Pediatric Infiltration and Extravasation

Abstract

Because intravascular therapy is common in pediatric nursing care and is accompanied by many challenges in tenns of maintaining a problem-free site, it is not surprising that infiltration and extravasation injuries are reported with relative frequency. As one might expect, the varying degrees of tissue damage, extended hospitalization, treatment, and resultant scarring often lead to subsequent charges of alleged negligence. Infiltration is the inadvertent administration of a nonvesicant solution into the tissue rather than infusion into the vessel as intended. Unfortunately, many practitioners seem to view infiltration as a benign event. Although it is true that the outcome of an infiltration is generally less dramatic than an extravasation, a gross accumulation of fluid in the tissue may be ofsufficient volume to cause compression of nerves, compartment syndrome, and compromised arterial circulation. The consequences of extravasation, the inadvertent administration of a vesicant solution/drug into the surrounding tissue, can be dire. Depending on the particular vesicant and volume extravasated, the injury can range from onc that is similar to a burn to one that results in severe tissue damage evidenced by significant pain. Ulceration, necrosis, and eschar formation necessitate debridement and, in some cases, amputation of the limb. Vesicant drug listings are well published in the literature. On the basis of my legal nurse consulting experience and reports from my colleagues, the following drugs are the ones we frequently encounter in our review of pediatric extravasation cases: