The Clinical and Economic Burdens of Infiltration and Extravasation with Peripheral Intravenous Catheters: A Contemporary Narrative Review

Abstract

Infiltration and extravasation are complications of peripheral intravenous catheter (PIVC) use, and some of the most common causes of catheter failure. The objective of this contemporary review is to characterize the incidence, risk factors, and clinical and economic consequences of PIVC-related infiltration and extravasation, as well as strategies for prevention. Recent evidence demonstrates that infiltration incidence ranges from 13% to 20%. Extravasation is less frequent, with a reported incidence of up to 4.5%. There are numerous patient and procedure-related factors that increase the risk of infiltration and extravasation, which are caused by the infusion of either a non-vesicant or vesicant, respectively. Infiltration is often perceived as a minor complication, but can result in skin damage (e.g., scars, blisters), infections, and nerve damage, amongst other injuries, while extravasation can occasionally lead to severe consequences such as tissue necrosis and even limb loss. Both infiltration and extravasation may require additional venipunctures, resulting in treatment delays and patient discomfort. In addition to the clinical consequences, infiltration and extravasation are associated with high economic burden. This review also highlights how different considerations should be taken based on the type of extravasations that may occur with PIVC administration of contrast media, radiopharmaceuticals, vasopressors, and chemotherapy. Ultimately, use of PIVCs requires careful risk assessment and mitigation, effective monitoring and diagnosis, and timely treatment to prevent or minimize the unnecessary burdens of infiltration and extravasation for the patient and healthcare system.