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Discussion

Paediatric IV infiltration :(

Last night I was infusing IV Ceftriaxone into my 10 month old patient's hand. It flushed fine, I connected the IV, wrapped the cannula back up with a crepe bandage and set the 50ml infusion to run over 30 minutes. 20 minutes later she was screaming and crying and wouldn't settle at all so I stopped the infusion, checked the site, and found that the IV had infiltrated. Her hand was swollen about 2x the size of her other one. I got the charge nurse and one of the doctors to come and check her over, we took the cannula out, and I monitored her hand for the rest of the shift. The swelling went down significantly, she was using the hand well, it was warm and well perfused and didn't seem to be hurting her, but I still can't stop thinking about it!! I've been a paediatric nurse for a year now and this has never happened to me before, which is why I think I'm worrying so much. I went for my break and had to go back early because I just couldn't relax and I stupidly started googling all the awful things that can happen to an infiltrated IV. I texted the nurse looking after her today and she said the doctors aren't concerned, and that the child's hand is less swollen than it was this morning but it's still quite puffy compared to the other. How long does swelling of this nature typically take to go down? And, as a nurse, do you ever stop constantly worrying about every single thing that you've done on your shift?!

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    I've just realised I've probably posted this in the wrong thread, so sorry if that's the case!

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    It sounds like you handled everything perfectly. You will stop obsessing eventually.

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    All I'm shocked about is that this is the first time it's happened to you. Ped's patients with their fat chubby little hands make it very hard to catch infiltrates. Plus that the IV site is usually wrapped with opaque dressings or tape.

    Sure you feel bad, tell yourself you are a good nurse for feeling badly about this. Many nurses would be nonchalant or put the blame on the patient, they kept picking at the site, or the nurse on the previous shift!

    So now that you accept the "blame" let it go! You'll be more careful now, but let it go and move on!

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    Good news is that antibiotic doesn't tend to extravate the tissue like vancomycin would, so the damage shouldn't be permanent. It can take a couple days for it to go down, for an extravasion with cef, a warm compress would be good (use cold for caustic drugs and if something like dopamine extravated). It happens to everyone; the biggie is making sure it flushes like a hose before using it, which you did. It happens to all of us and it sounds like she will be just fine!

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