Had a 2yr old patient today who was ordered IV fluid bolus, commenced infusion, with 20mins his hand got very puffy so I stopped the infusion and notified the doc who was happy fir me to turn the rate down. An hour later puffness disappeared so I recommenced the fluid with a much lower rate, been alright for seveal hours, however when these was about 30mls of fluid left pt's mom told me the puffness reappeared, I had a look and it wasn't as bad as before, so I turned the rate further down.
When the next nurse came she said the hand is puffy so I'm just gonna stop and see if theses any blood return.
I felt extremely guilty once I heard what she said because I always assumed slight puffness is not a main concerns if 1. pt not complaing and no signs of inflammation, 2. not giving any meds but only infusing 0.9% normal saline....
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
Puffiness is always a first sign of infiltration and with kids they can't tell you so you have to be super vigilant about checking IV sites with them. Next time, try drawing back with a syringe to check for blood return as confirmation the cannula is in the vein. An infiltrated IV can still flush in to the surrounding tissue so that's not always a good indicator. If infiltrated next time, remove the IV and apply a hot pack to help with swelling.
With all due respect and for the sake of technicality, kids absolutely can tell you although it may not always be directly. At the age that this OP mentioned a 2 year old likely won't verbalize that his hand is hurting, but on top of the obvious swelling there may have been increased fussiness, HR, etc. Another thing to consider is that the cannula can be partially in the vein and partially out so even if you get some blood return that is not a guarantee especially when there are other concerning signs such as swelling. And immediate IV removal folllowed by a heat pack can sometimes do more damage depending on the infusing medidcation.
To the OP, as another post stated, when in doubt pull it out. Another thing for future assessments is to employ the "T-L-C" method of touching both the IV extremity and the unaffected extremity, looking at both, and comparing both. It is also important to remember to not just look at the entry site, but the entire extremity - for instance the IV may be in the top of the hand but the fluid from an infiltrate might be gathering on the bottom/palm of the hand. Like others have mentioned, we have all made similar mistakes and you can take it as a learning experience and grow.
JadedCPN, BSN, RN
1,476 Posts
With all due respect and for the sake of technicality, kids absolutely can tell you although it may not always be directly. At the age that this OP mentioned a 2 year old likely won't verbalize that his hand is hurting, but on top of the obvious swelling there may have been increased fussiness, HR, etc. Another thing to consider is that the cannula can be partially in the vein and partially out so even if you get some blood return that is not a guarantee especially when there are other concerning signs such as swelling. And immediate IV removal folllowed by a heat pack can sometimes do more damage depending on the infusing medidcation.
To the OP, as another post stated, when in doubt pull it out. Another thing for future assessments is to employ the "T-L-C" method of touching both the IV extremity and the unaffected extremity, looking at both, and comparing both. It is also important to remember to not just look at the entry site, but the entire extremity - for instance the IV may be in the top of the hand but the fluid from an infiltrate might be gathering on the bottom/palm of the hand. Like others have mentioned, we have all made similar mistakes and you can take it as a learning experience and grow.