By: Heather Michon |
Taylor was just a year old when she was admitted to a local pediatric hospital and placed on intravenous morphine.
Insertion of an intravenous line is one of the most common procedures performed in hospitals, with an estimated 80% of patients receiving an IV at some point during their admission. This is usually a quick and fairly easy process, but challenges can arise, particularly when it comes to pediatric patients like Taylor.
Children’s veins are much thinner and more fragile than adults, and they often instinctively flinch from pain or anxiety. This makes it more difficult for medical staff to get a catheter properly placed in their veins. A 2012 pediatric study found that only 42.8% of IV insertions in children were successful on the first try, compared to 79% of adult patients.
Once the catheter is inserted, the next challenge is to make sure it stays properly anchored in the vein. This can be especially difficult with younger patients like Taylor, who are more likely to move their limbs despite the presence of a IV. If the catheter slips out or pushes through, fluid can begin to seep into surrounding tissue. This infiltration can cause pain and swelling around the insertion point, and in extreme cases, can lead to localized tissue death (necrosis) or compartment syndrome, a buildup of pressure in muscle tissue.
In an effort to prevent these complications, medical staff regularly monitor IV insertion sites for infiltration. They’re looking for the tell-tale signs of redness, blanching, swelling, pain, numbness, reduced pulse rate, or other symptoms that might indicate a problem.
Despite these best efforts, at some point in Taylor’s treatment, the catheter in her forearm slipped out of place just enough to cause a slow leak of fluid. More mild cases of infiltration can often go undetected in pediatric cases, especially where the visual signs are not obvious and the patient is too young to communicate pain or numbness.
Pediatric patients often receive arm boards, tape and dressings to help immobilize their arm while they have an IV. These additional coverings can make infiltrations more difficult to identify, meaning slow leaks may take days to notice.
As a result, not all of a patient’s medication is being delivered, making an infiltration also a medication dosing error. For Taylor, this meant going without the full doses of morphine to manage her pain for several days until the infiltration was eventually detected.
Staff later estimated it took 100 hours to detect the infiltration and get Taylor the relief she needed. It was a reminder that the smallest patients often require the greatest vigilance. Parents and caretakers should never be afraid to monitor, to ask questions, and most of all, to speak up if they sense something isn’t quite right. Often, it’s the only voice a baby has.
The strongest defense against infiltrations and other IV complications is early detection and recognizing the signs that something may be wrong. Download our How to Talk to Your Health Professional form to help you start the conversation.
Do you have an IV story to share? Tell us about it here.
The Effect of Intravenous Infiltration Management Program for Hospitalized Children – http://www.pediatricnursing.org/article/S0882-5963(15)00334-6/abstract
Does the Use of an Assistive Device by Nurses Impact Peripheral Intravenous Catheter Insertion Success in Children? – http://www.pediatricnursing.org/article/S0882-5963(10)00325-8/fulltext
Evidence-Based Practice to Prevent IV Infiltration – http://extranet.acsysweb.com/vsitemanager/SFHGA/Public/Upload/Docs/2012-Quality-Awards/Evidence-Based-Practice-to-prevent-IV-Infiltration.pdf