In 2016, Beverly visited her local hospital for what she thought would be a simple CT scan of her neck to diagnose the pain she had been experiencing more frequently. This outpatient procedure would give her medical team a better look to confirm their diagnosis of a condition called cervical spinal stenosis.
Beverly was informed that she’d need an IV inserted to administer contrast fluid that would help enhance the imaging. As someone who has undergone multiple surgeries, she knew this would be challenging because of difficult past IV insertion attempts. What she never expected, was for this procedure to change her life.
She mentioned having ‘bad veins’ to her medical team and after 3 or 4 attempts, a clinician was able to place the IV near the bend in her arm.
As it turned out, getting the IV in would be the least of Beverly’s worries. Just seconds after the contrast went into her IV, she screamed. “It was like it blew the vein and went right into my arm,” she remembers. “Oh, I screamed and jumped, so they came out running.”
At first, her medical team didn’t realize that the CT contrast fluid had been infused into the tissue under her skin instead of being delivered into the vein, resulting in a very painful extravasation.
“Worst pain I’ve ever felt in my life. I can’t even – it felt like my hand was like a brick and it felt like it was gonna pop,” she describes. “My skin was hard and lumpy. They eventually told me the lumpiness was where the contrast had settled in those little pocket areas underneath the muscle.”
Beverly looked on as her dominant hand laid flat with her palm and fingertips a bright white, fingers curled inward from the pain that radiated all the way up her arm. As nurses touched her hand and arm in various places, she realized she couldn’t feel anything when they touched her fingers and she began to cry.
After disconnecting the contrast and removing the IV, her medical team tried several different approaches to relieve Beverly’s pain. They elevated her arm, tried to massage the affected area, gave her pain medication, and even alternated ice and heat – nothing helped.
Expert opinions on how to treat an extravasation vary, but due to the severity of Beverly ’s symptoms and pain, a doctor felt there was only one option: immediate surgery.
“I don’t remember much more because I was in so much pain. All I remember is he said, ‘Oh my God, she has compartment syndrome.’”
Compartment syndrome is one of several complications that can occur from an IV extravasation or infiltration. When unintended fluid is going into the tissue in your hand or arm, it can cause increased pressure and painful swelling in those compartments.
The most common surgery performed to correct this is a fasciotomy, which cuts below the tissue to relieve the pressure and pain. Beverly’s surgeon made an incision from her palm to the middle of her elbow, which had to remain open for 4 days to let the swelling go down.
“It looks like a shark bite!” she remembers screaming when the dressing was initially removed. “I saw bone, I saw my muscle, I saw tissue and veins, I saw my whole arm gaping open. I almost passed out because I thought it was already closed.”
Beverly’s open wound after surgery.
Over the course of just a few days, Beverly had experienced an IV extravasation, compartment syndrome, and major surgery. Unfortunately, her road to recovery wasn’t much simpler.
She returned to her job at a national shipping company just two weeks after having surgery to close the wound. At work, she even had to wear a special sleeve to protect the wound from being poked and prodded by all of the boxes. Not to mention, she was still in a great deal of pain.
Beverly wearing the protective sleeve
“I was very angry and I spent a lot of time crying every night because my nerves hurt so bad. Even the sheets on the bed would hurt so bad,” she recalls.
Despite the challenges she faced, Beverly remains grateful for the surgeon that recognized her symptoms of compartment syndrome. She credits him with saving her left hand and arm, although they never fully recovered.
It took a full year after the incident for Beverly to regain most of the feeling and nerves. But unfortunately, part of her hand still remains numb to this day. She also has what she refers to as a snake, “a long, big, ugly scar on my forearm from the palm all the way to my elbow.”
Beverly’s scar today from her fasciotomy in 2016.
After her experience, Beverly wants others to be aware of how life-changing IV failure can be. “When I look back on it, I still feel bad for people who may not know that this can actually happen,” she says. “I feel like more attention should be spoken about the complications from IV infiltration. I never thought it would happen to me.”
But medical professionals caution that this type of IV failure can happen to anyone. “Any patient receiving an IV [of a vesicant] medication is at risk of extravasation. The first symptom is often stinging or burning at the site of administration,” says Larissa DeDea, PharmD, BCPS, PA-C, a clinical pharmacist with Northern Arizona Healthcare.
One thing patients and their caregivers can do to be proactive is to learn the symptoms of IV failure and speak up if they notice any of them. Being confident in identifying your symptoms as signs of an infiltration or extravasation early-on and telling a clinician can both help minimize harm to the patient.
As a patient with lupus, Beverly doesn’t expect to have fewer doctor’s appointments or hospital visits anytime soon. Although she does feel more confident speaking up about her concerns especially when it comes to an IV. But the anxiety from her experience hasn’t completely faded.
“I’m nervous all the time, thinking ‘Oh my God, please let them get a vein.’”
Your Recommended Reads:
- Patient Spotlight: Barby Woke Up During Surgery After Her IV Infiltrated
- When Can IV Failure Lead to Amputation?
- Are the Side Effects from IV Failure Reversible?
Extravasation of Radiologic Contrast – http://patientsafety.pa.gov/ADVISORIES/documents/200409_01b.pdf
How should extravasation injuries be treated? – https://journals.lww.com/jaapa/Citation/2011/12000/How_should_extravasation_injuries_be_treated_.2.aspx