and I am wondering if what seeped into my arm will yield any medicinal benefit or if it’s like not getting anything at all? This was a question posted by a reader of this blog.

Thanks for posting this interesting question.  While I could have readily given an answer based on my experience, I wanted to see if there were any written articles about “fluid reabsorption from an infiltrated IV” before posting a reply. There were several on the topic of IV infiltration, however, no specific publication on this. Here are my thoughts.

• We define infiltration as the inadvertent administration of nonvesicant drugs or fluids into the subcutaneous tissue. The subcutaneous tissue is not a large reservoir for fluid hence when fluid/solution escapes into this area, localized swelling will result.
• As the reader posted, the medication that infiltrated was Solu-medrol, which is a non-vesicant solution – in the event this medication infiltrates, it it will not cause tissue necrosis.
•  The absorption of fluid or medication in the subcutaneous tissue is known to be slow thus many medications are given intravenously. In the event of an  IV infiltration, the reabsorption of the infiltrated fluid/mediation will be slow and given the small volume,  it is doubtful that any benefit will be gained from the medication.
• While infiltration is one of the common complications of IV therapy, it can be prevented and managed if it occurs.

Here are few thoughts to consider.

1. Location, location, location:  When selecting an IV site, avoid areas of flexion  – this includes the wrist, hand, and antecubital fossa.  Be mindful of any punctures to veins above the area you are about to stick. If patient had a recent blood draw from the antecubital fossa, use the opposite arm to find a suitable site.  Oh, btw, infiltration/extravasation can also happen in patient’s with central venous access.

2. Bigger is not better: Use the smallest gauge IV catheter to administer the prescribed therapy.  Good flow rates are possible even with a small gauge catheter. Using an IV catheter too large for the vein will obstruct blood flow and might cause thrombosis distal to the IV site.

3. Know your medications:  Medications and solutions with an osmolarity greater than 600 mosmol/L  and pH lower than 5 or higher than 9 should not be infused via a peripheral IV. Know the adverse events, if any for each medication. If in doubt, always ask our friendly pharmacists!!

4. Secure your IV device: Use a stabilization device to anchor and avoid movement of the catheter. When using a dressing, avoid obscuring the IV site to allow you to observe the site.

5. Check  IV patency and assess site: Key to early recognition of complications. Refer to your organization’s policy on frequency of IV site checks.  Infusion pumps will not tell you if an IV site in infiltrating. Always aspirate for positive blood return prior to use, but remember, checking for blood return or back flow of blood is good for patency but not a reliable method for assessing infiltration at IV site. If infusion continues to run when you apply digital pressure 3 inches above peripheral IV site in front of catheter tip – suspect infiltration

6. Policy/procedure for infiltration/extravasation: Do you know if your organization has one ? Have you even read it? What are you expected to do when infiltration/extravasation happens?  Is there a rating scale to document the severity of the problem? Are you expected to complete an “incident report”? Can you photograph the site?

7. Hot or cold: Which do you use? What does your policy state about compress? Do you need an doctor’s order for this?

8. Antidote: Is there one for the medication you administered? Obtain physician’s orders for the appropriate antidote. How is it given?

9. Document, document, document!! I know, you’ve heard this before….if it’s not documented, you didn’t do it! Keep this in mind, you will not remember what happened in the past, so hopefully, your documentation can defend you.

10. Don’t forget the patient/family: Keep them informed and provide information regarding treatment and management.