iv infiltration help

I would wonder how soon after the line is placed, do you find infiltration? If it is soon afterwards, I would chalk that up to unsuccessful line placement, but if it is days later, then I would wonder where the actual IV catheter was placed. Placing the IV catheter in an area of flexion will increase infiltration risks as the child will not know, or care to keep the arm/wrist still to prevent damage to the vein.

My other question is: What are you infusing through the line? Chemical irritation to the vein will break the vessel down and allow the medication to permeate into the SQ tissue. I'd make sure that I did NOT have extremes in the drug's pH or Osmolarity.

Infiltrates to my knowledge are treated with a warm compress and then re-inserted. Of course there are certain drugs that are infused that you do not do in smaller arm veins and require a larger vein and it normally stated on the MAR. But always check on your own if the medication is suitable for hand/lower arm veins. Like certain aggressive antibiotics, or chemo drugs.

Infiltrates to my knowledge are treated with a warm compress and then re-inserted. Of course there are certain drugs that are infused that you do not do in smaller arm veins and require a larger vein and it normally stated on the MAR. But always check on your own if the medication is suitable for hand/lower arm veins. Like certain aggressive antibiotics, or chemo drugs.

I would have to disagree with your statement that infitrations are treated with heat or warm compresses. Heat is the agent of choice for infiltrations/extravasations of isotonic and vinca-alkaloids... but if the medication that is in the tissue is not under either catagory, then ice ideally is used.

I think in pediatrics, infiltrates are sometimes not "caught" as quickly as they could be.

Some complicating factors:

-In peds, you dont automatically change IV sites every few days. You generally use the IV until it stops working or they dont need an IV -anymore. (Infiltrates are often the end point of the IV no longer working.) So if most PIVs end with complications, the best we can do is to catch these complications EARLY.

-Young kids and babies often dont know the difference or cannot tell you the difference between the discomfort of a good IV being flushed with saline (or a med that burns slightly), and flushing an infiltrated IV.

-Squishy baby arms and legs can make it tough to tell if there is swelling or if it is just compression due to how the IV is taped.

If the nurse flushes an IV and the baby cries....is it the beginning of an infiltrate or is it just the baby not liking their arm being messed with, or how the cool fluid feels being flushed in? Sometimes nurses tend to not think its an infiltrate until there is obvious swelling, when it actually had starting infiltrating much sooner. Better safe than sorry - if you think its starting to infiltrate, start working on getting other access so that you can take the questionable IV out. Don't just leave it shift and shift because you dont want to risk taking out a good IV. Infiltrates can be much worse than the harm of removing an IV that wasnt actually bad. Swelling is a LATE sign.

We use the TLC method of IV assessment: Touch - should be warm, soft, and pain-free, Look - should be dry and have no redness, Compare - No swelling and same size as opposite extremity. Swelling isn't always where you think it will be, either. Look at the underside of the limb, or the dependent area.

At our hospital, we particularly emphasize comparing the limb with the IV to the opposite extremity....the comparison can make it easier to appreciate swelling that may not have been obvious otherwise. Remove tape if it seems to be the cause of a swollen appearance and see if it resolves. We also emphasize flushing PIVs a minimum of once a shift. In a baby, flushing the IV should NOT cause screaming and crying. If it does, that IV needs to come out. Not all nurses realize this, and just assume that the baby is fussy. Personally, I always hook my flush up to the IV, and then leave it alone for a minute or two until the baby is distracted, and then flush (so that I am sure that if the baby cries, it is not related to me touching them).

Correct taping can make identifying an infiltrate easier as well. If the arm is bandaged so completely that you cant see, then how will you know?! Stabilizing the catheter well is also good practice (of course), but can take some practice in small wiggly people.

Some articles that came up during a quick google search:

Improving Detection of IV Infiltrates in Neonates -- Driscoll, MD et al. 4 (1) -- BMJ Quality Improvement Reports

NEONATAL PIV INFILTRATES | ALL THINGS NICU

http://www.fda.gov/MedicalDevices/Safety/MedSunMedicalProductSafetyNetwork/ucm206357.htm

wow great feedback!