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Reducing extravasation and infiltration in the pediatric population: a best practice implementation project

Brandy Wilson^1,2, Linda Upchurch^1,2

¹School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.

JBI Evidence Implementation

|March 25, 2026

Insights

Implementing hourly assessments and education significantly reduced intravenous complications in pediatric patients. This evidence-based practice improves patient safety and care quality by preventing infiltrations and extravasations.

Area of Science:

Nursing Practice
Patient Safety
Pediatric Care

Background:

Peripheral intravenous (PIV) therapy is a common hospital procedure with frequent complications like infiltration and extravasation.
Evidence-based practices, including the Assess, Compare, Touch (ACT) method and rounding tools, are recommended to mitigate these risks.
Rising incidences of intravenous complications necessitate improved clinical practices.

Purpose of the Study:

To decrease infiltration and extravasation complications at PIV catheter sites in pediatric patients.
To implement and evaluate evidence-based practices for PIV management.
To improve the quality of care for pediatric patients receiving PIV therapy.

Main Methods:

Guided by the JBI Evidence Implementation Framework.
Conducted baseline and follow-up audits to assess adherence to PIV assessment policies.
Implemented educational strategies on hourly PIV assessment using ACT and a rounding tool.
Introduced an algorithm for managing extravasations and infiltrations.

Main Results:

Baseline audit showed only 9.09% hourly PIV assessment adherence using ACT.
No established protocol for managing extravasation/infiltration at baseline.
Post-implementation data on practice changes were collected via follow-up audit.
Nurse surveys indicated a need for enhanced education on managing PIV-related injuries.

Conclusions:

Continuing education and established protocols are crucial for improving PIV care in pediatric patients.
Strengthening staff knowledge and skills can effectively prevent PIV infiltrations and extravasations.
Evidence implementation projects can enhance the quality of care and patient safety.

Read full analysis

Abstract

Introduction:

Peripheral intravenous (PIV) therapy, the most common invasive procedure in hospitals, frequently results in complications. Infiltrations occur when infused fluids enter the surrounding tissue without harming the skin, while extravasations irritate the skin and tissue, occasionally necessitating surgical intervention. Evidence-based practices recommend the use of quality standards, such as Assess, Compare, Touch (ACT) and a 60-minute rounding tool to address the rising incidence of intravenous complications.

Objectives:

The objective of this evidence implementation project was to decrease the complications associated with infiltration and extravasation at the site of PIV catheters in pediatric populations.

Methods:

This project was guided by the JBI Evidence Implementation Framework. A baseline audit identified inconsistent adherence to policy, including the crucial hourly rounding to assess the infusion site. Barriers to best practice were identified and improvement strategies were implemented, including education on hourly PIV assessment using ACT and a rounding tool for nurses. Additionally, an algorithm for extravasations and infiltrations was implemented. A follow-up audit was conducted to determine changes in practice.

Results:

The baseline audit revealed that although 100% of PIV sites were properly stabilized with adhesive dressings, only 9.09% of catheters were assessed every hour using ACT. Additionally, 100% of catheters were removed and infusions stopped immediately after extravasation or infiltration, but none of the affected extremities were elevated. Only 27.27% of cases involved notifying a physician or nurse practitioner, and there was no established protocol for managing extravasation or infiltration. Survey results from 40 nurses showed that 72.5% felt educated on catheter securement and assessment, but only 52.5% had received education on managing PIV-related injuries.

Conclusions:

Continuing education and protocols can improve the quality of care of pediatric patients with PIV by strengthening staff knowledge and skills to prevent infiltrations and extravasations.

Spanish Abstract:

http://links.lww.com/IJEBH/A545.

Keywords:

extravasation infiltration medical complexity pediatric

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