Title: Characterization of Extravasation Events in Brain and Spinal Cord Injury Rehabilitation Patients
Authors: Muhan Wang, Lauren Wilcox, Virginia Montgomery
Background: Extravasation injuries are a significant source of treatment-related harm in hospitalized patients, with reported incidences of non-vesicant extravasation ranging from 0.1% to 6% in adult patients. Extravasation events can result in tissue injury, necrosis, and increased healthcare costs if not promptly recognized and managed. In the acute rehabilitation setting, caring for patients with acquired brain injury (ABI) and spinal cord injuries (SCI), identification of extravasation is particularly challenging. Impaired sensation, altered cognition and communication barriers can limit patients’ ability to perceive or report symptoms associated with infiltration and extravasation, leading to delayed recognition and more severe injury. Additionally, variability in documentation and management, including the use of non-pharmacologic interventions such as warm or cold compresses, can contribute to inconsistent care. This study evaluates current practices in the management and documentation of extravasation and infiltration events and to identify opportunities for standardization and process improvement to enhance patient safety.
Methods: This retrospective, single-center cohort study included ABI and SCI rehabilitation inpatients admitted between July 1st, 2019, and July 31st, 2025. Adult patients (≥18 years) with peripheral intravenous lines (IV) who had documented extravasation or infiltration events within the institution or received phentolamine injection, terbutaline injection, or topical nitroglycerin 2% for extravasation or infiltration were included. Patients with central lines only or no IV access were excluded. Baseline characteristics were collected via EPIC electronic medical records. The primary outcome was to describe cases of extravasation. Secondary outcomes included identification of patient and treatment-related factors potentially contributing to extravasation risk.
Results: A total of 43 documented events were identified among 33 patients. After excluding two patients due to one central line associated event and one event occurring outside the institution, 31 patients with 40 documented events were included in the final analysis. Among these patients, 16 had ABI, nine had SCI, and six had dual ABI and SCI. The study population was majority male (n=27, 87%) with a mean age of 49 years (SD 17). Of the 40 events, 12 (30%) could be attributed to IV medication administration. Medications administered within 24 hours of documented infiltration or extravasation events included anti-infectives (n=4), multiple medications administered during the same period (n=3), IV fluids (n=2), dopamine (n=2), or dexamethasone (n=1). No pharmacologic antidotes were administered in any documented extravasation cases. The majority of events (n=28, 70%) were not associated with medication administration reflecting line occlusion rather than extravasation or infiltration. Documentation review identified one instance of warm compress recorded as an intervention for line occlusion.
Conclusion/Discussion: The results demonstrate most documented events were likely not true extravasations associated with medications, and no cases required pharmacologic antidote use. One of the limitations of the study is inconsistency in documentation. Discussions with nursing staff suggested documentation of infiltration or extravasation may represent an occluded IV line rather than medication leakage, contributing to misclassification. The development of a standardized order set presents an opportunity to further align documentation and management efforts. These findings highlight the important role of physical assessments, informed staff, and accurate and detailed documentation with appropriate details in identifying infiltration and extravasation events in a high-risk neurorehabilitation population. The findings offer a strong foundation for quality improvement focused on improving documentation accuracy, streamlining management approaches, and strengthening education. Collaborative education and the use of standardized tools may promote consistency and support patient safety within the rehabilitation setting.
