Infiltrates are a common complication of IV therapy. They should be caught as early as possible to prevent potentially devastating outcomes, such as compartment syndrome or even loss of limb.
Check IV sites frequently (my hospital has an every hour policy). Monitor for puffiness and swelling. In very small patients, serious IV infiltrates can happen rapidly. Compare the site of the IV to the same site on the other side of the body. Do they look the same? If one starts to look puffier than the other, your IV is going bad. Is the skin pink or blanched? The picture above is a very severe case of blanching- watch for poor coloring before it gets that bad.
Watch for pain. Some children are simply scared of a flush or don’t understand the different feeling- it’s very important for a nurse to be able to differentiate between fear/normal discomfort/achiness and real pain. Infusing IVs should not hurt. If a child who previously had no response to flushing, or isn’t paying attention to you, suddenly starts crying that’s not a good sign for the IV. If a child wakes up from sleep crying after a flush, that’s a very bad sign. The IV may not necessarily be infiltrated yet, but it’s on it’s way out and should be restarted if it’s still needed.
Feel the site. Is it soft and squishy or does it feel firm? Is the skin warm or cool? As infiltrates worsen, you can feel the fluid accumulating under the skin. Sometimes it can be difficult to detect infiltrates in young children whose limbs always look puffy due to chubbiness. In these children it’s especially important to feel the sites.
NEVER. EVER. TAPE. OVER. YOUR. SITE. Yes, it’s important to secure the IV: BUT DO NOT COVER THE SITE TO DO THIS. It is absolutely essential that the site be visible (or easily accessible) at all times. Welcome sleeves and arm boards can be used for securement, but they must be able to be positioned in ways that you can check the site.
Don’t tape circumferentially or use arm bands on the same side as an IV. If an infiltrate should occur, these can greatly compromise the circulation of the swelling limb and make matters even worse.
Should an infiltrate occur: remove the IV immediately. Apply heat and elevate the limb. Multiple puncture procedure may be necessary in severe cases (several pokes to the infiltrated area with a needle and compression applied to release the accumulated fluids- requires an MD order). Surgery and loss of limb can happen, but this is a worst case scenario. Don’t let an infiltrate advance to that point!
Check your sites frequently! An infiltrate WILL happen to you, know how to catch it early!
Wow, great info. Especially for peds.