Strategic Analysis of Fluid Extravasations to Improve Vascular Safety (SAFE IVS)

Peripheral intravenous infiltration and extravasation injuries (PIVIEs) in pediatric patients are a significant yet underrecognized source of preventable harm, often due to inconsistent detection and limited standardization. This study implemented a structured quality improvement initiative to enhance early detection, classification, and management of PIVIEs at C.S. Mott Children's Hospital, supporting the institution's goal of zero preventable harm.

This single-center, prospective quality improvement study was conducted at a 347-bed academic pediatric hospital from January 2023 to December 2024. All patients with a documented PIVIE were included. Key interventions included creation of a multidisciplinary PIVIE Prevention Task Force, standardized event review, development of a pediatric infusion agent risk classification algorithm, and updated antidote protocols. Outcomes measured included PIVIE reporting volume, antidote timeliness, and classification documentation. Descriptive statistics were used to assess trends. Following intervention, 628 PIVIEs were reported-a 465.8% increase from 111 events reported during the 2021-2022 period. Implementation of an institutional standard of care form and a centralized database improved documentation and expedited antidote administration. A pediatric-specific classification system was developed and applied to over 90 high-use agents, enabling risk-based clinical decision-making.

Interdisciplinary, structured interventions markedly improved reporting, documentation, and treatment of pediatric PIVIEs. Adoption of standardized classification tools and review processes may help hospitals reduce IV-related complications. Policymakers and accrediting bodies should consider incentivizing pediatric vascular safety metrics, supporting integration of pediatric-specific risk frameworks, and encouraging cross-institutional data sharing to drive broader improvements in care.