The 2016 Infusion Therapy Standards of Practice, due to be available by the end of January includes a new standard on Nerve Injury. This new standard uses “paresthesia” to describe this type of pain that can occur during venipuncture or associated with infiltration/extravasation.
During catheter insertion, complaints of electrical shock-like pain going in either direction on the arm, tingling, feelings of “pins and needles” or numbness is an indication that a nerve has been damaged by the needle. Nerves and veins are located very close together, making it nearly impossible to choose a venipuncture site without some risk of nerve injury. The new standard will contain a list of nerves and anatomical locations where this problem is most frequently reported.
This event must be managed by carefully removing the needle and finding another location for the venipuncture. The chance of permanent nerve damage and subsequent complex regional pain syndrome (CRPS) increases when the inserter ignores these patient complaints and continues with the procedure in the same location. Pay careful attention to the type of pain complaints during all venipuncture procedures and never assume that this is the typical discomfort felt with most venipunctures.
Paresthesia may also occur when excessive fluid is accumulating in the tissue. Nearby nerves are compressed causing these sensations. The fluid could be infusing I.V. fluid, blood from hematoma formation, or edema from inflammatory processes such as thrombophlebitis. Again, this is a reason for immediate catheter removal. Failure to remove the catheter quickly also increases the risk of permanent nerve damage and CRPS.
The bottom line is paying careful attention to the patient’s complaints, asking questions about the type of pain, and taking quick action to reduce the risk of nerve damage.
Read this new INS standard when it is available to learn more details. Additionally, investigate our comprehensive online education course on Infiltration and Extravasation. Details are located here.