Addressing the hidden costs of IV infiltration and extravasation in health care

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Nearly one in four patients admitted to U.S. hospitals will experience harm, according to a study published last year in the New England Journal of Medicine. And medical error is the nation’s leading cause of accidental death, with conservative estimates of more than 250,000 patients dying annually from preventable medical harm.

Infiltration and extravasation injuries from intravenous (IV) therapy are common but often under-recognized complications that can have serious consequences for patients and significant financial costs for health care organizations. In fact, up to 50% of inserted IVs will fail.

Andrew Barton RN, BSc, NMP

There is a rising incidence of infiltration/extravasation injuries around the globe. With the increasing use of IV therapies, as patients are living with complex medical conditions requiring IV treatment, the incidence of these injuries is growing. For instance, my employer, the U.K. National Health Service, received 467 claims for infiltration/extravasation injuries over a 10-year period, costing 16 million pounds in damages and legal fees.

A lack of awareness and reporting is also a key issue for health care organizations. Poor recognition of infiltration/extravasation when it occurs has led to misdiagnosis and underreporting, making it difficult to quantify the actual rate and cost of these injuries. This is being exacerbated by the global health care staffing shortage.

In the U.K., treating severe infiltration/extravasation injuries can cost tens of thousands of pounds per case due to extended hospital stays, additional procedures and outpatient follow-up care. One case study estimated costs of nearly 39,000 pounds for a single patient who experiences an IV injury.

As a result, we have designed new guidelines and toolkits including ones from the National Infusion and Vascular Access Society that aim to improve awareness, prevention, recognition and treatment of these injuries. In the U.S., Rep. Nanette Diaz Barragán has introduced H.R.9377, the National Patient Safety Board Act of 2022. The board would model the efforts of the National Transportation Safety Board and the Commercial Aviation Safety Team and would exist as a new independent federal agency dedicated to improving and promoting public health and welfare by monitoring and anticipating adverse events and creating recommendations and solutions to prevent medical error.

The economic burden for any clinical organization that routinely places IVs is substantial. Beyond the direct treatment costs, infiltration/extravasation injuries lead to drug wastage, delayed treatments, extended hospital stays and potential litigation costs. The full financial impact is likely much higher than current estimates.

Most importantly, the impacts on patients are severe. These injuries can cause permanent tissue damage, scarring, loss of function and significant emotional distress. Some patients require months of follow-up care and may never fully recover.

Certain medications present a higher risk than others when administered intravenously. Vesicant drugs like chemotherapy agents, vasopressors, and solutions with nonphysiological pH or high/low osmolarity are particularly dangerous if extravasated. Extra precautions are needed when administering these medications.

This is why early detection is critical. Recognizing the signs of infiltration/extravasation early and taking prompt action can significantly reduce the severity of injuries. However, detection can be challenging, especially in unconscious or intubated patients.

Add to this the fact that many health care providers lack adequate training on recognizing and managing infiltration/extravasation. Improved education and standardized protocols are immensely needed across all clinical areas where IV therapy is administered.

Luckily, monitoring technology shows promise. A recent trial of proprietary technology made by U.S.-based company ivWatch demonstrated that continuous monitoring of IV sites can identify infiltrations before they become clinically apparent, potentially preventing many injuries. Cost-benefit analysis favors prevention like this. While implementing new monitoring technology has up-front costs, the potential savings from preventing even a small number of serious infiltration/extravasation injuries likely justifies the investment for many health care organizations.

As IV therapy continues to serve as a lifeline in modern medicine, infiltration and extravasation injuries represent a significant but often overlooked patient safety issue with substantial clinical and economic impacts. To improve patient safety and reduce unnecessary health care costs, health care leaders should consider implementing comprehensive strategies for improving awareness, education and prevention alongside emerging monitoring technologies to tackle this critical issue.

Andrew Barton, RN, BSc, NMP, is the chair of the National Infusion and Vascular Access Society, an organization that aims to represent IV therapy and vascular access practice within the U.K. to ensure that national policy and guidelines align with best practice and are evidence-based. He is a nurse consultant for IV therapy and vascular access and leads a team of infusion nurses, vascular access nurses and home IV therapy nurses who are all part of an infusion and vascular access service unit.