Perioperative Intravenous Infiltration: From Recognition to Prevention

Peripheral intravenous (PIV) access is nearly universal in perioperative care and beyond. It is often regarded as low-risk. Yet perioperative PIV infiltration remains a persistent source of patient harm, particularly in anesthetized or sedated patients who cannot report early symptoms. Injuries range from transient soft tissue edema to severe complications, including skin necrosis, nerve injury, and compartment syndrome requiring surgical intervention. Furthermore, if the sole PIV access is nonfunctional, administration of life-saving rescue medications and transfusions may be delayed. Despite its frequency and potential severity, perioperative PIV infiltration remains inconsistently reported and understudied. This narrative review examines the epidemiology, mechanisms, prevention, detection, and management of perioperative PIV infiltration. We particularly emphasize its implications in high-risk populations, drug-specific injury mechanisms, and perioperative system vulnerabilities. We highlight gaps in evidence and propose priorities for future research and quality improvement.