New Meridian challenge: extravasation / safe administration of intravenous medicines


Posted on 11 November 2020 (Permalink)

A call has been put out by our Meridian Innovation Exchange, inviting submission for an innovative solution that is able to detect extravasation earlier than the human eye.

The Problem

Devices used to administer intravenous (IV) medicines into patients sit in patient’s blood vessel. A large number of drugs are administered through these devices to treat a wide number of serious illnesses. They are life saving devices.

Blood vessels are narrow tubes which means it is very easy for these IV devices to become dislodged. When this happens, instead of the device sitting in the patient’s blood vessel, it sits in the surrounding tissues. This is called extravasation.

If IV medicines are administered into a device that has extravasated, serious, life changing injuries can occur. These can cause loss of digits (fingers / toes), loss of function / sensation and can cause permanent scarring.

IV devices can become dislodged at any time during infusions. This means that checks done by nurses when they connect an infusion will not detect all extravasations. Serious incidents have also shown us that even when nurses complete their checks on these IV devices, it can sometimes be very difficult to detect an extravasation for a number of reasons including:

  • Early signs of an extravasation can be very subtle and difficult to see until they have become worse as the infusion is allowed to continue.
  • Assessments rely on nurses vision which varies between each individual, lighting conditions (especially at night), compliance of the patient (they understandably don’t like being disturbed at night), reduced visibility of the site due to dressings / bandages needed to secure the IV device.
  • Some patients are unable to communicate if they feel pain around an IV device which is often an early sign of extravasation.

What is needed?

We need a probe or a sensor that is able to detect extravasation earlier than the human eye.  There are two possible options. Option 1 is the preferred option.

Option 1

A sensor that continuously sits over the site of an IV device whilst infusions are in progress. It needs to be able to detect the first signs of extravasation (e.g. swelling, temperature change, colour change) in the tissues around the IV device. It will also need to:

  • Be small, flat and light so that it is comfortable for the patient.
  • Minimise risk of pressure injuries from the device.
  • Not cause burns as some continuous monitoring probes can do.
  • Alert nursing staff to changes.
  • Be easy to apply and stay in place on movable limbs / joints etc.
  • Must be inexpensive so that it is scalable across all patients with IV devices of all ages across the NHS.
  • Be cleanable to comply with infection control processes.

Option 2

A handheld device that can be intermittently applied to the site of an IV device when nurses are doing IV site checks. It needs to be able to detect the first signs of extravasation (e.g. swelling, temperature change, colour change) in the tissues around the IV device. It will also need to be:

  • Easy to use
  • Quick as young patients and patients with delirium don’t remain still for long
  • Inexpensive so that it is scalable across all patients with IV devices of all ages across the NHS.
  • Not require the application of gels sometimes used for scanning as these will affect dressings that are securing the IV device.
  • Be cleanable to comply with infection control processes.

All innovations will be reviewed by Karl Emms Lead Nurse for Patient Safety at the Birmingham Children's Hospital.  He is looking forward to reviewing any ideas or innovations and is keen to give feedback and co collaborate along with his clinical colleagues.  

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