Management and Prevention of Peripheral I.V. Infiltration and Extravasation.

A Guide for Anesthesiologists in Uganda

Introduction

People use Peripheral intravenous (P.I.V.) catheters in medical procedures worldwide. When fluids from a P.I.V. leak into the surrounding tissues, it can harm the tissues, cause infections, and make the patient stay in the hospital longer.

As a crucial aspect of patient care, anesthesiologists play a vital role in the management and prevention of P.I.V. infiltration and extravasation.

This article will provide comprehensive information on the needs and priorities of anesthesiologists in managing P.I.V. complications. Additionally, we will explore the latest best practices and treatment options for preventing and managing P.I.V. complications, such as tissue damage, infections, and prolonged hospitalization.

Our aim is to provide accurate and up-to-date information that will help anesthesiologists optimize patient care and improve patient outcomes.

Needs and Priorities

Anesthesiologists in Uganda encounter distinct challenges in preventing and managing P.I.V. infiltration and extravasation. These challenges may include limited resources, fewer training opportunities, and lack of proper equipment.

These factors can contribute to a higher risk of P.I.V. complications such as infections and tissue damage.

Different beliefs and a lack of information for patients may make it harder for doctors and patients to talk to each other. To make sure patients get better and stay healthy, it's important to solve these problems and use good plans to stop and treat P.I.V. problems.

Case Study

This case study presents a patient who experienced P.I.V. infiltration and the interventions taken to manage and prevent such complications.

Patient History:

Ms. Nambozo, a 45-year-old female, was admitted to a regional hospital in Uganda on January 5th, 2023, with a diagnosis of pneumonia. She had no known allergies and had never had an intravenous (IV) catheter inserted before. Ms. Nambozo was being managed by an anesthesiologist, Dr. Essy, who was responsible for her IV therapy.

Case Presentation:

On January 6th, 2023, Dr. Essy inserted a P.I.V. catheter in Ms. Nambozo's right arm. The insertion was successful, and the catheter was secured using an appropriate dressing. The site was assessed frequently for signs of infiltration or extravasation.

On January 7th, 2023, Ms. Nambozo began to complain of pain and discomfort in her right arm. The site of the catheter was swollen, red, and warm to the touch.

Dr. Essy was informed of these symptoms and assessed the site immediately. He observed that the catheter had infiltrated, and he quickly removed it.

Dr. Essy then elevated Ms. Nambozo's right arm and applied a warm compress to the site. He also administered an antidote to counteract the effects of the infiltrated medication. Ms. Nambozo’s symptoms improved significantly within an hour, and she reported feeling much better.

Findings:

This case study illustrates the importance of preventing and managing P.I.V. infiltration and extravasation. Despite Dr. Essy's best efforts to prevent complications, Ms. Nambozo still experienced infiltration. However, because Dr. Essy was able to detect the complication early and remove the catheter promptly, Ms. Nambozo's outcome was favorable.

Global Incidence and Impact:

Globally, the incidence of P.I.V. complications is significant. According to a study published in the Journal of Infusion Nursing, the incidence of P.I.V. complications ranged from 10% to 68%, depending on the patient population and the catheter type used (Gorski et al., 2016). Complications can include infection, tissue damage, and prolonged hospitalization. These complications can result in increased healthcare costs and decreased patient satisfaction

Prevention Strategies

Anesthesiologists can take several steps to prevent P.I.V. complications.

1. Proper site selection and assessment - Selecting an appropriate site for the IV insertion is essential. Anesthesiologists should assess the patient's veins for size, location, and condition before placing the catheter. Avoid a vein that is too small, fragile, or located near a joint.

2. Use of the correct catheter size - The catheter size should be appropriate for the vein selected. A catheter that is too large for the vein can cause trauma, which increases the risk of infiltration and extravasation.

3. Catheter securement - The catheter should be secured firmly in place using a suitable dressing. The dressing should not be too tight, as it can impede blood flow and cause the catheter to become dislodged.

4. The use of ultrasound-guided insertion of P.I.V. catheters has been demonstrated to reduce the incidence of infiltration and extravasation.

5. Regular site assessment - After the IV insertion, the site should be assessed frequently to check for signs of infiltration and extravasation. Any changes in the appearance or feel of the site should be reported immediately.

6. Patient Education - Patients should be informed about the IV catheter, its purpose, and potential complications. They should be instructed to report any pain, discomfort, or changes in the appearance of the site immediately.

Management Strategies

It's important to recognize and treat P.I.V. infiltration and extravasation. Despite preventive measures, IV infiltration and extravasation can occur.

Here are some management strategies that anesthesiologists can use to manage these complications:

1. Early detection - Anesthesiologists should assess the site frequently and look for signs such as swelling, redness, pain, and leakage.

2. Catheter removal - If infiltration or extravasation is suspected, you should immediately remove the catheter. Remove the catheter gently and slowly, taking care not to apply excessive pressure, to prevent additional trauma.

3. Elevation and warm compress - Elevating the affected limb and applying a warm compress can help reduce swelling and relieve pain.

4. Administration of antidotes - In certain situations, it may be necessary to administer an antidote to counteract the effects of the infiltrated or extravasated medication.

Conclusion:

Anesthesiologists play a vital role in preventing and managing P.I.V. infiltration and extravasation. IV infiltration and extravasation are common complications of IV therapy that can lead to serious consequences if not managed.

Anesthesiologists in Uganda can reduce the incidence of these complications by following preventive measures such as proper site selection, catheter securement, and regular site assessment.

Early detection and appropriate management strategies such as catheter removal, elevation, warm compress, and administration of antidotes can help minimize the impact of these complications.

By following the best practices and treatment options outlined in this article, anesthesiologists can help reduce the incidence of P.I.V. infiltration and extravasation and improve patient outcomes.