Download Management of Infiltration / Extravasation of Intravenous Iron Therapy

WOMEN AND NEWBORN HEALTH SERVICE
King Edward Memorial Hospital
CLINICAL GUIDELINES
OBSTETRICS & GYNAECOLOGY
PARENTERAL THERAPY
IRON THERAPY
MANAGEMENT OF INFILTRATION / EXTRAVASATION OF
INTRAVENOUS IRON THERAPY
Keywords: Iron infusion, extravasation, infiltration, iron therapy, ward 4 infusion unit
AIM
To describe the appropriate management of a woman who has sustained infiltration /
extravasation of intravenous (IV) iron therapy.
PROCEDURE
BACKGROUND
Paravenous leakage of all forms of IV iron therapy results in permanent skin pigmentation and may
cause skin irritation thus it is imperative that the infusion is stopped immediately if
infiltration/extravasation is suspected. Volumetric pumps will initially continue to flow until fluid
accumulates in the subcutaneous tissues, thus careful observation and monitoring of the cannula
insertion site is imperative.
Recognition of infiltration/extravasation
Table 1: Signs and symptoms of infiltration and extravasation
Infiltration
Tenderness/discomfort at insertion site
Extravasation
As infiltration in addition:
Swelling above or below insertion site
Burning stinging pain
Taut skin above or below insertion site
Redness may occur followed by
blistering, tissue necrosis and ulceration
Fluid leak at insertion site
Coolness/blanching around insertion site
Numbness or tingling above or below
insertion site
MANAGEMENT OF THE INFILTRATION
1. Remove the cannula immediately and abandon the infusion.
2. Do not attempt to resite the infusion.
3. Reassure and provide a full explanation to the patient.
4. Assess and document the volume of infiltration by recording the volume of the infused fluid.
5. Inform the patients RMO so an assessment can be made of sensory deficit which could
indicate nerve damage or compartment syndrome.
6. Further advice may be required from other specialities including Dermatology (skin staining),
Plastic Surgery (sensory deficit) or Haematology (anaemia management) as per individual
patient symptoms.
7. Apply a cold pack to the infiltrated site and elevate the affected limb.
8. If iron staining is immediately visible, measure the site and arrange for hospital photographs to
be taken. This will aid ongoing monitoring of the patient
9. Clearly document the management in the patient’s medical records.
10. Complete a clinical incident form.
11. The patient will be followed up as an out-patient where long term management will be
discussed.
12. Laser therapy has been successful in reducing the skin staining long term.
2014
All guidelines should be read in conjunction with the Disclaimer at the beginning of this section
Page 1 of 2
MANAGEMENT OF EXTRAVASATION
If redness or blistering is apparent, then tissue necrosis can occur and management is aimed at
limiting further tissue damage.
1. Remove the cannula immediately and abandon the infusion.
2. Do not attempt to resite the infusion.
3. Reassure and provide a full explanation to the patient.
4. Assess and document the volume of infiltration by recording the volume of the infused fluid.
5. Inform the patients RMO so an assessment can be made of sensory deficit which could
indicate nerve damage or compartment syndrome.
6. Hydrocortisone cream may relive the irritation.
7. Further advice may be required from other specialities including Dermatology (skin staining),
Plastic Surgery (ulceration or sensory deficit) or Haematology (anaemia management) as per
individual patient symptoms.
8. Apply a cold pack to the infiltrated site and elevate the affected limb.
9. If redness, blistering or iron staining is immediately visible, measure the site and arrange for
hospital photographs to be taken. This will aid ongoing monitoring of the patient
10. Clearly document the management in the patient’s medical records.
11. Complete a clinical incident form.
12. The patient will be followed up as an out-patient where long term management will be
discussed.
13. Laser therapy has been successful in reducing the skin staining long term.
REFERENCES / STANDARDS
Doellman D, Hadaway L, Bowe-Geddes LA et.al. (2009) Infiltration and extravasation. Update on prevention and
management. Journal Infusion Nursing 32;4. 203 – 211.
Dougherty L (2008) IV therapy: recognising the differences between infiltration and extravasation British Journal
of Nursing 17;14. 896 – 901.
Erner RA, Meganlathery SB and Styler M (2004) Extravasation of systematic hemato-oncological therapies. Annals
of Oncology 15 (6) 858 – 862
Raulin C, Werner S and Greve B. (2001) Circumscripted pigmentations after iron injections- treatment with Q
switched laser systems. Lasers in Surgery and Medicine 28. 456 – 460.
National Standards – 1- Care Provided by the Clinical Workforce is Guided by Current Best Practice
1- Incident Management and Reporting
9- Recognising and Responding to Clinical Deterioration
7- Blood and Blood products treatment options
Legislation - Nil
Related Policies – KEMH Clinical Guidelines: O&G: Parenteral Therapy: Iron Therapy
Other related documents – Nil
RESPONSIBILITY
Policy Sponsor
Initial Endorsement
Last Reviewed
Last Amended
Review date
Nursing & Midwifery Director OGCCU
August 2014
August 2017
Do not keep printed versions of guidelines as currency of information cannot be guaranteed.
Access the current version from the WNHS website.
Management of Infiltration / Extravasation of Intravenous Iron Therapy
Clinical Guidelines: Obstetrics & Gynaecology
2014
King Edward Memorial Hospital for Women
Perth, Western Australia
All guidelines should be read in conjunction with the Disclaimer at the beginning of this section
Page 2 of 2