American Association for Hand Surgery

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Outcomes and Management of Peripheral Intravenous Infiltration Injuries
Joseph T Gibian, BS1, Danny Zakria, BA1, Cooper March, BS1, Basil Schaheen, MD2 and Brian C Drolet, MD2, (1)Vanderbilt University School of Medicine, NASHVILLE, TN, (2)Vanderbilt University Medical Center, Nashville, TN

Background: Although intravenous (IV) infiltration occurs commonly, there is sparse data regarding complications and outcomes after infiltration. In addition, there is wide variation in protocols for the management of IV infiltrations. We aim to delineate outcomes and propose algorithms for management of these injuries.

Methods: We performed a retrospective review of all patients with IV infiltrations at a tertiary care centerÕs inpatient and outpatient facilities between January 1, 2016 and December 31, 2018. Data on patient demographics, infiltrate characteristics, outcomes, and interventions were recorded.

Results: 480 patients with 496 infiltrations were included.  Patients had a mean age of 36.8 years, and 53.8% were female.  Hydration fluids and antimicrobials were the most common infiltrants. The upper extremity was involved in 89.6% of events. Of all events, 8.6% led to a superficial soft tissue infection, 3.4% led to necrosis or eschar formation, and 2.1% led to ulceration or full-thickness wound formation. There were zero cases of compartment syndrome, and only 3.6% resulted in long-term defects, all of which were cosmetic. Plastic or orthopaedic surgery was consulted in 25.2% of events.  No patients required emergency surgery, 7 (1.4%) required bedside procedures, and 7 (1.4%) patients underwent non-acute operations.

Conclusions: A hand specialist was consulted in about one-quarter of IV infiltrations, yet none were deemed surgical emergencies. Instead, the majority of complications were monitored and managed by the primary team. Therefore, we propose algorithms that utilize nursing staff, wound care teams, and primary physicians with less specialist involvement to manage these injuries.

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