IV issues in nursing homes: What to watch for

In a nursing home, residents sometimes need the intravenous delivery of medications. For example, an elderly person may be dehydrated or need special medications to help keep them healthy. IVs are largely safe, but there is a risk that IV medications could get mixed up or that the delivery method could cause problems.

Peripheral IVs, the IVs that go into the hands and arms (most often) are a common way to deliver fluids. Unfortunately, extravasation and IV infiltration are both possibilities.

What is IV infiltration?

IV infiltration occurs when there is an accidental leak of nonvesicant solutions into the tissues around the IV or into the vein. These medications won’t necessarily cause severe issues like blisters or tissue damage, but they can cause symptoms like swelling, pain or, in a worst-case scenario, compartment syndrome.

What is IV extravasation?

Extravasation is more serious that infiltration in most cases. This is because vesicant drugs leak out with this delivery failure, and vesicant drugs may cause severe tissue damage or blistering. Vesicant solutions must be delivered into the vein.

If delivery failure occurs, there is a possibility of tissue death (necrosis). Some medications that may lead to these kinds of issues include:

• Vasopressin
• Epinephrine
• Dextrose concentrations greater than or equal to 12.5%

Drugs that may cause this condition but that have fewer reports include:

• Pentobarbital sodium
• Vancomycin hydrochloride
• Arginine

Why do these IV failures occur?

IV extravasations and infiltrations are most likely to occur because of the catheter exiting the vein, leakages through the insertion site, or because of increased vein porosity. Rarely is this condition caused by a nurse’s errors. Instead, medical negligence tends to come into play when a nurse is not checking on the patient’s IV regularly, fails to respond to complaints of pain or irritation, or does not treat the IV infiltration or extravasation correctly. Unfortunately, failure to monitor patients is a common form of nursing home neglect.

Careful monitoring can help eliminate the risk of these injuries and the complications associated with them. If your loved one is harmed due to failure to monitor, then you may have grounds for a nursing home neglect claim. To learn more, please see our Elder Abuse FAQ.