Tom Sharon
Avoid third-degree burns and permanent damage


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Infusion lines to blood vessels

The infusion lines deliver fluids, minerals, and nutrition directly into the blood vessels. Most intravenous (IV) lines are put in an arm (peripheral intravenous lines), but some go directly into the chest wall (central intravenous lines). One common problem is when a peripheral intravenous line infiltrates, meaning the vein ruptures and the intravenous liquids infuse into the surrounding tissues. This causes massive swelling and, if it continues, leads to a chronic ulceration. Some intravenous fluids are caustic, and infiltration results in almost immediate sloughing and third-degree burns. It is important to check the infusion entry site for swelling, redness, and heat. If any of these problems exist, a registered nurse must respond by closing off the line and removing it. If this does not happen within three minutes, dial the operator and page the nursing supervisor. This is an urgent matter, and the nurses must treat it as such.

I have reviewed hundreds of cases in which patients incurred third-degree burns and permanent damage to tendons and nerves, resulting in terrible scars, due to the nurses' failure to take immediate action with an infiltrated intravenous line. One such case was a newborn boy named Johnny. As is normally the case, one of the neonatal ICU nurses started an intravenous line in the baby's right foot. The intravenous fluid infiltrated and infused into the soft tissues of the foot for about four hours. Apparently, the nurse responsible for making hourly assessments of the intravenous site failed to do so. By making frequent observations, the nurse would have noticed that the child's foot was growing larger. The result was the equivalent of a third-degree burn and a permanent clubbing deformity.
Moreover, it is especially important to note that Johnny's mother was present the whole time. If she had known about the possibility of swelling caused by infiltration, she would have been able to get the nurse to intercede or summon the supervisor to take action. The greatest danger-to being hospitalized is being uninformed while relying totally on the "flawless" performance of the professional and ancillary staff.

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