Journal of Pediatric Nursing (2015) xx, xxxxxx

The Effect of Intravenous Infiltration

Management Program for Hospitalized Children
Soon Mi Park PhD, RN a , Ihn Sook Jeong PhD, RN b,, Kyoung Lae Kim RN a ,
Kyung Ju Park RN a , Moon Ju Jung RN a , Seong Suk Jun PhD, RN b
a

Department of Nursing, Pusan National University Yangsan Hospital, Yangsan, South Korea
College of Nursing, Pusan National University, Yangsan, South Korea

Received 15 June 2015; revised 14 October 2015; accepted 18 October 2015

Key words:
Child;
Infusion therapy;
Management;
Infiltration;
Extravasation

Purpose This study aimed to identify the effect of IV infiltration management program among
hospitalized children.
Design and Methods: This was a quasi-experimental study with history comparison group design with
2,894 catheters inserted during 3 months comparison phase and 3,651 catheters inserted during
4 months experimental phase. The intervention was composed of seven activities including applying
poster, documentation of catheter insertion, parents education, making infiltration report, assessment of
vein condition before inserting catheter, appropriate site selection, and documentation of catheter
insertion, and assessment of peripheral catheter insertion site every shift. Data were analyzed using of
X2-test, Fisher's exact test.
Results: The infiltration incidence rate was 0.9% for experimental group and 4.4% for comparison
group, which was significantly different (x2 = 80.42, p b .001). The catheter maintenance period
(p = .035) and infiltration state (p = .039) were significantly different among participants with
infiltration between comparison and experimental groups.
Conclusions: IV Infiltration management program was founded to be effective in reducing the IV
infiltration incidence rate and increasing early detection of IV infiltration.
Practice Implications: Considering the effect of IV Infiltration management program, we recommend
that this infiltration management program would be widely used in the clinical settings.
2015 Elsevier Inc. All rights reserved.

INTRAVENOUS (IV) INFUSION is a process often

performed on hospitalized patients (Flippo & Lee, 2011;
Kagel & Rayan, 2003; Walter & Pitter, 2009). This
technique is an effective method for the administration of
some drugs, and is also used for delivery of drugs to pediatric
patients with absorption defects due to diarrhea, dehydration,
or peripheral blood vessel collapse. This method is also used
for pediatric patients who need to maintain a high blood drug
concentration, being infected with strains of bacteria with a
high resistance to antibiotics and therefore must receive

Corresponding author: Ihn Sook Jeong, PhD, RN.

E-mail address: jeongis@pusan.ac.kr.
http://dx.doi.org/10.1016/j.pedn.2015.10.013
0882-5963/ 2015 Elsevier Inc. All rights reserved.

medications through IV insertion for a certain period, and

require continuous pain relief.
Peripheral IV insertion is a basic nursing technique, but it
is also a complex and technically difficult procedure that
needs to be performed successfully within a limited time
(Thomas, 2007). IV insertion is particularly difficult in
children who have thin and weak blood vessels, and move
continuously due to the pain associated with insertion
(McCullen & Pieper, 2006). According to a previous
study, the success rates of peripheral IV insertion performed
on pediatric patients were 42.8% for the first trial, 39.7% for
the second trial, 37.5% for the third trial, and 38.8% for the
fourth trial (Peterson, Phillips, Truemper, & Agrawal, 2012).
According to a prospective study on patients in the

2
emergency room with an average age of 53 years, a success
rate of 79% for first insertion was observed along with a
total success rate of 98.6% (Sebbane et al., 2013). These
results indicate that the first trial success rate of peripheral
IV insertion for pediatric patients is very low compared to
that of adults, and the patients consequently become
more vulnerable to IV infiltration and extravasation
(hereafter IV infiltration) (Fang, Fang, & Chung, 2011;
Sung & Kim, 2007). IV infiltration causes inconvenience or
delay in treatment due to re-insertion into the vein, and may
also result in the need for surgery due to tissue damage
(Talbot & Rogers, 2011; Willsey & Peterfreund, 1997) or
cause permanent damage in pediatric patients (CliftonKoeppel, 2006). Therefore, primary prevention of IV
infiltration in the early stage is extremely important. An
effort to minimize damage by noticing injury at an early
stage is also needed.
Although the hospital also made efforts to prevent IV
infiltration among pediatric patients with the use of posters,
education of guardians, and IV infiltration monitoring, the IV
infiltration rate has not been decreased. Therefore, we have
developed and implemented an IV infiltration management
program by establishing a professional team for prevention
and effective management of IV infiltration in hospitalized
pediatric patients. This management program includes IV
infiltration prevention practices that have not been previously enforced in order to reduce the additional occurrence of
IV infiltration in this hospital.
The aim of this study was to evaluate the effectiveness of
a new IV infiltration management program by comparing the
occurrence rate of IV infiltration and characteristics of
pediatric patients with IV infiltration before and after
application of the program.

Methods
Research Design
This was a synchronized quasi-experimental study using a
historical control to analyze the rate of IV infiltration by
application of an infiltration and extravasation management
program for patients in a children's hospital, and to identify
the characteristics of pediatric patients with IV infiltration.

Study Participants
The participants in this study were children or teenagers 0
to 19 years old who received peripheral IV insertions when
hospitalized from August 1, 2011 to February 29, 2012 at a
children's hospital with 126 beds located in Yangsan city,
Korea. Patients who were hospitalized from August 1 to
October 31, 2011 formed the comparison group in this study
and did not participate in the IV infiltration management
program, representing a total of 2,894 cases of IV insertion.
Pediatric patients who were hospitalized from November 1,
2011 to February 29, 2012 formed the experimental group
which received care under the IV infiltration management
program, with a total of 3,651 cases of IV insertion.

S.M. Park et al.

Intervention
The Comparison Group
The comparison group received the routine usual care for
preventing IV infiltration. The specific care was as follows:
1. Posters on how to prevent IV infiltration were
displayed on the wall(s) of all patient rooms.
2. After IV catheter insertion, the nurses recorded the
date and time of IV catheterization, the size of IV
catheter, and the name of the practitioner at the site of
IV insertion.
3. After IV catheter insertion, the nurses educated the
patients' guardians by providing leaflets on how to
prevent IV infiltration. The guardians were asked to
touch the site of IV insertion, remember the feeling,
and make frequent observations to alert the nurses
when any abnormalities developed.
4. When IV infiltration occurred, nurses were supposed
to immediately stop the infusion, and assess the IV
infiltration site, and document this on an IV
infiltration record including demographics, IV infusion related characteristics (e.g., duration, site, size of
IV catheterization, and type of drug injected), and IV
infiltration related characteristics (e.g., stage and size
of skin damage).
The Experimental Group: The IV Infiltration
Management Program
The IV infiltration management program was applied to
the experimental group. This program was developed by the
research team composed of one pediatric nursing team
leader, three pediatric head nurses, and one nursing
professor. They reviewed articles and guidelines related to
the IV infiltration prevention and management of peripheral
intravenous infusion (Doellman et al., 2009; Earhart &
McMahon, 2011; European Oncology Nursing Society
(EONS), 2007; Hadaway, 2007; Infusion Nurses Society,
2006; Ingram & Lavery, 2005). Because some of recommendations from the IV infiltration prevention guidelines
had already been implemented, the team selected other
recommendations which had not been included in the
original IV infiltration prevention programs. The additional
recommendations were as follows:
1. Prior to IV catheter insertion, the nurse assessed the
condition of the patients' blood vessel and selected the
best vein for peripheral administration. Small size and
poor condition of veins were one of the factors
contributing to the risk of infiltration (Doellman et al.,
2009). Then, he/she decided whether he/she could
perform IV catheterization by himself/herself or
referred to the IV insertion team. When insertion
failed twice, the nurse was supposed to refer to the IV
insertion team to complete the task. In the first step,
there was no formal assessment tool. The nurse simply

Inttravenous Infiltration Management Program

assessed the vein of the patients, and then they made a
decision regarding whether they performed IV catheterization by themselves or referred to the IV
insertion team.
2. Prior to IV catheter insertion, the nurse assessed the
patient's movement or thumb sucking habits, and
selected appropriate IV sites to secure. An unstable
catheter, poor securing of the IV site, and uncooperative movement by the patient were factors contributing to the risk of infiltration (Doellman et al., 2009).
In the second step, there was also no formal
assessment tool. The nurse just observed and asked
care givers about the patients' activities.
3. After IV catheter insertion, the nurse monitored the IV
site at least once every shift and documented the IV
insertion record. There were two types of IV
insertion record: one for the beginning and the other
one for maintenance. The IV insertion record
included general characteristics of the subject, the
date of insertion, the site of insertion, the size of the
catheter, and the type of infusate, and the drugs
injected. Nurses who performed IV catheterization at
the start entered this into the IV insertion record (for
start) and other staff nurses examined the IV site at
least once during their shift and made entries in the IV
insertion record (for maintenance).

Study Instrument
The study instrument was the data collection form,
consisting of 3 parts; demographics of study participants, IV
infusion related characteristics, and IV infiltration related
characteristics. The demographics included gender and age.
The IV infusion related characteristics were duration, site,
size of the IV catheterization, and the type of drug injected.
The IV infiltration related characteristics included stage of
IV infiltration and type of skin damage incurred. The stage of

Table 1

Infiltration criteria used for this study.

Stage Symptoms
0

1
2

Absence of redness, warmth, pain, swelling, blanching,

mottling, tenderness or drainage. Flushes with ease (no
IV infiltration).
Absence of redness, swelling. Flushes with difficulty.
Pain at site.
Slight swelling (less than 1 inch) at site. Presence of
redness. Pain at site. Good pulse below site. 12 second
capillary refill below site.
Moderate swelling (1 to 6 inches) above or below site.
Blanching. Pain at site. Good pulse below infiltration
site. 12 second capillary refill below infiltration site.
Severe swelling (more than 6 inches) above or below
site. Blanching. Pain at site. Decreased or absent pulse.
Capillary refill greater than 4 seconds. Skin cool to
touch. Skin breakdown or necrosis.

3
IV infiltration was scored on a scale of 0 to 4 by using
Flemmer and Chan (1993)'s criteria, where 0 indicated no
IV infiltration while 1 to 4 indicated the extent of effusion of
fluid that had occurred. Larger number associated with more
severe IV infiltration occurred (Table 1). Flemmer and Chan
(1993)'s criteria were easy to grade by observation and touch
of IV sites. However, it was not clear from their criteria what
size of swelling was defined as slight, moderate, and severe.
Thus, we defined the size of swelling as slight when it was
less than 1 inch, moderate when it was 1 to 6 inches, and
severe when it was greater than 6 inches, based on the
Infusion Nurses Society (2006) criteria.

Study Procedure
This study was conducted after obtaining approval from
the Institutional Review Board of Pusan National University
Yangsan Hospital (05-2011-057). First, the IV infiltration
management program was introduced to nurses working in
the pediatric department of the study hospital four times, and
the head nurse or nurse in charge monitored whether the
program has been applied in clinical practice. Data were
collected prospectively and retrospectively by one of the
researchers. Data were collected prospectively by using the
IV insertion record and IV infiltration record for the
experimental group, and retrospectively from the IV
infiltration record for the comparison group. The IV
insertion record and IV infiltration record were filled in by
staff nurses and the staging of IV infiltration was graded by
staff nurses. For this, head nurses educated staff nurses on
how to grade the staging of IV infiltration by using
PowerPoint slides, and staff nurses graded the staging of
IV infiltration for the patients, which was confirmed by the
head nurses before collecting data to enhance the inter-observer reliability.

Data Analysis
SPSS Win (version 18.0) was used for data analysis, and
a two-tailed test with a significance level () of 0.05
was performed.
1) IV infiltration rate was calculated according to the
standard method of the Infusion Nurses Society
(2006). A chi-square or Fisher's exact test was

Table 2 Infiltration incidence rate between comparison and

experimental groups.
Variables

Comparison Experimental
group
group

Number of
2894
intravenous
catheter insertion
Number of infiltration 127
Infiltration incidence 4.4
rate (%)

3651

34
0.9

x2

80.42 b .001

S.M. Park et al.

performed to evaluate differences in IV infiltration
rate between two groups.

IV infiltration rate %
number of IV infiltration occurrence=number of total
IV insertions  100

2) The demographics, IV infusion related characteristics,

and IV infiltration related characteristics of patients
with IV infiltration were analyzed with frequency and
percentage, or average and standard deviation.

Results
IV Infiltration Rates
For the comparison group, the number of total IV
insertions was 2894, the number of IV infiltration occurrences was 127, and the IV infiltration rate was 4.4%. For the
experimental group, the number of total IV insertions was
3651, the number of occurrences of IV infiltration was 34,
and the IV infiltration rate was 0.9%. A significant statistical
difference in the IV infiltration rate was observed between
the two groups (X2 = 80.42, p b .001; Table 2).

Characteristics of Participants With IV Infiltration

Demographics
Demographics of participants with IV infiltration are
listed in Table 3. Among the patients with IV infiltration,
58.3% of the comparison group and 67.6% of the
experimental group were male. In addition, 34.6% of the
comparison group and 23.5% of the experimental group were
less than 1 year old and considered infants. One to 3 year old
toddlers were 10.2% and 32.4%, respectively, thus the age
distributions of the two groups were significantly different
(X2 = 14.09, p = .007).
IV Infusion Related Characteristics
IV infiltration related characteristics of the participants
with IV infiltration are listed in Table 4. The most frequent
duration of IV catheterization was 24 to 48 hours, accounting for 31.6% of the comparison group and 44.0% of the

experimental group. The period that differed most significantly between the two groups was 48 to 72 hours with
29.1% for the comparison group and 2.9% for the
experimental group. A significant difference in the duration
of IV catheterization was observed between the two groups
(X2 = 11.97, p = .035).
The most common intravenous insertion site was the back
of the hand, with 48.8% of the comparison group and 50% of
the experimental group. The location of the greatest
difference between the two groups was the wrist, with
7.9% for the comparison group and 20.6% for the
experimental group. However, there was no significant
statistical difference in insertion site between the two groups.
For the size of the IV catheters, 24G was used
more frequently than 22G and there was no significant
difference in the effect of the size of IV catheters between the
two groups.
The most frequently injected fluid was 5% dextrose with
59.7% of the comparison group and 44.1% of the
experimental group. The most frequently administered
antibiotic was cefotaxime, including 48.0% of the comparison group and 29.4% of the experimental group. There was
no significant difference in the fluid types and drugs injected
between the two groups.
IV Infiltration Related Characteristics
IV infiltration related characteristics of the participants
with IV infiltration are listed in Table 5. The most frequent
IV infiltration stage was stage 2 with 74.0% of the
comparison group and 76.4% of the experimental group. The
IV infiltration stage associated with the greatest difference
between the two groups was stage 3 with 20.5% of the
comparison group and 5.9% of the experimental group along
with stage 1 with 3.1% and 11.8%, respectively. A
significant difference was observed between the two groups
(X2 = 8.38, p = .039).
No damage to the skin was observed most frequently,
and accounted for 96.8% of the comparison group and
94.1% of the experimental group. This difference was
not significant.

Discussion
Table 3 Demographic characteristics among participants with
infiltration between control and experimental groups.
Characteristics

Gender

Male
Female
Age (year) b 1
1 b 3
3 b 6
6 b 12
12 b 19

Comparison Experimental x2
group
group
(n = 34)
(n = 127)
n (%)

n (%)

74
53
44
13
24
31
15

23 (67.6)
11 (32.4)
8 (23.5)
11 (32.4)
3 (8.8)
5 (14.7)
7 (20.6)

(58.3)
(41.7)
(34.6)
(10.2)
(18.9)
(24.4)
(11.8)

0.99

.321

14.09 .007

This study was conducted in order to evaluate the

effectiveness of the new IV infiltration management program
by comparing the occurrence rate of IV infiltration and
characteristics of pediatric patients with IV infiltration before
and after application of the program. In this study, three new
preventive practices for IV infiltration management were
added to the existing nursing practice performed in the study
hospital; assessing the condition of the patients blood vessel
and referring to the IV insertion team, selecting the best IV
sites for fixation, and assessing the IV site at least once per
every shift.
Based on the results, the IV infiltration rate was
significantly lower in the experimental group than the
comparison group. In fact, the IV infiltration rate for the

Inttravenous Infiltration Management Program

Table 4

Infusion therapy related characteristics among participants with infiltration between control and experimental groups.
Comparison group (n = 127) Experimental group (n = 34) x2

Characteristics

n (%)
0 ~ b 24
31 (24.4)
24 ~ b 48
40 (31.6)
48 ~ b 72
37 (29.1)
72 ~ b 96
15 (11.8)
96 ~ b 144
4 (3.1)
Insertion site
Dorsum of hand
62 (48.8)
Wrist
10 (7.9)
Forearm
15 (11.8)
Brachium
2 (1.6)
Instep
33 (26.0)
Ankle
5 (3.9)
Catheter size
24G
120 (98.4)
22G
2 (1.6)
Hypertonic fluid administered Dextrose 5%
75 (59.1)
Dextrose 10%
10 (7.9)
TPN
12 (9.5)
Isotonic fluid administered
Sodium chloride 0.225% 28 (22.0)
NS
13 (10.2)
Antibiotics administered
Cefotaxime
61 (48.0)
Sullbacillin
26 (20.5)
Shincef
10 (7.9)
Vancomycin
9 (7.1)
Other medications administered Ambroxol
64 (50.4)
15% Mannitol
13 (10.2)
Phenytoin
10 (7.9)
Catheter maintenance (hours)

n (%)
11 (32.3)
15 (44.0)
1 (2.9)
4 (11.8)
3 (8.8)
17 (50.0)
7 (20.6)
2 (5.9)
1 (2.9)
6 (17.7)
1 (2.9)
33 (97.1)
1 (2.9)
15 (44.1)
2 (5.9)
5 (14.7)
7 (20.6)
3 (8.8)
10 (29.4)
5 (14.7)
2 (5.9)
1 (2.9)
12 (35.3)
2 (5.9)
1 (2.9)

11.97 .035

6.12

.295

1.00

.381

1.54

0.03

3.77
0.57

2.45

.214
1.000
.359
.855
1.000
.052
.449
1.000
.690
.117
.740
.460

TPN: total parenteral nutrition NS: normal saline.

Fisher's exact test.

comparison group (4.4%) was considered very low when

compared to the two previous research studies conducted in
South Korea by 9.3% (Kim, 2006) and by 23.7% (Sung &
Kim, 2007). IV infiltration rate for the experimental group
(0.9%) was surprisingly lower than reported in the previous

Table 5 Infiltration related characteristics among participants

with infiltration between comparison and experimental groups.
Comparison Experimental x2
group
group
(n = 127)
(n = 34)

Characteristics

n (%)
Stage of
infiltration

1 point

2 point
3 point
4 point
Dermatologic None
injury
Erosion
Uncer/
Necrosis

4 (3.1)

n (%)
4 (11.8)

8.38 .039

94 (74.0) 26 (76.4)
26 (20.5) 2 (5.9)
3 (2.4)
2 (5.9)
123 (96.8) 32 (94.1)

1.06 .589

3 (2.4)
1 (0.8)

1 (2.9)
1 (2.9)

studies. We could provide two explanations for this result.

First, this study's hospital was approved by the Joint
Commission International and Korea Institute for Healthcare
Accreditation and has tried to minimize the occurrence of IV
infiltration. Second, selection of an appropriate vein and IV
site was very important. The largest, softest, and most pliable
vein was the best choice for avoiding IV infiltration
(European Oncology Nursing Society (EONS), 2007), and
no curvature, no joint area was good for securing the IV
catheter (European Oncology Nursing Society (EONS),
2007; Hadaway, 2007). The new IV infiltration program
included selection of the best vein and IV sites for fixation as
a recommended practice, and assessing the IV site often and
regularly.
IV infusion related characteristics among patients with IV
infiltration were analyzed to further evaluate the specific
effects of the program. Characteristics that differed significantly between the two groups were patient age, duration of
IV catheterization, and IV infiltration stage. Patient age was
categorized as 0 to 1 year old (infants), 1 to 3 years old
(toddlers), 3 to 6 years old (preschoolers), 6 to 12 years old
(middle childhood), and 12 to 19 years old (teenagers). IV
infiltration showed the highest incidence in infants in the
comparison group, and in toddlers in the experimental group.

6
This result indicating that the lower age group showed higher
IV infiltration was consistent with the previous evidence that
using a small blood vessel is a well-known risk factor for IV
infiltration (European Oncology Nursing Society (EONS),
2007). However, the reason for the difference in age
distribution between the two groups could not be easily
explained. We could assume that the new IV infiltration
program was very effective in reducing the risk of infants
with very high risk of IV infiltration, but was less effective in
toddlers because they were likely to be more active and able
to move more freely than infants (Sauerland, Engelking,
Wickham, & Corbi, 2006).
For IV infiltration stage, the experimental group showed
higher in 1 point and less in 3 points than the comparison
group, suggesting that IV infiltration was detected at an
earlier stage in the experimental group than the comparison
group. Thus, it was suggested that although the IV
infiltration management program could not prevent occurrence of IV infiltration, it was seemingly helpful for early
detection of the condition. When it failed to prevent IV
infiltration, the IV site were to be monitored with detection at
as early stage as possible to reduce the size of skin damage
(European Oncology Nursing Society (EONS), 2007). In this
program, assessing the peripheral catheter insertion site
every shift appeared to be the most important attribute to
early detection of IV infiltration.
Less than 48 hours of the duration of IV catheterization
was 56% of the comparison group, and 76% of the
experimental patients. That is, the duration of IV catheterization was shorter in the experimental group than the control
group. Considering that the patients analyzed had IV
infiltrations, this result may support early detection of IV
infiltration among the experimental group. Thus, the IV
infiltration management program which enforced monitoring
the IV site at least once per every shift and recording the
findings on the sheets was helpful in detecting the possibility
of IV infiltration earlier and more regularly.
This study is very significant as it provided a set of
nursing practices which can actively prevent occurrence of
IV infiltration. However, the following limitations should be
considered. First, this study was conducted in one children's
hospital and monitored the occurrence of IV infiltrations for
3 months before and after the program. Thus, generalization
of the results of this study was limited. This investigation is
recommended to be repeated in various institutions for
longer periods. Second, the stage of IV infiltrations was
based on the records made by nurses in charge of patient
care. Although all nurses working at this hospital received
training on how to evaluate the stage of IV infiltrations, we
did not assess the consistency in measuring the stage among
the nurses, which could increase the possibility of measurement error. Third, the IV infiltrations management program
was composed of 3 nursing practices. We evaluated the
overall effects of the program, but the individual effect of
each plan was not assessed. Fourth, while it was recommended to assess the peripheral IV site every hour for

S.M. Park et al.

children when infusing (Infusion Nurses Society, 2006;
Masoorli, 2003) and every four hours when capped or
locked, we assessed the IV site at least once per shift if the IV
was infusing, and did not monitor IV site if the IV was
locked/capped. More frequent assessment would be helpful
to increase the earlier detection of IV infiltration.

Conclusion
As a result of implementing the 4-month IV infiltration
management program for pediatric patients receiving
peripheral IV infusion at a children's hospital, the occurrence
of IV infiltrations was less than 1%, which was significantly
lower than that of the comparison group who did not receive
the program, suggesting that the program may improve
prevention. And, the IV infiltration management program
was helpful in detecting occurrence of IV infiltration at the
early stage. Further studies to determine the individual effect
of the IV infiltration management program and for selection
of the most effective method are recommended.

Acknowledgments
This research was supported by Basic Science Research
Program through the National Research Foundation of Korea
(NRF) funded by the Ministry of Science, ICT and future
Planning (2015R1A2A2A04003415).

References
Clifton-Koeppel, R. (2006). Wound care after peripheral intravenous
extravasation: What is the evidence? Newborn and Infant Nursing
Reviews, 6, 202211. http://dx.doi.org/10.1053/j.nainr.2006.10.001.
Doellman, D., Hadaway, L., Bowe-GeAddes, L. A., Franklin, M., LeDonne, J.,
Papke-O'Donnel, L., ... Stranz, M. (2009). Infiltration and extravasation.
Journal of Infusion Nursing, 32, 203211.
Earhart, A., & McMahon, P. (2011). Vascular access and contrast media.
Journal of Infusion Nursing, 34, 97105. http://dx.doi.org/10.1097/
NAN.0b013e31820b4a11.
European Oncology Nursing Society (EONS) (2007). Extravasation guidelines 2007. Brussels, Belgium: EONS (Retrieved from http://www.
cancernurse.eu/documents/EONSClinicalGuidelinesSection6-en.pdf).
Fang, L., Fang, S. H., & Chung, Y. H. (2011). Factors affecting the
unplanned peripheral reinsertion in pediatric patients from a teaching
hospital in Taiwan. Journal of Infusion Nursing, 34, 366372. http://dx.
doi.org/10.1097/NAN.0b013e318230661c1.
Flemmer, L., & Chan, J. S. (1993). A pediatric protocol for management of
extravasation injuries. Pediatric Nursing, 19, 355358.
Flippo, P. L., & Lee, J. (2011). Clinical evaluation of the Sorbaview Shield
securement device used on peripheral intravenous catheters in the acute
care setting. Journal of the Association of Vascular Access, 16, 9598.
http://dx.doi.org/10.2309/java.16-2-6.
Hadaway, L. (2007). Infiltration and extravasation. American Journal of
Nursing, 107, 6172. http://dx.doi.org/10.1097/01.NAJ.0000282299.
03441.c7.
Infusion Nurses Society (2006). Infusion nursing standards of practice.
Journal of Infusion Nursing, 29, S1S92.
Ingram, P., & Lavery, I. (2005). Peripheral intravenous therapy: Key risks
and implication for practice. Nursing Standard, 19, 5564. http://dx.
doi.org/10.7748/ns2005.07.19.46.55.c3923.
Kagel, E. M., & Rayan, G. M. (2003). Intravenous catheter complications in
the hand and forearm. The Journal of Trauma Injury, Infection, and
Critical Care, 56, 123127.

Inttravenous Infiltration Management Program

Kim, H. J. (2006). Factors related to the restart PIV in hospitalized
children-data from patients cared by the IV team nurses. (Unpublished
master's thesis) Seoul: Younsei University.
Masoorli, S. (2003). Pediatrics: Small children at high risk. Journal of the
Association of Vascular Access, 8, 4243.
McCullen, K. L., & Pieper, B. (2006). A retrospective chart review of risk
factors for extravasation among neonates receiving peripheral intravascular
fluids. Journal of Wound Ostomy Continence Nursing, 33, 133139.
Peterson, K. A., Phillips, A. L., Truemper, E., & Agrawal, S. (2012). Does
the use of an assistive device by nurses impact peripheral intravenous
catheter insertion success in children? Journal of Pediatric Nursing, 27,
134143. http://dx.doi.org/10.1016/j.pedn.2010.10.009.
Sauerland, C., Engelking, C., Wickham, R., & Corbi, D. (2006). Vesicant
extravasation part 1: Mechanisms, pathogenesis, and nursing care to
reduce risk. Oncology Nursing Forum, 33, 11341141. http://dx.doi.
org/10.1186/06.ONF.1134-1141.
Sebbane, M., Claret, P. G., Lefebvre, S., Mercier, G., Rubenovitch, J.,
Jreige, R., ... de La Coussaye, J. E. (2013). Predicting peripheral venous

7
access difficulty in the emergency department using body mass index
and a clinical evaluation of venous accessibility. The Journal of
Emergency Medicine, 44, 299305. http://dx.doi.org/10.1016/j.
jemermed.2012.07.051.
Sung, S. H., & Kim, H. S. (2007). Risk factors of intravenous infiltration in
children. Clinical Nursing Research, 13, 6172.
Talbot, S. G., & Rogers, G. F. (2011). Pediatric compartment syndrome
caused by intravenous infiltration. Annals of Plastic Surgery, 67,
531533. http://dx.doi.org/10.1097/SAP.0b013e3182085915.
Thomas, J. (2007). Standard practice and evolving trends in pediatric
intravenous access. Air Medical Journal, 26, 811. http://dx.doi.org/10.
1016/j.amj.2006.10.006.
Walter, Z., & Pitter, D. (2009). Peripheral venous catheters: An underevaluated problem. International Journal of Antimicrobial Agents, 34,
S38S42. http://dx.doi.org/10.1016/S0924-8579(09)70565-5.
Willsey, D. B., & Peterfreund, R. A. (1997). Compartment syndrome of the
upper arm after pressurized infiltration of intravenous fluid. Journal of
Clinical Anesthesia, 9, 428430.