How Do You Prevent Infiltration?

Preventing infiltration during intravenous (IV) therapy is crucial for patient safety and effective treatment delivery. It primarily involves meticulous attention to detail during IV insertion, proper site maintenance, and continuous monitoring.

Understanding IV Infiltration

Infiltration occurs when an IV solution or medication leaks out of the vein and into the surrounding subcutaneous tissue. This happens due to the catheter puncturing the vein wall, dislodging from the vein, or increased pressure within the vein. While often not severe, it can cause discomfort, swelling, pain, and delay necessary treatment. In some cases, if the solution is a vesicant (damaging to tissue), it can lead to more serious tissue damage, known as extravasation.

Key Strategies for Preventing IV Infiltration

Effective prevention strategies focus on careful technique, appropriate equipment selection, and vigilant patient care.

1. Proper IV Site Selection

Choosing the right venipuncture site is fundamental to preventing infiltration.

• Anatomical Considerations:
  • Select a site that is visible, palpable, and accessible.
  • Avoid areas of joint flexion (e.g., wrist, antecubital fossa) to prevent catheter movement and vein irritation.
  • Opt for the most distal site possible in the chosen extremity to preserve proximal sites for future use.
  • Consider the patient's dominant hand and lifestyle to minimize disruption.
• Patient-Specific Factors:
  • Avoid sites with signs of infection, previous venipuncture, phlebitis, or compromised circulation.
  • Assess skin integrity and choose a vein that is healthy and resilient.

2. Use of Appropriate Cannula Size

The size of the IV catheter significantly impacts the risk of infiltration.

• Smallest Effective Gauge: Always select the smallest gauge catheter that can adequately deliver the prescribed therapy. A smaller gauge causes less trauma to the vein wall and allows for better blood flow around the catheter, reducing the risk of vessel irritation and subsequent infiltration.
• Purpose-Driven Selection: For rapid fluid administration or viscous solutions, a slightly larger gauge might be necessary, but this decision should be weighed against the potential for increased vein trauma.

3. Secure Cannulation Technique

A precise and confident insertion technique minimizes vein trauma.

• Single Attempt Preference: Aim for a successful venipuncture on the first attempt to reduce vein irritation and tissue damage. If multiple attempts are necessary, avoid reusing the same vein or area.
• Proper Angle and Vein Entry: Insert the catheter at an appropriate angle (typically 10-30 degrees) to ensure a smooth entry into the vein. Confirm blood return in the catheter hub before advancing the catheter fully.
• Bevel Up: Always ensure the needle's bevel is facing upwards during insertion to facilitate easier vein entry and minimize trauma.

4. Stabilization of the IV Catheter

Once inserted, the catheter must be securely stabilized to prevent movement and dislodgement.

• Sterile Dressing: Apply a sterile, transparent semi-permeable dressing over the insertion site immediately after securing the catheter. This allows for continuous visualization of the site.
• Taping and Securement Devices: Use sterile tape or an engineered catheter stabilization device to secure the catheter hub to the skin, preventing pistoning (in-and-out movement) and rotation.
• Looping Tubing: Create a loop with the IV tubing and secure it to the skin below the insertion site to minimize tension on the catheter and prevent accidental pulling.

5. Regular Monitoring and Assessment

Consistent and thorough monitoring is critical for early detection and intervention.

• Frequent Site Checks: Regularly inspect the IV insertion site for any signs of infiltration:
  • Swelling: Localized edema around the site.
  • Coolness: The skin around the site may feel cool to the touch.
  • Pain or Tenderness: The patient may report discomfort or pain at the site.
  • Blanching: The skin may appear pale or blanched.
  • Slowed Infusion Rate: The drip rate may decrease or stop altogether, even with the roller clamp open.
  • Fluid Leakage: Visible leakage of fluid from the insertion site.
• Comparison: Compare the appearance and temperature of the IV extremity to the contralateral limb.
• Palpation: Gently palpate the area above the insertion site; it may feel taut or spongy.

6. Patient Education and Communication

Empowering patients with knowledge can significantly aid in prevention.

• Educate on Symptoms: Inform the patient about the signs and symptoms of infiltration and emphasize the importance of immediately reporting any discomfort, swelling, or changes at the IV site.
• Activity Restrictions: Instruct the patient on how to protect the IV site, avoiding bending the limb at the insertion point or excessive movement that could dislodge the catheter.
• Communication is Key: Encourage an open dialogue where patients feel comfortable voicing concerns.

7. Use of Infusion Devices

Automated infusion devices contribute to controlled and consistent fluid delivery.

• Infusion Pumps: Utilize infusion pumps to ensure accurate and consistent flow rates. These devices help prevent sudden changes in pressure that could lead to infiltration.
• Smart Pumps: Modern smart pumps with dose error reduction systems and integrated libraries can help prevent medication errors and potentially reduce the risk of infiltration by maintaining precise control over flow and pressure.

Summary of Prevention Tips

By diligently adhering to these comprehensive strategies, healthcare professionals can significantly reduce the incidence of IV infiltration, ensuring safer and more effective intravenous therapy for patients.