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Practice Problem: Peripheral Intravenous Infiltrations and Extravasation (PIVIE) can cause severe skin and tissue damage. Prompt intervention helps prevent moderate or severe skin tissue damage. In the U.S. PIVIE complications can cost $10,895 versus $7,009 per patient without PIVIE. An Australian ED estimated the annual cost of PIV occlusion/infiltration and dislodgement of $14.01 million Australian dollars.

Quality event reviews demonstrated a staff knowledge deficit of treating extravasations per guidelines. Treatment could be delayed if the Vascular Access Team (VAT) was not available. Education on treatment of IV extravasation was needed to address this practice gap.

PICO(T) Question: In hospitalized pediatric patients can education and training a staff response team for IV extravasation treatment increase knowledge, confidence, and competence in providing the appropriate treatment and increase the percentage of extravasations treated per guidelines?

Literature/Evidence: Search strategy in the CINAHL (EBSCOhost) database used MeSH headings and keywords, including English articles published within the last ten years. Evidence highlighted included nursing education, pediatric extravasation and tissue damage, and response team.

Targeted nursing education programs have demonstrated they can improve nursing care and patient safety. Nursing students who received high-fidelity simulation and targeted traditional education on extravasation treatment had higher competency scores than those who did not received this education.

Specific nursing education programs have demonstrated statistically significant improvement on nurses' knowledge, practice and minimized patients' complications of chemotherapy extravasation.

Practice Change(s): In 2023, a dedicated VAT member began staffing our campus. Staff reported not knowing how to treat extravasations, causing treatment delays, or extravasations not being treated per guidelines. Staff and nursing leadership determined the need for additional training on extravasation treatment.

Extravasation Treatment classes including lecture and skills practice began in May 2023. Classes were provided only to Team Leaders and Charge RNs so patients could be treated when the VAT team was not available. Classes were modified by VAT in June 2024 including lecture and hands skills training for PIVIEs. In June 2024 nurse leaders expanded classes to add Resource RNs with Team Leaders and Charge RNs.

Implementation/Pilot Testing: Pre / post education surveys were given to attendees of the revised Extravasation Treatment Class in February 2025. Pilot data collection ended in May 2025.

Quality review reports of PIVIEs were reviewed from January 2023 through April 2025 to determine if there was delayed treatment or PIVIE not treated per guidelines.

Outcomes/Results: Quality reports of PIVIEs in 2023 showed 3 of 5 (60%) were not treated per guidelines. In 2024 and from January to April 2025 100% of PIVIEs received recommended treatment after these classes.

Surveys showed classes increased staff confidence in treating extravasations. In pre-class surveys classes only 1 of 33 respondents (0.03%) felt very prepared in overall treatment of extravasation. After classes 25 of 36 respondents (69%) felt very prepared to treat extravasation.

Recommendations/Conclusions: Lecture and skills training were beneficial in helping staff treat PIVIE per guidelines. Extravasation Treatment classes increased staff confidence and competence in treating extravasation and decreased the number and percentage of PIVIEs not treated per guidelines.

Publication Date

9-22-2025

Keywords

Pediatric nursing

Disciplines

Pediatric Nursing

Improving Confidence and Competence in Treating Pediatric Peripheral Intravenous Extravasation

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