Peripheral IV albumin infiltration management
Albumin leakage into surrounding tissue from a peripheral IV is managed first by immediate cessation of infusion, site assessment for evolving tissue injury, and re-direction of therapy to a new IV site. [1][2] Neurovascular compromise and suspected compartment syndrome require urgent escalation to surgical/plastic evaluation. [1][2]
Initial assessment and classification
- Extravasation severity assessment should consider infused volume, time course of symptoms, and local swelling plus neurovascular findings. [2]
- Infiltration is characterized by leakage of a non-vesicant solution into surrounding tissue and can still cause local inflammation and compartment syndrome. [1]
- Injury progression can occur hours after the event. [2]
Immediate actions at first recognition
- Stop administration immediately and transfer fluids/medications to another IV site. [1]
- Disconnect tubing from the catheter. [1]
- Attempt aspiration of residual infusate from the catheter with a small syringe. [1][2]
- Gently remove the catheter when feasible after aspiration, using measures that reduce risk of epidermal stripping if swelling is severe. [1]
- Elevate the affected limb to approximately 45° for 24 to 48 hours when feasible. [1]
- Do not flush the intravenous device after extravasation/infiltration. [2]
- Avoid routine warm or cold compresses unless directed by a provider or clinical nurse specialist. [1][2]
Ongoing monitoring and documentation
- Mark and photograph the entire area of injury. [2]
- Provide ongoing reassessment of swelling and symptoms because progression can occur. [2]
- Complete an incident report and notify the appropriate clinical team per local policy. [1]
Indications for antidotes and targeted therapies
- Antidotes and specific washout protocols are indicated for higher-risk infusates or for clinically apparent tissue injury. [2]
- Hyaluronidase may be considered for severe extravasation to promote dispersion of extravasated fluid when indicated by protocol or local specialist guidance. [2]
- Phentolamine and topical nitroglycerin are reserved for vasopressor-associated ischemic injury and are not indicated for non-vasoactive infiltrations. [1]
Washout procedure and escalation criteria
- Suspected compartment syndrome or threatened limb perfusion is a surgical emergency requiring immediate referral to the relevant surgical/plastic team. [1][2]
- Washout procedures should be planned when severity thresholds are met per local guidance, commonly within 12 hours of meeting criteria. [2]
Common pitfalls to avoid
- Continuing the infusion after early recognition is a key preventable error; infusion should stop at the first sign. [1]
- Flushing the line after extravasation/infiltration should be avoided. [2]
- Using warm or cold compresses without protocol direction can be inappropriate depending on infusate category and injury risk. [1][2]
Treatment goals
- Prevent progression to neurovascular compromise by early cessation, elevation, aspiration, and close reassessment. [1][2]
- Maintain limb perfusion and detect compartment syndrome early through serial neurovascular checks and symptom surveillance. [1][2]