When Can IV Failure Lead to Amputation?

While some IV infiltrations and extravasations resolve within a few days or weeks, there
are cases where the complications related to IV failure from infiltrations and
extravasations are severe enough to require surgery or even amputation.

What is Compartment Syndrome?

Most IV-related amputations seem to arise from a condition known as compartment
syndrome.
Compartments are spaces in the body where muscles, nerves, and blood vessels can
become compressed by injury, trauma, or the build-up of fluids. This compression
decreases blood flow in the compartment, leading to nerve and tissue damage.
There are 36 compartments in the arms and legs, but the most commonly affected
areas are in the lower leg or the forearm, where IVs are often inserted.

How Infiltration Can Lead to Compartment Syndrome

When an IV infiltrates, the fluid that should have been carried through the veins ends up
seeping into the tissues surrounding the IV site. The buildup of fluid can lead to
compartment syndrome.
Symptoms usually begin within 6 to 8 hours, but sometimes may not be seen for up to
48 hours. The most common symptom is acute pain at the affected compartment, often
described as throbbing. Patients may also have tingling or numbness around the
compartment, or suffer skin blistering, swelling, or discoloration.

Treatment for Compartment Syndrome

The standard treatment for compartment syndrome is a fasciotomy; the cutting into the
affected compartment to relieve pressure and restore blood flow.
But if the damage to the tissue is too severe, amputation of the limb from just above the
compartment may be the only option. This is because the increased pressure in the
compartment can lead to tissue death, which releases toxins into the bloodstream that
can cause massive, and potentially fatal, infection.
How to Be Your Own IV Advocate
Early detection is critical in the treatment of compartment syndrome. The best way to
prevent these complications from occurring is to catch and treat infiltrations and
extravasations as quickly as possible.
Your medical team will monitor your IV for signs of infiltration, but as patients and
patient advocates, you can help. You may see the red flags of IV failure before a nurse
does, or be concerned with continued pain or swelling after your release. If you see
anything you think is questionable, don’t be afraid to speak up and ask!

What is a Saline Flush and Why Do I Need One?

If you’re in the hospital and receiving medication through an IV, you should expect your
healthcare provider to use a saline flush before and after any medication is
administered.

What is a Saline Flush?

A saline flush is a mixture of salt and water that is compatible with your body’s fluids
and tissues. It is used to push any residual medication or fluid through the IV line and
into your vein. This keeps the PIV line clean and reduces the risk of infection or
occlusion.
If you are no longer receiving fluids or medications through your IV line, a saline flush
can also be used at scheduled times to make sure your IV line stays open and free from
any blood. This ensures that the catheter is still clear and available to use again if more
medications or fluids are needed later on.

How Does it Work?

First, your provider prepares the flush using a syringe and bottle of normal saline
solution – or uses a prefilled flush syringe that’s been prepared under sterile conditions
and is ready for use.
Next, your healthcare provider cleans the IV port or hub, connects an IV saline flush
syringe to the port, injects the flush solution into the IV line, and then starts the
medication drip if indicated. Before beginning another medication in the line, your
provider will flush the line again.

When Do You Flush an IV Line?

Flushes are usually scheduled once every eight hours, and before and after
administering medication through your IV line.
If you’re receiving several medications through the same line, flushing will be used in
between drugs to prevent mixing of medications that are incompatible. For IV lines that
are continuously in use, a saline flush isn’t needed; the infusing IV fluid itself prevents
clot formation.

What Does it Feel Like?

Flushing with saline should be painless if the tubing is in its proper place, although if the
saline isn’t warmed before use, you may feel a cold sensation.
Just because an IV flushes well, does not mean there isn’t a problem. A painful flush
may indicate an infiltration or phlebitis. Tell your provider right away if you feel any pain
or discomfort.