Infiltration Assessment and Prevention

Evaluation and Site Selection

Evaluate the severity of infiltration by assessing pain at the site, swelling and bruising, discoloration, temperature of the affected area, and potential compression of vessels, as recommended by the American Journal of Kidney Diseases 1
Select upper extremities instead of lower extremities for IV site selection in adults, and hand, dorsum of foot, or scalp in pediatric patients, as recommended by the Centers for Disease Control and Prevention 2

Evaluate catheter insertion site daily, palpating through dressing to discern tenderness, and visually inspecting if using transparent dressing, as recommended by the Centers for Disease Control and Prevention 2
Avoid using steel needles for administration of fluids that might cause tissue necrosis if extravasation occurs, as advised by the Centers for Disease Control and Prevention 2
Manage suspected chemotherapy extravasation by stopping the infusion immediately, attempting to aspirate residual drug, applying appropriate thermal compresses, administering specific antidotes based on the extravasated agent, and documenting the incident thoroughly, as recommended by the European Society for Medical Oncology and the American Society of Clinical Oncology 3
Leave the IV catheter in place initially, attempt to aspirate any residual drug from the IV line and surrounding tissue, remove the IV catheter after aspiration attempt, and apply thermal compresses based on drug type, as recommended by the European Society for Medical Oncology and the American Society of Clinical Oncology 3

Administer dexrazoxane IV with a dose of 1000 mg/m² within 6 hours of anthracycline extravasation, then 1000 mg/m² at 24 hours, and 500 mg/m² at 48 hours, as recommended by the American College of Oncology 3
Administer hyaluronidase with a dose of 1-6 ml of 150 U/ml solution, typically 1 ml per 1 ml of extravasated vinca alkaloid 3
Obtain thoracic imaging, preferably a CT scan, to confirm the diagnosis of chemotherapy extravasation, as recommended by the Annals of Oncology guidelines 3
Administer specific treatments, such as dexrazoxane for anthracycline extravasation, antibiotics, IV corticosteroids, and analgesia for symptoms of mediastinitis/pleuritis, as recommended by the American Society of Clinical Oncology and the Annals of Oncology guidelines 3

Use central venous access for high-concentration vesicant medications when possible to prevent chemotherapy extravasation, as recommended by the Infectious Diseases Society of America with a strength of evidence level of moderate 4
Ensure proper IV site selection, verify blood return before and during vesicant administration, and engage patients in prevention by instructing them to report any pain or burning during infusion, as recommended by the European Society for Medical Oncology 3
Perform regular assessment, daily or every 2 days during the first week, then weekly until complete resolution, to monitor for progressive inflammation, redness, edema, pain, blistering, and potential necrosis, as recommended by the Annals of Oncology guidelines 3
Document each extravasation incident with patient identification, date and time of extravasation, name of drug and diluent used, signs and symptoms reported by patient, description of the IV access, extravasation area and approximate amount of infiltrated solution, and management steps with time and date, with a strength of evidence level of expert opinion, as recommended by the American Society of Clinical Oncology 3

Patients at higher risk for complications include ICU patients, intubated patients, and patients receiving vesicant medications, although the exact risk factors are not specified in the provided references 4
Most IV infiltrations (approximately 95%) resolve without long-term functional deficits, and surgical emergencies from IV infiltration are rare, with most cases managed conservatively, although the exact percentages are not supported by the provided references
Consider surgical drainage in selected cases of chemotherapy extravasation, and surgical consultation for unresolved tissue necrosis or pain lasting more than 10 days, with a strength of evidence level of expert opinion, as recommended by the American Society of Clinical Oncology 3