works very well to test if the IV will hold up to the power injector. It very often does cause the patient to get light-headed for about a minute. The patient doesn't get that same effect with the contrast because it is the same osmolarity as the blood.

[SoccerMomNC]

Thanks for you replies.
Our protocol (only for the heart CT) is an 18 g in the right AC if possible. If not the left is the next best choice. This does seem to be a problem, especially when your asking the pt to keep their arms above their head for the scan. I am thinking I may try to stick just below the AC so I can better monitor my site. Another thing we are doing is dimming the lights to decrease stimulation and HR. This makes it difficult to see the IV. I am going to suggest NOT dimming the lights or else I am using a flashlight to check my site!!
We flush the IV manually with 10 cc NS quickly after insertion to test it. BTW, the pt with the infiltrate said (afterward) that his IV hurt with the test bolus but he thought it was normal. He was pitching for a little league baseball game that same day
From now on, if the pt tells me that they have a MAJOR event/plans going on that day, I will use the non-dominant arm for the IV!!