IV infiltrate :(

classicdame, MSN, EdD · Oct 11, 2012

so sorry this happened. Now you understand why assessments are crucial. I bet you will be teaching new grads/students about it too. Don't beat yourself up though, as we have all had to learn some lessons "the hard way".

Peeker19 · Oct 11, 2012

OH yes I will be teaching all new grads and students for SURE!

We all have our stories that we pass on to the next generation of nurses and this is one of mine that I will hope that everyone will learn from and never happens to anyone else....I even told the patient about swelling at the IV site and she said she never felt it so don't be fooled that they will complain of pain or discomfort with an infiltration, cause it is just not true and does not always happen.

brownbook · Oct 11, 2012

I have had the same thing happen. Working night shift, not wanting or needing to turn on the bright overhead lights for every patient assessment or intervention. Knowing a good night sleep is as beneficial as some of the interventions we do.......but knowing the patient needs to be assessed and checked or they wouldn't need to be in a hospital.

There is no magic solution or answer. You will be more careful from no on.......but you probably won't have the time to turn on the over bed lights every two hours and closely check every patients IV site.

Carry a small flashlight pen with you. I bet for a few weeks, months, you will be closely checking your patients IV sites frequently.

A lot of it has to be your gut feeling, or a nagging feeling that "that IV just isn't running really well".......or......"does he have fat arms...or is that IV infiltrated....it just doesn't look right."

Even on the busiest nights you have to stop and listen to that gut feeling, turn on the bright overhead lights, wake up the patient and do a thorough assessment.

You will survive this guilt, you will get over it, you will be a better nurse for it.

Bad things will happen, be proud of yourself that at least you feel awful and guilty....some nurses wouldn't.

The patient didn't die......odds are good that once the swelling goes down all will be fine. In the old timey days IV infusions used to be intentionally given slowly into the muscle or fat....this was before my time...I have only heard of it.

imintrouble, BSN, RN · Oct 11, 2012

Cut yourself some slack.

Sometimes bad things happen even when you do everything right.

RNperdiem, RN · Oct 11, 2012

Hugs to you.

You are not alone with this type of story. A lot of us have been where you are now.

If you learn something from this and can use it in the future, try to do that.

Then forgive yourself and be strong.

sbostonRN · Oct 11, 2012

Big hugs I know how you feel...a similar thing happened to me, only the pt's family caught it and reported it. I felt terrible as you do. Be thankful it was NS and not Vanco! A hard lesson but a good one.

iluvivt, BSN, RN · Oct 12, 2012

The good things are that it was NS and in the forearm,with NS being isotonic it is much easier on the tissue and there is tissue in the FA as opposed to other sites such as a hand. As others have pointed out timely assessment are critical to perform. Make sure you know the date the PIV was inserted (potential of complications increase as dwell time increases),always compare to the other arm to aid in determining swelling,feel the site for coolness,pain or tenderness or induration. I have seen thousands of infiltrations/extravastions in my 31 yr career and most turn out OK and some need various interventions. The key here is to make it a learning experience for yourself. Yes you are correct providing infusion care to the bariatric patient can be very challenging to securing an access and then caring for it, Hang in there it will all be OK and I can guarantee it will not be your last infiltrate but hopefully you will catch the next one earlier.

*4!#6 · Oct 12, 2012

I have had so many IV's infiltrate on me it is unbelievable. All of them I caught early, (so far). I always feel the site, ask about pain, and watch for any frequent alarming of the pump. If it's a lock, when I flush I always observe for pain or leaking, or difficulty flushing. If I have any question I will flush again and feel the site, I will also try to check for blood return although there isn't always blood return on a working IV.

I think on obese patients it would be hard to see an infiltrate. Also it was only NS, so it was a good thing it wasn't a vesicant.

Bortaz, MSN, RN · Oct 13, 2012

At least you care that it happened. We had a baby in my NICU infiltrate, d10 w/ ca, burned his ankle to the bone, required wound care nurse for 2 weeks, leg was 4x the size of the opposite limb. IV was running at 3 ml/hr. How long was it out to cause that much swelling and damage? Hours, to be sure.

The nurse was definitely upset...upset that the charge nurse wrote it up and reported it to the neonatologist. Otherwise, she showed no concern for what had happened. She's a new nurse, too. We chart IV checks q1hr...I just wondered why no one did anything about those 12 hours of "patent, no swelling, no infiltration" she'd charted while that baby's meat was being burned away.

iluvivt, BSN, RN · Oct 13, 2012

Infiltration and extravasations are a whole other ball of wax on neonates and infants. The statue of limitations can also be longer so document carefully on these and make sure you know your institutions policies and procedures on these, The KEY here is always prevention especially with extravasations.

turnforthenurse, MSN, NP · Oct 13, 2012

I'm sorry this happened to you, but it is a good lesson learned. This is why frequent assessment is crucial...it's my hospital's policy to assess IV sites Q4Hs (for peds it's Q1H). Fortunately your patient had NS and it wasn't a vesicant!