Every medical institution where IV therapy is provided should have policies and procedures that address the manner by which a patient’s IV site needs to be assessed so as to prevent injury.
The Infusion Nurses Society publishes “Standards of Practice,” which many medical institutions adopt, require infusion nurses to be familiar with the fluid being infused into the patient. In particular, these Standards of Practice mandate that the infusion nurse be aware of the fluid’s potential adverse effects and those interventions that need to be implemented if an extravasation or infiltration occurs.
Before starting the infusion, the infusion nurse needs to assess the patency of the patient’s vein by checking for brisk blood return and lack of resistance when flushing the line. In addition to confirming vein patency, infusion nurses should avoid inserting IV lines into veins located in joint sites due to the increased risk of catheter dislodgement by movement. Also insertions into veins located in the hand and wrist should be avoided so as to minimize the risk to the patient of an inadvertent nerve injury.
After the IV has been placed and the fluid and/or medication begins to be infused, frequent site assessments must be performed. With non-vesicant fluids, site inspection for infiltration every several hours in an adult patient may suffice. However, pediatric patients should have their IV lines more frequently assessed for infiltration. When vesicant medications, such as many chemotherapy medications, certain antibiotics and nutritional supplemental high in glucose concentration are infused, the Oncology Nursing Society recommended site assessments be performed for signs of extravasation every 10-15 minutes because of their potential risk to the patient for significant injury.