Reducing extravasation and infiltration in the pediatric population: a best practice implementation project

Introduction: Peripheral intravenous (PIV) therapy, the most common invasive procedure in hospitals, frequently results in complications. Infiltrations occur when infused fluids enter the surrounding tissue without harming the skin, while extravasations irritate the skin and tissue, occasionally necessitating surgical intervention. Evidence-based practices recommend the use of quality standards, such as Assess, Compare, Touch (ACT) and a 60-minute rounding tool to address the rising incidence of intravenous complications. Objectives: The objective of this evidence implementation project was to decrease the complications associated with infiltration and extravasation at the site of PIV catheters in pediatric populations. Methods: This project was guided by the JBI Evidence Implementation Framework. A baseline audit identified inconsistent adherence to policy, including the crucial hourly rounding to assess the infusion site. Barriers to best practice were identified and improvement strategies were implemented, including education on hourly PIV assessment using ACT and a rounding tool for nurses. Additionally, an algorithm for extravasations and infiltrations was implemented. A follow-up audit was conducted to determine changes in practice. Results: The baseline audit revealed that although 100% of PIV sites were properly stabilized with adhesive dressings, only 9.09% of catheters were assessed every hour using ACT. Additionally, 100% of catheters were removed and infusions stopped immediately after extravasation or infiltration, but none of the affected extremities were elevated. Only 27.27% of cases involved notifying a physician or nurse practitioner, and there was no established protocol for managing extravasation or infiltration. Survey results from 40 nurses showed that 72.5% felt educated on catheter securement and assessment, but only 52.5% had received education on managing PIV-related injuries. Conclusions: Continuing education and protocols can improve the quality of care of pediatric patients with PIV by strengthening staff knowledge and skills to prevent infiltrations and extravasations. Spanish abstract: http://links.lww.com/IJEBH/A545