Risks for extravasation include factors relating to patients, procedures carried out and drugs administered.
Patient-related factors:
- Very young and elderly patients who have small and fragile veins
- Patients with thickened and damaged veins following repeated IV access, for example cancer patients
- Patients with veins that made venous access difficult (Kim et al 2020):
- Patients with excised lymph nodes, limb amputation, or closed vena cava
- Obese patients in which peripheral venous access is more difficult
- Patients who are unable to remain still e.g., young children or patients with behavioural issues
- Patients receiving anticoagulants may lose more blood if extravasation occurs
- Patients on sedatives or analgesics may not notice the early signs or symptoms of extravasation
- Procedure-related factors:
Inadequately trained or inexperienced staff
- Multiple attempts at cannulation
- Inappropriate selection of equipment such as type of catheter or size of needle
- Poor fixation technique
Drug-related factors: Drugs can be categorised for risk of tissue damage based on their osmolarity, pH and whether or not they are a vesicant
High-risk:
- Osmolarity >600 mOsm/L
- pH <4 or >9
- Vesicant drug
Moderate-risk:
- Osmolarity 450–600 mOsm/L
- pH 4 to 5 or 7.5 to 9
- Non-vesicant drug
Low-risk:
- Osmolarity <450 mOsm/L,
- pH 5 to 7.5
- Non-vesicant drug
