Pediatric IV Infiltrate

WalkieTalkie, RN · Jan 29, 2009

The fluids will get absorbed by her body. I doubt there will be any permanent damage. I've had this happen a couple of times with fluids and within hours the site looks almost 100% better. Just be glad there weren't any meds in the IV, that's a whole different situation.

Daytonite, BSN, RN · Jan 29, 2009

i was an iv therapist for many years. when we put ivs into children of that age we often placed their hands on child sized styrofoam hand boards and used kerlix to hold them in place. a curious 2-year old will pull the iv out. we seldom unwrapped the iv. we would touch it lightly to see if there was pain. you can compare the two hands to see if the iv hand or arm looks enlarged. otherwise, we had plenty of kids whose ivs we eventually found infiltrated after unwrapping them. it is nothing to worry about unless the iv fluids infusing were something very irritating. just elevate the extremity and try to keep warm compresses on it. the iv fluid will absorb into the child's tissues and then the circulatory system and she should suffer no ill effects. i've never heard of anyone getting fired or suspended for something like this. they would have to have a pretty harsh manager writing them up to do that. when i was an iv therapist i can't tell you how many patient's ivs i changed daily for infiltrations and phlebitis. we would sit in our department office and wonder how some of the staff nurses missed these things. never heard of hardly anyone getting disciplined for this. never heard of any patients suffering any ill effects either. i can only remember one case of a patient getting a severe artery infection after an arterial line went bad. doctors inserted and dressed the arterial line, not the nurses.

azxyrn · Jan 29, 2009

Infiltrations occur all the time, although I won't condone you not checking the site per protocol, as the prior post states the fluids will be absorbed and within a small matter of time. Back in the day, subcutaneous hydration aka hypodermoclysis/CSCI, (essentially the same thing as an infiltration), was used with great result for rehydration. Ultimately I think that from the way you feel about the situation shows that you are guilty of being a caring and compassionate person who's empathy towards your patients speaks highly of your character and morals. In regards to your situation, I have only seen a written or verbal disciplinary action towards nurses who forget to monitor the site and cause injury. So my best advice is relax, and try to not let this happens again. The family of your patient is probably happy that you resolved the issue upon being notified of the situation....

Cheers :smokin:

perfectbluebuildings, BSN, RN · Jan 29, 2009

IV infiltrates can happen fast in small children too, with running IVF, so it is likely it would have happened even if you had been checking every hour. I had a patient I was checking her IV at least every two hours per protocol, was OK, soft, flushing well; then one check her whole foot & calf (it was a saphenous vein) was hard & edematous, just from 30 cc/hr of fluid. I felt absolutely horrible. Warm, moist heat helps the fluid re-absorb more quickly, like wrapping the site in a warm wet washcloth. It looks so dramatic, but resolves with usually no lasting effects; it is a good idea to tell the patient's parents that too. It is so important to check the IV sites often on little ones, because even as often as you check it sometimes they will infiltrate so fast; I never forgot after that patient and I am sure you never will either!!

And also double-check the pressures on your pump- I have come in sometimes and see pumps set up to 300 or more (our policy is to set at 100), and the IV has been beeping all shift but just kept resetting/increasing the pressures, and of course it is now infiltrated; or sometimes there are pumps that malfunction.

Good luck... you sound like a caring nurse and I doubt this is going to result in a big disciplinary action- maybe just an incident report, but that happens to all of us!!

tryingtohaveitall · Jan 29, 2009

It stinks that this happened, use it at a learning experience and try not to berate yourself. It is difficult when you're taking care of a fussy child who just went to sleep, but still, there are things that can't be ignored. Our policy (pediatric facility) is to check IV sites hourly. This is important because it's true that 30 or 40ml in a child can cause a decent infiltrate, going a few hours makes it very bad. Thankfully (as others have said) there were no medications infusing. That is the saving grace in this. I'm sure she'll be fine given from what you've said.

Just curious, what is your hospital's policy for checking sites? What was documented?

queenjean · Jan 29, 2009

Do your pumps have a pediatric setting? If so, make sure you use this all the time. If not; maybe this is something your hospital needs to invest in.

So, what have you learned? Will it happen again? Will you let an IV go more than an hour on a child without checking it?

Unfortunately, in our profession, when we make a mistake, it can harm someone. You got lucky. I've gotten lucky before, too. Now you have a decision to make. Will you learn from this mistake? Or will you just beat yourself up over this, and never move forward?

I completely mis-programmed a PCA pump, and the nurse who double checked it didn't do so thoroughly. I got lucky, in that the person I overdosed was a drug seeker and had such a high tolerance, it didn't even phase her. For a day or two, I wasn't sure I could go back to work. Ever. And then I just decided--everyone makes mistakes. I can either learn from it, or I can go to work at a coffee shop. I will never.ever. program a pump while distracted, and I will always double check someone else's pump extremely carefully.

Evaluate what you did wrong, what you can improve, and become a better nurse. This is what it means to be an experienced nurse.

cchsmp1999 · Jan 30, 2009

I have definitely learned from this experience, and will never forget it. I would never make this mistake again and things like this stay with you forever and I hope I am given another chance to prove myself as a caring nurse.

Thank you for all your responses, I really appreciate it.

newpedrn · May 4, 2009

Hi, a similar incident happened to me a couple nights ago. A 14month-old with D5 1/2NS running at 50ml/hr d/t dehydration. The pt was extremely anxious with staff and had a hard time falling asleep. I was able to do my hourly PIV assessment before she fell asleep. However, after she fell asleep, the mother asked me not to disturb her from sleeping. I was only able to touch and feel the PIV through the diaper. (Her PIV was covered w/ diaper to prevent her from ripping it out) A couple hours later, I found her whole arm swollen. I kept her arm elevated then asked the resident to examine her. I was terrified!! I even asked every single nurse that was working to assess her. Everyone told me it is fine and the swelling will go down eventually. Later, I found out that her arm got all blistered and had to be transferred to a burn center in another hospital. Although I heard that she was discharged now, I still feel terrible of what had happened.

I would like to ask what kind of damages could happen with IV infiltrate like this? Has anyone seen anything similar to this? Will I loose my license from a bad IV infiltrate? Please help!!

tryingtohaveitall · May 4, 2009

Ugh, I'm so sorry this happened, to you and to her. Most infiltrates that are only from MIVF do fine, it's usually the ones with medications that turn really ugly. I think we've all let an IV go an hour or two without checking it extremely well in a case like this, but I never let them go any longer for reasons such as this. Unfortunately, now you have the voice of experience to explain to a mother what can happen if you don't do a good assessment.

I'm not sure how long you've been a pedi nurse. With time, you can get pretty good at slipping down a siderail quietly and gently doing an assessment without waking a toddler. I know, not always, but usually once they're so worn out and fall asleep, they'll stay that way. We also keep flashlights at every bedside, for neuro checks but they also come in very handy when you're trying not to wake an irritable child and mom.

Again, sorry this happened and I hope you both come out ok from this. (hugs)

edited for funny typo (taking a toddler vs. waking a toddler)

msmcrn · Sep 1, 2009

this just happened to me last night/this morning. i had been running D5W 1/2 NS + 20meq of KCl over 6 hrs while she was NPO. we found that the IV was badly infiltrated after i had started vanco, just half of the dose went in. i keep thinking about the pt and whether or not she's ok, pr if the affected extremity is ok. i had to take her to the OR, for a scheduled procedure, right after we found the infiltrate, so i feel like i couldn't follow up on what happened. i just put warm packs on the site and sent her away. i keep praying she's ok.

IVRUS, BSN, RN · Sep 1, 2009

this just happened to me last night/this morning. i had been running D5W 1/2 NS + 20meq of KCl over 6 hrs while she was NPO. we found that the IV was badly infiltrated after i had started vanco, just half of the dose went in. i keep thinking about the pt and whether or not she's ok, pr if the affected extremity is ok. i had to take her to the OR, for a scheduled procedure, right after we found the infiltrate, so i feel like i couldn't follow up on what happened. i just put warm packs on the site and sent her away. i keep praying she's ok.

As an FYI,

If she had a Vanco infiltrate, use ice to site, instead of warmth.

Vancomycin is a Vesicant with a pH of 2.5-4.5. It should ideally never be given peripherally, but in some cases, it is. Warmth should be used for infiltrates of isotonic solutions and for Vinca-Alkaloids.

Ice (to prevent further uptake of the damaging drug to the tissues) should be placed in all other cases.

Pt's with vesicant extravasations have needed to receive skin grafts because of tissue necrosis.

I pray that in this case, it was a small amt that extravasated, though you did say that 1/2 of the drug infused.

Was this a 250cc bag?

I would always alert the MD to this kind of situation and monitor, monitor, monitor.