Infiltration—also called extravasation—is the extravascular accumulation of a solution being infused. This can result in tissue irritation, compartment syndrome, or tissue necrosis; in addition, the patient is denied necessary fluids or medications. Because vital intravenous (IV) medications are frequently delivered to a patient by means of infusion therapy, infiltration can have serious effects on a patient's health.
A number of infiltration incidents have been reported to ECRI implicating all types of infusion pumps. However, infusion pumps typically play only an ancillary role in such incidents, and the belief that the pumps themselves produce infiltration is inaccurate. Rather, the usual causes of infiltration are dislodgment or improper insertion of either a catheter or—in the case of a subcutaneous injection port—a needle. Thus, to avoid problems, staff members should monitor IV sites of patients who are receiving infusions through pumps at least hourly to ensure that catheter or needle dislodgment and subsequent infiltration do not occur.
Another common misconception is that occlusion alarms on infusion pumps will signal infiltration. In fact, pumps will alarm only when downstream pressure reaches a specified value, and elevated pressures resulting from infiltration are typically far lower than occlusion-alarm-triggering levels. ECRI is not aware of any currently marketed infusion pump that can reliably detect infiltration.
ECRI Recommendations
- During routine hospital training, instruct staff members that infusion pumps do not detect infiltration and that patients receiving infusions through these devices should therefore be supervised closely and IV sites should be assessed hourly.
- Inform all clinical engineering personnel that infusion pumps submitted for maintenance following infiltration incidents can be returned to service after routine inspection and documentation.
- Instruct clinical engineering personnel to monitor the trends of repair requests that indicate infiltration. If this problem is persistent, additional staff training on avoiding infiltration may be needed.