Infiltrated IV lead to infection?

[allthesmallthings]

When one of my patient's IV's infiltrated, another nurse said I should pull it out IMMEDIATELY before it got infected. I don't really understand that; the cannula is still sterile, right? How's it going to get infected? Besides, before an IV infiltrates, a little bit of that same sterile cannula is still inside the tissue between the actual skin puncture and the vein puncture, so how does it make a big difference in infection risk if the whole cannula is in the tissue?

[Jolie, BSN]

Will removing the infiltrated IV 10 minutes sooner greatly lessen the risk of infection at the infiltration site? Probably not, but it is still the best practice and the right thing to do for everal reasons:

1. As another poster correctly pointed out, the minute the IV catheter touched the patient's skin, it's sterility was lost. It is inevitible that some skin contaminants were introduced into the patient's vein at the time of insertion and that others have ascended the catheter during the time it's been in place. The longer it remains in place, the greater the risk of infection, especially that you now have added tissue injury to the mix. All invasive procedures (even something as routine as IV insertion carried out with good technique) place the patient at risk for infection. A basic principle of infection control calls for invasive measures to be discontinued as soon as is prudent to minimize infection risk. As soon as an IV is un-usable, it needs to come out. Look at it from a risk-benefit perspective. It has no benefit to the patient, only risk. How do you succesfully defend that decison in court? You don't, because you can't.

2. Leaving an old IV in place while starting a new one is unnecessarily uncomfortable for the patient. Have you ever had both hands/arms tied up with IVs? Even temporarily, this is unsettling for a patient, who has impaired use of both extremities, instead of just one.

3. The IV needs to be removed promptly for safety reasons (other than infection control). It is entirely possible that you may be called away from the patient's bedside before you get the new IV started and the fluids transferred over. Someone else may come in the room and think that the fluids have been inadvertently turned off, and re-start them, resulting in additional pain and tissue injury for the patient. Not every patient is able to speak up and explain why a pump at the bedside is not running. You may also forget to remove it even after the new IV is in place. Think I'm kidding? I've seem far stranger things happen.

I realize it seems like no big deal, and in a perfect world without distractions, it probably isn't. But the risk-benefit ratio sums up why it is necessary to remove it immediately.

[Zookeeper3]

i'm not talking about some drug; the fluid was ns. besides, even if it were a tissue-damaging drug, wouldn't turning off the iv be the thing that actually helps/makes a difference, not actually the action of removing the iv? the drug would still be in the tissue, whether or not the iv had been pulled; obviously, if something's infiltrated, you're going to stop flow.

i'm asking how the cannula itself, not the drug, could be immediately harmful; is there actually any reason for me to immediately pull the cannula, as this nurse said, rather than ten minutes later, after i've put in a new iv?

ah i got you, if it was a vessicant, usual policy is to aspirate and pull out the cath as it is "presumed" to possibly have some meds left in it.

i think your irritated from being called out on doing one before the other. honestly and many will disagree with me, a few minutes doesn't matter unless the patient is complaining about it... if they are uncomfortable, i'd put their discomfort first and pull it.

now, if they are on blood pressure meds and i need an iv stat or they will crash... i'll deal with the bad iv in a bit, it's not my priority... same as a basic infiltrate i may or may not have left it while another was established.

there may be some underlying issues your having with this person? if not, then don't sweat it, there are 10 ways to skin the cat... all ten can be right as long as policy is followed. you may have one of those hospitals where the iv policy says "pull the cannula stat". when in rome....

[talaxandra]

3. The IV needs to be removed promptly for safety reasons (other than infection control). It is entirely possible that you may be called away from the patient's bedside before you get the new IV started and the fluids transferred over. Someone else may come in the room and think that the fluids have been inadvertently turned off, and re-start them, resulting in additional pain and tissue injury for the patient. Not every patient is able to speak up and explain why a pump at the bedside is not running. You may also forget to remove it even after the new IV is in place. Think I'm kidding? I've seem far stranger things happen.

I realize it seems like no big deal, and in a perfect world without distractions, it probably isn't. But the risk-benefit ratio sums up why it is necessary to remove it immediately.

I couldn't agree more. Even in ten minutes makes no appreciable clinical difference to infection or localised phlebitis, there's no reason to leave it in and every reason to remove it immediately. Plus patients always feel reassured by prompt action, and happy patients are less litigious patients.