Infiltration and extravasation

What are infiltration and extravasation?

• Infiltration happens when fluid, nutrition, or medicine leaks from a vein into the surrounding tissue.
• Extravasation is when certain medicines called vesicants leak into the tissue and can cause more serious damage.

Why does it happen?

It can occur if:

• The intravenous catheter moves out of the vein
• The vascular access device is not secured properly
• The catheter is inserted incorrectly
• Even normal movement can sometimes cause it

How is extravasation diagnosed?

It can be hard to spot straight away.

Some fluids may feel uncomfortable but cause no harm.
Other fluids or medication can damage tissue even if symptoms
aren’t obvious at first.

Signs and symptoms

Tell your nurse or doctor immediately if you notice:

• Swelling
• Tenderness or discomfort
• Redness near the infusion site
• Fluid leaking at the cannula site
• Numbness, tingling, or pins and needles
• Burning or stinging pain
• Skin that doesn’t blanch when pressed
• Blisters
• Dark or dead-looking skin
• Difficulty giving an infusion

Possible complications

• Some medicines carry a higher risk
• Damage may not appear straight away – it can take days
  or weeks.
• Most cases are mild and heal quickly
• Occasionally, specialist treatment is needed. If so,
  your doctor or nurse will explain and support you

What happens if it occurs?

Treatment depends on the area affected and the amount of fluid involved.

Steps include:

• Stop and disconnect the infusion while leaving the vascular access device in place
• Try to remove any remaining medicine using a syringe
• Examine the area and decide on treatment following NHS Fife’s extravasation protocol
• Outline the affected area
• Give an antidote if needed to reduce tissue injury
• Elevate and monitor the limb
• Apply a hot or cold compress depending on the medicine
• Take medical photographs to record the injury
• Record the incident in NHS Fife’s reporting system

Are there long-term effects?

If treated quickly, there are usually no lasting problems.
The area may feel sore for a few days. Early diagnosis reduces damage.

Tissue injury can worsen over days or weeks, so seek help if you notice changes after discharge.

Watch for changes such as:

• Colour changes in the affected area
• Blistering, flaking, or peeling skin
• Increased pain or discomfort
• Anything else that worries you about your arm or hand

Who to contact after discharge

• If you are attending hospital as an outpatient:
  Speak to the doctor or nurse in charge of your care.
• If you have been discharged: Contact your GP. 
  They may refer you to a specialist if needed.