Infiltration (medical)

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Infiltration is the diffusion or accumulation (in a tissue or cells) of substances not normal to it or in amounts in excess of the normal. The material collected in those tissues or cells is also called infiltration.

Infiltration is sometimes used to define the invasion of cancer cells into the underlying matrix or the blood vessels.

1 Etiology
2 Signs/Symptoms
3 Clinical Criteria for Grading
4 Nursing Treatment
5 References

[edit] Etiology

Infiltration may be caused by:

Puncture of distal vein wall during venipuncture
Puncture of any portion of the vein wall by mechanical friction from the catheter/needle cannula
Dislodgement of the catheter/needle cannula from the intima of the vein which may be a result of a poorly secured IV device or the selection of which venous site is used.
Improper cannula size or excessive delivery rate of the fluid

[edit] Signs/Symptoms

The signs and symptoms of infiltration include:

Inflammation at or near the insertion site with swollen taut skin with pain
Blanching and coolness of skin around IV site
Damp or wet dressing
Slowed or stopped infusion
No backflow of blood into IV tubing on lowering the solution container.

[edit] Clinical Criteria for Grading

Grade	Skin appearance	Edema	Skin on examination	Symptoms
0.	No symptoms
1.	Skin blanched	Edema <1 inch in any direction	Cool to touch	With or without pain
2.	Skin blanched	Edema 1-6 inches in any direction	Cool to touch	With or without pain
3.	Skin blanched, translucent	Gross edema >6 inches in any direction	Cool to touch	Mild-moderate pain Possible numbness
4.	Skin blanched, translucent Skin tight, leaking Skin discolored, bruised, swollen	Gross edema >6 inches in any direction Deep pitting tissue edema	Circulatory impairment	Moderate-severe pain Infiltration or any amount of blood product, irritant, or vesicant

[edit] Nursing Treatment

The use of warm compresses to treat infiltration has become controversial. It has been found that cold compresses may be better for some infiltrated infusates and warm compresses may be more effective for others It has also been documented that elevation of the infiltrated extremity may be painful for the patient. To act in the best interest of the patient, following IV infiltration, consultwith the physician for order regarding compresses and elevation.