IV Infiltration- Prevention, Treatments and Resources

Purpose:
To engage the IV Therapy Nurses in a partnership with Direct Care Nurses and the patient and family for early recognition of an IV infiltrate, reliability of grading, early intervention to minimize adverse outcomes and follow-up of the infiltrate until it is resolved.

Significance:
Infiltration is the most common adverse outcome of IV therapy. The INS standard of practice (2006)require the RN to be competent to assess the site, determine the need for intervention/treatment. Infiltrates must be documented using a standard scale to measure the grade & severity of the infiltrate.

Strategy and Implementation:
The IV nursing team developed a tool to record and track IV infiltrates using a standard scale. After the IV Nursing Team developed interrater reliability in grading IV Infiltrates they then worked with direct care nurses to build the same level of competency in this assessment. Next they developed a database to track the location, grade, IV solution and the duration of infiltrations. They also collected data regarding the age of the child and the last time the IV site was assessed. Next the IV team nurses developed reference cards with the Infiltration Scale and single page handout for patient and family education. Then working with Nursing Practice Council they developed a Nursing Plan of Care to standardize the first response and continued treatment of IV Infiltrates. Finally the IV team nurses placed the IV Infiltration scale in the Electronic Medical Record so that every nurse could easily access and use this scale and also document their assessment.

Evaluation:
Data is shared with the Quality Council quarterly. They continue to evaluate assessment practices and establish interrater reliability when an Infiltrate is identified. NDNQI surveillance shows 0 IV infiltrates for the past 8 months. The 8 months prior to this intervention there were 4.

Implications for Practice:
The partnership between the IV Nurse, the Direct Care Nurse and the patient/family lead to improved patient outcomes through early recognition, reliable assessment, timely intervention and tracking. These steps work together to reduce the frequency, grade level and the severity of IV infiltrates.