Outcomes and Management of Peripheral Intravenous Infiltration Injuries

Abstract

Background: Although intravenous (IV) infiltration is relatively common, data regarding complications and outcomes of this problem remain limited. In addition, there is wide variation in institutional protocols for the management of IV infiltrations. Through retrospective review, we aim to delineate complications and outcomes, and propose an algorithm for the management of these injuries. Methods: We performed a retrospective review of all patients who had an IV infiltration at a tertiary care center’s inpatient and outpatient facilities between January 1, 2016, and December 31, 2018. Results: In all, 479 patients with 495 infiltrations were included, with a mean age of 36.7 years. The upper extremity was involved in 89.6% of events. Of all the events, 8.6% led to a superficial soft tissue infection, 3.2% led to necrosis or eschar formation, and 1.9% led to ulceration or full-thickness wound formation. There were zero cases of compartment syndrome. Only 5.1% resulted in any long-term defects; none resulted in a functional defect of the extremity. Patients with vascular disease did not experience worse outcomes compared with healthy individuals. Plastic or orthopedic surgery was consulted in 25.3% of events. No emergent surgical intervention was required, 7 (1.4%) required bedside procedures, and 7 (1.4%) patients underwent nonacute operations. Conclusions: A specialist was consulted in about one-quarter of IV infiltrations, yet none were surgical emergencies. Instead, most complications could be monitored and managed by a primary team. Therefore, we propose algorithms involving nursing staff, wound care teams, and primary physicians with limited specialist consultation to manage these injuries.

<p>Under-Reporting of a Critical Perioperative Adverse Event: Intravenous Infiltration and Extravasation</p>

“…It is also hypothesized that intravenous infiltration may be under-reported due to a low rate of long-term or serious adverse complications as a result of this complicating event. A recent study by Gibian et al 7 reviewed 495 infiltration events and found that 8.6% resulted in a soft tissue infection, 3.2% experienced necrosis and 1.9% suffered ulceration. The authors further found that only 5.1% of these patients were deemed to suffer from long-term defects secondary to the infiltration.…”

Profiles and Outcomes of Skin Injuries Caused by Injectable Drug Extravasation

“…3,4 Furthermore, several studies have evaluated the severity of skin injuries associated with extravasation and their outcomes in clinical practice. [5][6][7] However, most are single-center studies and lack external validity. In addition, to the best of the authors' knowledge, no study has comprehensively analyzed the risks of extravasation-related adverse events (AEs), their corresponding skin injury profiles, and their outcomes according to the use of specific drugs, including those for the combination of cytotoxic and noncytotoxic drugs.…”

“…Furthermore, several studies have evaluated the severity of skin injuries associated with extravasation and their outcomes in clinical practice 5–7. However, most are single-center studies and lack external validity.…”

Delayed presentation of vincristine extravasation

“…However, in some cases, the onset of symptoms may be delayed by a few days. [9][10][11][12][13] The rate of extravasation with vincristine is reported 1%-2%. 14 The diagnosis of delayed symptoms of extravasation after vincristine may be complicated.…”