Forum topic

 There is no database where organizztions feed information about extravasation events into it and someone analyzes it. That does not exist. We must rely upon publication of case reports and animal studies. Hospitals rarely can tell what their own experience is with infiltraiton or extravasation. Once we know that a drug has the potential to cause tissue damage it is managed as a vesicant. Just because there are no recent published case reports, it should not be removed from the list of vseicants. I recently sent a request to the FDA about a particular drug through the Freedome of Information Act. There was only 1 published case study about this drug causing tissue damage at the site of infection. FDA send back a 60 page lists of more than 7000 reported evens with that drug. These reports did not contain conclusive evidence about the cause of these events but the descriptions from the healthcare professional cretating the individual reports included tissue damage.

Some drugs cause greater tissue damage than others but there are many factors involved. Concentration is one factor and this would apply to K riders. Mixed in 1000 mLs it might not be a vesicant but in 100 mLs if easily cause be. Then there is many nursing issues that your pharmacists is overlooking including site selection in areas of joint flexion, choices about the catheter size, use of appropriate catheter stabilization, complete site assessment practices before and during infusion, etc. 

There are 3 questions about any complication but this especially applies to infitlration/extravasation:

1. What was done to prevent the problem? This is measured by following INS Standards. 

2. How quickly was the infiltration/extraasation recognized? Immediately should be the goal

3. Was the nursing and medical management complete and accurate? Use of antidotes, correct use of heat or cold based on the drug, appropriate surgical consutlation when necesary. 

These questions can be used to measure staff practices and they are certainly used when evaluating medical records for a lawsuit. Infiltration/extraasation is the most common cause of infusion related lawsuits. So this pharmacists is not acting to protect his/her patients, staff, or facility and needs to be educated about the many nursing care issues. 

Lynn

At our institution, a small community hospital, the Vascular Access Team partnered with the Pharmacy Director and the Infusion Coordinator in Nursing to identify 20 IV drugs that were most likely to cause phlebitis.  We then labeled all these medications with an "eyeball" label, so that the nurse at the point of care would pay extra attention to the IV site when infusing these drugs.  We also educated ordering providers in the institution, especially about switching to oral forms of drugs like Levaquin as soon as possible.  We are working on an alert in our EMR that would remind ordering providers of the phlebitis risk. 

IV infiltrations and phlebitis are, imho, are our "dirty little secret" in health care.  We believe that we can significantly reduce the incidence of this complication.  Value-based purchasing demands this of us going forward. 

Genine Schwinge, ANP-BC,PNP

Vascular Access Coordinator

J T Mather Memorial Hospital

Port Jefferson, NY 11777

 Good management for phlebitis, not that would not address infiltraiton/extravasation. Phlebitis is happening inside the vein while infiltration/extravasation is occurring outside the vein. Different issues, causes, risk factors, etc. Infiltration/extravasation is the most frequent infusion related cause of lawsuits, not phlebitis. Lynn