Infiltration and extravasation.

Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. Consequences range from local irritation to amputation. While immediate action using appropriate measures (ie, dilution, extraction, antidotes, and supportive treatments) can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures. However, timely surgical intervention, when necessary, can prevent more serious adverse outcomes. Clinicians should be prepared to act promptly when an event occurs. Thorough incident documentation helps determine whether infusion care meets the standard of practice and is a keystone to medicolegal defense. Author Affiliations: Vascular Access Specialist and Neonatal/Pediatric PICC Nurse, Cincinnati Children’s Hospital, Cincinnati, Ohio (Ms Doellman); President, Lynn Hadaway Associates, Inc, Milner, Georgia (Ms Hadaway); Vascular Access Specialist, University of Louisville Hospital, Louisville, Kentucky (Ms Bowe-Geddes); CPHQ Director, Clinical Services Group, Hospital Corporation of America, Nashville, Tennessee (Ms Franklin); General Surgeon, Greater Baltimore Medical Center, Baltimore, Maryland (Dr LeDonne); Clinical Nurse Manager, Vascular Access Service, University of Michigan Health Systems, Ann Arbor (Ms Papke-O’Donnell); Vascular Access Specialist, Neonatal Nurse Practitioner, Doctors Medical Center, Modesto, California (Ms Pettit); Oncology Consultant, River Ridge, Louisiana (Ms Schulmeister); and Vice President, Operations East, Critical Homecare Solutions, Conshohocken, Pennsylvania (Dr Stranz). Editorial support was provided by Barbara Joan Goldman, RPh, of Advogent, and funded by Baxter Healthcare Corporation. Corresponding Author: Darcy Doellman, BSN, RN, CRNI, Cincinnati Children’s Hospital, 3333 Burnet Ave, Cincinnati, OH 45229 ([email protected]). I nfiltration—the inadvertent leakage of a nonvesicant solution into surrounding tissue—and extravasation—the inadvertent leakage of a vesicant solution into surrounding tissue—are both known risks of intravenous (IV) therapy. While the injury is usually minor and resolves spontaneously, some cases result in serious complications, including full-thickness skin loss and muscle and tendon necrosis requiring reconstructive surgery or even amputation, leading to longer hospital stays, increased morbidity, and increased costs. However, management of infiltration and extravasation lacks evidence-based standardization, and many institutions do not have adequate policies and procedures in place. Furthermore, because infiltration and extravasation occur infrequently and ethical concerns prohibit controlled research, most treatments are empirical and are based on small uncontrolled trials, case reports, or animal studies. Additional barriers to optimal management include failure to identify the problem in a timely fashion; failure to disseminate or update management information; inadequate staffing; high staff turnover; lack of knowledge about effective treatments due to research limitations, as described above; and cost. To better understand infiltration and extravasation, a panel of clinicians with expertise in nursing, vascular access, general surgery, and pharmacy convened in September 2007 in Phoenix, Arizona. Objectives of the advisory roundtable were to present current clinical practice, review the pertinent literature, and summarize current management options. The discussion was cochaired by Darcy Doellman, BSN, RN, CRNI, and Lynn Hadaway, MEd, RN,BC, CRNI, and made possible by an educational grant from Baxter International, Inc. While the panel discussion covered VOLUME 32 | NUMBER 4 | JULY/AUGUST 2009 203 Infiltration and Extravasation Update on Prevention and Management The Art and Science of Infusion Nursing Darcy Doellman, BSN, RN, CRNI®; Lynn Hadaway, MEd, RN,BC, CRNI®, Leigh Ann Bowe-Geddes, BS, RN, CRNI®, Michelle Franklin, BSN, RN, MBA, CRNI®, Jack LeDonne, MD; Lorelei Papke-O’Donnell, MSN, RN, CRNI®, Janet Pettit, MSN, RNC, NNP, CNS, Lisa Schulmeister, MN, RN, APRN-BC, OCN®, FAAN; Marc Stranz, PharmD NAN200044_203-211 7/2/09 4:53 PM Page 203