Pediatric IV infiltrate

[bronxgirl1]

Hi, I am new at this but not new at nursing. I had an infant patient, who I had cared for who experience an moderate IV infiltrate. It was the end of shift and report was given. I clocked out, and then afterwards the oncoming nurse, called me back into the room as I was leaving to have me check the infiltrate. I stated that was not good, and informed this nurse that IV was checked every hr, but knowing what I have read these things can happen very quickly especially if what is infusing is a vesicant. I looked at the arm after she removed everything and the arm was pretty swollen and pink. I think paged the provider to take a look asap. In the meantime, the oncoming nurse called the charge nurse and stated this patient needed a medication that starts with an H. Deep down in my heart, I know I continuously checked this IV, and no hard skin or swelling noted. I was called about this incident, and told what could possibly happen. Definitely worked too hard for my license to have it taken away. Please advise. Thanks

[Lnr567]

I would recommend filing your own incident report in your own words. Explain everything just as you did to us. Do it sooner rather than later and be as thorough as possible.

[brownbook]

Pediatric, (and adult) IV's infiltrate frequently. No nurse looses her license over an infiltrated IV. When the pedi patient is chubby, when the IV is wrapped, covered up, with a lot of gauze or whatever you use, it can infiltrate and not be caught.

It has happened to me, it has happened to many pediatric nurses. Don't go into a panic. You're a good nurse. Sure you'll feel bad, but you will learn from this. But it may happen again for the reasons I listed.

YOU WILL NOT LOSE YOUR LICENSE!

[~PedsRN~, BSN, RN]

These things happen, and baby IV's infiltrate FAST. It doesn't take much. I have had a few that have been embarrassingly bad. It just is what it is. Definitely fill out your incident report, but honestly - these things happen.

[brownbook]

Hay....... I know its loses......stupid computer can't spell! Or doesn't know basic grammar!

[VANurse2010]

Infiltration is a complication of IV therapy, not a sign of negligence.

[iluvivt, BSN, RN]

Infiltration is a complication of IV therapy, not a sign of negligence. ...NOT Exactly

Sorry I am going to disagree and there are many many lawsuits filed that support this......a nurse can indeed be found negligent if an IV infiltration or extravasation leads to a complication that causes a permanent loss or damage to a patient. The key here is prevention. A nurse needs to do everything possible to prevent the potential injury and minimize the delay in detecting the complication. These complications can include compartment syndrome, nerve damage, tissue damage or necrosis that can lead to pain permanent injury, functional losses even loss of limb. So absolutely you can be sued for failure to provide the standard of care in regards to pediatric IV therapy, failure to follow the protocols in place, failure to recognize the complication early and report it and failure to treat it appropriately. But there is hope and that hope is with acquiring the knowledge and skills needed to prevent and minimize the problem.

[VANurse2010]

Infiltration is a complication of IV therapy, not a sign of negligence. ...NOT Exactly

Sorry I am going to disagree and there are many many lawsuits filed that support this......a nurse can indeed be found negligent if an IV infiltration or extravasation leads to a complication that causes a permanent loss or damage to a patient. The key here is prevention. A nurse needs to do everything possible to prevent the potential injury and minimize the delay in detecting the complication. These complications can include compartment syndrome, nerve damage, tissue damage or necrosis that can lead to pain permanent injury, functional losses even loss of limb. So absolutely you can be sued for failure to provide the standard of care in regards to pediatric IV therapy, failure to follow the protocols in place, failure to recognize the complication early and report it and failure to treat it appropriately. But there is hope and that hope is with acquiring the knowledge and skills needed to prevent and minimize the problem.

In other words, common sense nursing assessment and due diligence - not a revelation to anyone competent.

[iluvivt, BSN, RN]

May I ask what were you infusing? The medication they probably were going to administer is called Hyaluronidase . Several brands are available such as Vitrase and Hylenex, Hyaluronidase is an enzyme that breaks down Hyaluronic acid. This acid keeps the cells together. When this antidote is administered it breaks down the glue that holds the tissue together and the offending agent gets spread out and it also exposes the offending agent (the vesicant or drug) to an increased blood supply to take up the medication. It is given Subcut in multiple injections at and around the site of extravasation or infiltration. It is critical that you know what the difference between and infiltration and extravasation is and that you know what IV medications and solutions have the potential to cause tissue damage and necrosis. Once you know this you can be hyper-vigilant in not only monitoring these sites but you can make the best decisions on the administration of these agents. Take for example Calcium Chloride,you would NEVER want to give this peripherally when you have a central access. I have seen this happen so many times as the nurse did not know it was a vesicant as is IV contrast with the ionic type being more so! Hyaluronidase is also the antidote you would use for a Calcium Chloride and I recently treated 2 patients with this and one did have a central line and the nurse chose the peripheral route...oops...not a good choice because she simply did not not know or look up what she was administering. I am going to post a few tips on assessing pediatric IV sites if you are interested..are you?

[IVRUS, BSN, RN]

May I ask what were you infusing? The medication they probably were going to administer is called Hyaluronidase . Several brands are available such as Vitrase and Hylenex, Hyaluronidase is an enzyme that breaks down Hyaluronic acid. This acid keeps the cells together. When this antidote is administered it breaks down the glue that holds the tissue together and the offending agent gets spread out and it also exposes the offending agent (the vesicant or drug) to an increased blood supply to take up the medication. It is given Subcut in multiple injections at and around the site of extravasation or infiltration. It is critical that you know what the difference between and infiltration and extravasation is and that you know what IV medications and solutions have the potential to cause tissue damage and necrosis. Once you know this you can be hyper-vigilant in not only monitoring these sites but you can make the best decisions on the administration of these agents. Take for example Calcium Chloride,you would NEVER want to give this peripherally when you have a central access. I have seen this happen so many times as the nurse did not know it was a vesicant as is IV contrast with the ionic type being more so! Hyaluronidase is also the antidote you would use for a Calcium Chloride and I recently treated 2 patients with this and one did have a central line and the nurse chose the peripheral route...oops...not a good choice because she simply did not not know or look up what she was administering. I am going to post a few tips on assessing pediatric IV sites if you are interested..are you?

Iluvivt, you are always such a wealth of information. TY and you are so right on with this reply. May I also add to this info, that when one has an extravasation, it may not readily show the damaging effects on day one, two or even, three. Sometimes this may be a continuing event/incident in which you must assess the site on an ongoing basis for tissue blistering, sloughing and the eventual necrosis. Though it may be rare, sometimes this doesn't come to fruition for two or three weeks later. SO, just seeing the swelling recede is not an indicator that the patient is "out of the woods".

[iluvivt, BSN, RN]

Yes that is correct that the damage may not be apparent or evident for quite awhile and it can even occur even if it has been treated but of course the chances are reduced. There are certain locations, such as the hand with very little tissue and a lot of tendons, and skin types that lend themselves to a higher chance of injury and functional losses. Not only is prevention and early intervention important it is also essential that patients with these types of occurrences are taught that injury may still occur and they need to seek treatment and that needs to be documented in the medical record. I see this piece left out all the time. I always feel bad for the nurse (those caring wonderful creatures) that want fast reassurance that all will be OK and no permanent damage will occur and then I must tell them the facts. I then tell them that what we can do and what they need to add to their knowledge base.