The world of healthcare is full of risks. Invasive devices such as IV cannulas help to save thousands of lives each day. However, they also pose a hidden risk of extravasation (a problem which occurs when fluids leak into the surrounding tissue of the patient, creating conditions in which severe infections and damage may occur to the tissue). Extravasation can cause iatrogenic morbidity and mortality, but it is a less discussed topic due to underreporting.
Extravasation Prevention Benefits
Avoiding extravasation shortens patients’ hospital stays. Extravasation-related infections generally necessitate prolonged hospital stays for wound care, antibiotic administration, and monitoring. Hopmans and Colleagues (2020) performed semi-annual point-prevalence surveys to detect and prevent infections that occur due to IMD from 2007-2016. They surveyed extravasation incidents that occurred in surgical wards. Results showed length of stay reduced when controlling extravasation by 3 days but antibiotics usage increased by 5%. Patients can recover more rapidly by reducing their risk of extravasation and infection, which results in shorter hospital stays and lower medical expenses.
Second, extravasation control improves patient outcomes and lowers the risk of complications. Grasselli et al. (2017) in their retrospective research (n = 92) found a risk of severe infection. In a similar retrospective study, Allou et al. (2019, n = 220) found that extravasation infections increase hospital and intensive care unit stays. Both studies agree that healthcare professionals can improve patient wellbeing, and raise the standard of care by efficiently controlling infections.
Moreover, Storr et al. (2017) argue that hospitals can deploy their resources more effectively when there are fewer infections since less is needed for wound care, extra therapies, and complication management. This is further supported by Shahida et al. (2016) who presented the case of countries with minimal resources like Bangladesh. Encapsulating, infection prevention is beneficial for patients and the healthcare system.
Clinical Education Impact on Extravasation
Clinical education is essential to prevent extravasation and resultant complications. Morgaonkar et al. (2017) assessed the effectiveness of in-class or offline video training using simulation (n = 75). The nurses were required to cannulate manikin in pre and post-training. A checklist was also used which assessed their knowledge regarding infection prevention and control. The training package comprised theory, PowerPoint presentation, video simulation, and practice on manikin. Pre and post-cannulation results showed marked improvement (48% pre-test vs. 92% post-test) in reducing extravasation while mean results regarding infection knowledge also improved (7.91 pre-test vs. 9.22 post-test). Whilst the sample size is small the study concluded that nurses receive the knowledge and skills necessary for efficient infection prevention and control through clinical education. In another study,
Keleekai et al. (2016) assessed a blended program with a 2-hour online course followed by an 8-hour live simulation training for peripheral IV cannulation. It reports significant improvements in knowledge (31% increase) and skills (24% increase). The results showed that training has the potential to improve nurse knowledge and patient safety.
Sensing Devices
This case presented the issue of extravasation of the patient’s peripheral IV cannula site which can lead to complications such as infection. Currently, extravasation is detected manually by nurses. They do this through visualization and tactical inspections (such as changing color of the skin and swelling). Systemic factors such as time constraints and responsibilities within the healthcare setting can impede the culture of safety (Kamada et al., 2023) and eventually lead to extravasation.
An unconventional way to detect extravasation is to use technology-sensing devices. Hirata et al. (2023) reviewed and proposed the use of sensing devices with single, and multimodal sensing. The author concluded that the use of sensing devices can improve the detection of extravasation. These devices have the potential to reduce human error and allow more responsive care. However, spreading infections in this review is an issue that will be assessed when research with large sample sizes is conducted using sensing devices.
Barriers and Contributing to Adopting Sensing Devices
One of the barriers to adopting sensing devices to prevent extravasation is resources. From the perspective of nurses, there are time constraints. Nurses need to be trained to use the equipment, perform tests, and interpret results. For example, Gautam et al. (2017) in their experiment (n = 100) argue that a single sensor device such as ultrasound requires nurses to perform color-flow injection tests, which consumes their time and requires expertise to interpret results. From the perspective of a hospital, there are resource constraints. For example, some sensor devices are patch-based and expensive for medium and small-sized hospitals (Hirata et al., 2023). Commercialization is another issue particularly for skin deformation and temperature-based devices (Hirata et al., 2023).
Despite the barriers, a major contributor to the adoption of sensing devices is accuracy and real-time data regarding vascular function. Gautam et al. (2017) found that color-flow injection is 100% sensitive and specific respectively. Likewise, Du et al. (2017) found that optical devices are 93% sensitive and 95% specific while also providing real-time data after every 1.2 seconds. This motivates healthcare providers to adopt these technologies to identify issues like extravasation, reduce infections, and improve treatment.
Conclusion
Prevention of extravasation is crucial for favorable patient outcomes. This can benefit in preventing infection, reducing the length of stay, and improving resource allocation. Clinical education is beneficial to perform cannulation and prevent infections. Sensing devices (single and multi) have the potential to track vascular functions. Resource constraints are an issue in the adoption of sensing devices, but these are outweighed by accuracy and real-time data benefits.
