IV Infiltrate

[dreamrider212]

I work in an infusion clinic setting with long runnning infusions such as Rituxan & IVIG. We had an incident where a pt had fallen asleep during her infusion and was covered with a blanket and several pillows, obscuring her IV site. She awoke shortly before her infusion finished and an infiltrate was observed to her right mid AC. I'm wondering if anyone else has had this problem with sleeping pts or have suggestions how to avoid in the future other than waking them up every 30 mins when titrating. Also, if you are unable to visualize an IV site, do you chart that?

[adventure_rn, MSN, NP]

I'm not an infusion nurse, so bear with me, but it seems like the most reliable (and sometimes only) way to know that an IV has infiltrated is to check the site; therefore, you have to risk waking up the patient bundled in a blanket cave. It's kind of like inpatient nursing: nurses try to be respectful of patients' sleep schedules, but you're in the hospital to receive medical treatment, not to sleep. I'm guessing that patients would also rather have their naps interrupted than have their IVs infiltrate.

In order to keep patients happy, I'd just try to clearly lay out that expectation before you begin, i.e. "Mr. Doe, I will need to check your site every 30 mins; we do this so that the IV medication doesn't damage your tissues if the IV becomes dislodged. You're welcome to sleep during the infusion, but it may be more comfortable for you if you leave your [iV-site-extremity] exposed; that way, I'll be less likely to wake you up when I check the site." If a patient is freezing and wants to be wrapped up in 47 blankets, maybe work out a system with that patient so that the site/extremity is covered by blankets that can easily be pulled up to check the site and then be replaced, rather than having them wrapped around that extremity.

No matter what, I definitely wouldn't chart that you checked the site if you didn't, but I also wouldn't want to chart that I hadn't checked an IV site in hours.