Pediatric compartment syndrome caused by intravenous infiltration

The small diameter and fragility of infant veins increases the risk of intravenous (IV) fluid extravasation. Modern pump delivery systems, designed with pressure sensors to detect and respond to flow obstructions in the IV line, are in wide use to limit the amount of fluid that reaches the extravascular space. In some instances, the pump safety systems can fail to detect rising pressure and may lead to compartment syndrome.

Retrospective chart review of patients treated for extremity compartment syndrome as a result of an IV infiltration.

Three infants (mean age, 9 months) were identified. Each patient had a large volume of IV fluid delivered into the subcutaneous tissue through a pump infusion system. In all cases, the sensor failed to alarm and to disable the system, and the problem was identified only after routine nursing evaluation of the IV site. Findings included the following: tissue blanching, decreased capillary refill, and severely restricted active/passive motion of the affected extremity. Peripheral pulses were present in all patients. Compartment pressure elevation (>30 mm Hg) was confirmed prior to operative intervention by a slit catheter system. Fasciotomy was required in the hand and forearm of 2 patients, and of the thigh, leg, and foot in 1 patient. Each infant recovered full use of the extremity.

The reason that these pumps failed to detect the dangerously elevated pressures is unclear, but may be related to a combination of fluid dynamics and pump engineering. Routine nursing evaluation remains the gold standard for detection of these events.