Yes and no. An Intravenous or IV line can become dislodged from a vein in the absence of any negligence or error on the nurse’s part. However, any infiltrated IV line or misplaced catheter should be diagnosed right away to help minimize tissue, nerve or muscle damage. The longer IV fluids or medications are allowed to drip or infuse into the tissues of an arm or hand instead of the vein or bloodstream the more damage there will be. Depending on how fast the fluid was running, the type of fluid or medication that was running, and how long of a delay there was in diagnosing the infiltrated IV, it could lead to blisters, burns, nerve damage, muscle damage, compartment syndrome or even amputations.
An infiltration or extravasation injury occurs as a result of an accidental injection or leakage of fluid, blood products, lipids, total parenteral nutrition (TPN) chemotherapy drugs, antibiotics or other medications into the tissue surrounding the area of an IV injection site instead of in the vein or bloodstream. Not only is this doing damage to a patients hand or arm, the patient is also not receiving the correct dosage of medication, nutrition or fluids that could lead to other serious complications and even death. This is why it is so important that nurses are thorough and diligent when performing IV assessments and identify any malfunctioning, displaced or infiltrated IV line as soon as possible.
When it comes to IV therapy, doctors, anesthesiologists, IV teams and nurses have a duty to follow certain standards of care to protect patients, especially infants, from the injuries and damages that IV infiltration and extravasation incidents can cause. Many times, premature babies or sick infants will have IV lines not only in their arms but also in the scalp, feet or lower extremities. Any significant infiltrations in those areas could lead to very severe and permanent injuries. Some of the things nurses can do to help minimize or quickly identify IV infiltrations are:
- Choosing the correct catheter size for the patient and what needs to be infused
- Choosing the correct site for the size of catheter that is going to be used
- Following proper procedures for IV insertion
- Apply transparent dressing over IV site
- Do not cover the insertion site with gauze or anything else that obstructs the view
- Properly secure the IV catheter and tubing to arm or hand with additional tape
- Monitor the IV site as per protocol and check for blood return
- Check the IV site if the tubing or catheter was tugged on or got caught on or tangled up in sheets or blankets
- Check the IV site after a patient was moved from the bed, stretcher or chair
- Check the IV site when a patient returns back to the floor or their room after having a test or procedure performed
- Don’t just check that the fluid is running in, also check the site for coolness, swelling or changes in color
- Address any alarms that keep going off on the infusion pump
- If a patient is not receiving the proper infusion rate per hour, check out why.
- Check the IV for proper placement if the patient starts complaining of pain, burning or discomfort at the catheter site.
- Infants are unable to tell you their IV line hurts so you must be more alert for the signs of an IV infiltration in a premature baby, infant or newborn.
- When in doubt or if not sure if an IV line is still in the correct place, start a new IV line
- If the patient is a difficult stick, have a more experienced member of the healthcare team like an anesthesiologist, neonatologist, emergency room physician or IV team member start the IV line.
Pediatric hospitals, neonatal intensive care units (NICU’s) and other medical facilities measure the severity of IV infiltration injuries on a common scale of 0 to 4.
0 = No symptoms
1 = Skin blanched, edema < 1 inch in any direction, cool to touch, with or without pain
2 = Skin blanched, edema 1 to 6 inches in any direction, cool to touch, with or without pain
3 = Skin blanched, translucent; gross edema > 6 inches in any direction; cool to touch; mild to moderate pain; possible numbness
4 = Skin blanched, translucent; skin tight, leaking; skin discolored, bruised, swollen; gross edema > 6 inches in any direction; deep pitting tissue edema; circulatory impairment; moderate to severe pain; infiltration of any amount of blood product, irritant or vesicant. Scale 4 infiltration injuries are the most severe and can result in severe burns, skin grafts, nerve damage, long term scarring, disability and even loss of the affected limb.
Sometimes, an IV infiltration can lead to compartment syndrome that may require a fasciotomy to release the pressure away from the nerves, blood vessels and muscles.
The most severe type of IV Infiltration usually occurs when highly caustic medications known as vesicants infiltrate the tissues surrounding the IV site causing burns and tissue death or necrosis. Some of the more common vesicants are chemotherapy medications, Potassium, Dopamine, Nitroglycerin, TPN, Erythromycin, Gentamycin, and blood products. In some instances, an infiltrated medication can also be treated with an antidote medicine that is injected around the infiltrated fluid area to help stop or halt the damage that is occurring.
It is not only important for a nurse or doctor to keep a careful eye on any IV line, it is also extremely important that a patient tell their doctor or nurse if their IV line starts to hurt or burns. The faster an IV infiltration is noticed and treated, the better the outcome.
If you or your child had an IV infiltration that went undiagnosed or untreated and it led to severe or significant injuries, you may be eligible for compensation. Here at the nationally known Beasley medical malpractice law firm, we have on staff two physicians in addition to three nurses who were certified emergency room nurses and neonatal intensive care (NICU) nurses who have started and monitored IV lines on patients as small as a tiny premature baby to patients that were difficult sticks or who had very fragile or collapsed veins. Our collective knowledge assisted in obtaining two of the largest medical negligence verdicts in Pennsylvania history, $100 million and $55 million, and the largest punitive damage award against a physician in Pennsylvania, $15 million, as well as hundreds of other multimillion dollar judgments and settlements. Please feel free to contact one of our experienced IV infiltration lawyers, doctors or nurses at 1.888.823.5291 for a strictly confidential and free consultation.