Best Practices in the Prevention and Management of Intraoperative Intravenous Infiltration

Intravenous (IV) infiltration is a common complication of IV therapy, with complications that can range from mild swelling to damage to surrounding tissues and compartment syndrome. Intraoperative detection is particularly difficult when patients are anesthetized and unable to report symptoms or positioned in a way that may limit visibility of hands to appreciate early infiltration. We present the case of an 83-year-old male who developed hand swelling at the IV site during a right craniotomy for meningioma removal, initially unrecognized due to hand tucking for surgical positioning. This case highlights the need for standardized IV infiltration prevention and management strategies in the surgical setting, in which there may be restricted access or visualization of IV catheters. Quality improvement strategies in this setting would include approaches that promote catheter securement, regular monitoring of IV catheter sites, plans of action in the case of suspected infiltrated IVs, and interdisciplinary communication that may facilitate timely and organized interventions.