Turning a Difficult Event Into Safer Care for Pediatric Patients
Over the last three years, pediatric teams have achieved a 55% reduction in pediatric IV injuries.
When an IV infiltrates, medication flows into the soft tissue surrounding the injection site, rather than into the bloodstream as intended. The signs can be subtle: swelling, discomfort or a medication that does not seem to be working the way it should. In adults, those changes are easier to observe, but they’re much harder to spot in infants and young children.
That is one reason MaryAnn Zock, a staff nurse with vascular access at University of Vermont Medical Center, has spent the past several years helping nurses better understand, document and respond to Peripheral IV Infiltration or Extravasation (PIVIEs) — injuries that occur when fluid or medication being delivered through an IV leaks into the surrounding tissue.
“These injuries are never going to be 100% preventable,” Zock says. “But we can absolutely recognize them earlier and prevent lasting harm.”
The work began after a challenging pediatric case prompted a deeper review of vascular access practices across the organization. What followed was not a single policy change, but a broader culture shift — one focused on earlier recognition, clearer documentation and greater vigilance at the bedside.
Andrea Aldrich, RN, senior patient safety coordinator, was one of the key drivers of this change, helping to implement a best practice bundle, introducing new equipment, enhancing education on PIVIE, updating policy and grading criteria, refining assessment processes and conducting causal analyses on all events to support continuous learning and improvement.
“PIVIE education is especially important in pediatric care, where patients may be unable to explain what they are feeling,” Aldrich says. “For babies, even swelling can be difficult to detect. Chubby arms and legs can make an injury easy to miss unless staff are intentionally looking for changes.”
One tool now built into pediatric practice is TLC: touch, look and compare. Nurses are prompted not only to assess the IV site, but to compare one limb with the other — a simple step that can help reveal swelling before an injury becomes more serious.
You can hear the difference now in how nurses talk about these injuries,” says Evan Mahakian, a risk manager with UVM Health who has worked closely with Zock and others to implement and share this work more broadly. “There’s a much greater awareness that pediatric infiltrates are serious and need immediate attention.”
Over the last three years, pediatric teams have achieved a 55% reduction in pediatric PIVIEs.
For babies, even swelling can be difficult to detect. Chubby arms and legs can make an injury easy to miss unless staff are intentionally looking for changes.
A national audience
That awareness has spread beyond UVM Medical Center. Zock and Mahakian presented the work at the Association for Vascular Access national conference last September, speaking to a national audience about both the clinical lessons and the system changes that followed. Zock has also shared the work at regional vascular access meetings across the country.
Meanwhile, their work is still evolving. Zock continues to review trends, identify gaps and work with colleagues to make the process easier for nurses at the bedside. One ongoing challenge is ensuring that injuries are consistently documented, so the team can better measure whether interventions are reducing harm.
For Zock, the goal is to make sure that when IV injuries happen, they are recognized quickly, treated appropriately and used as opportunities to improve care.
“Part of our patient safety philosophy is that when things don’t go right, we try to learn from them and improve,” Zock says. “This was an opportunity to take something difficult and use it to make care safer for the next patient.”
