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"Grade 4 peripheral intravenous infiltration with skin tears has seldom been reported" Wang et al (2021).
Extravasation case study with pictures

Abstract:

Grade 4 peripheral intravenous infiltration with skin tears has seldom been reported. On 4 August 2020, a 35-year-old female patient was admitted to the emergency department of our hospital because of postprandial abdominal pain for 2 hours. She was diagnosed with a severe acute pancreatitis with type II diabetes mellitus. On 7 August, a vein detained needle was inserted into the dorsal vein of her right foot to infuse drugs. On 9 August, a grade 4 infiltration, discoloured and bruised skin with a swollen area of 11 cm × 9 cm around the infusion part of her right foot, was discovered. The infusion was stopped immediately and the residual drug was aspirated at the infusion site. When removing the vein detained needle, the skin surrounding the infusion site on the right foot was torn by the adhesive dressing. The size of the skin tears was 6 cm × 3 cm (type 3). The patient was provided with appropriate dressing, manual lymphatic drainage, and surgical intervention. Two months later, she was fully recovered with no functional impairment of the affected foot. Timely local wound interventions could lead to a satisfactory outcome for severe peripheral intravenous infiltration with skin tears.

Reference:

Wang J, Li MM, Zhou LP, Xie RH, Pakhale S, Krewski D, Wen SW. Treatment for grade 4 peripheral intravenous infiltration with type 3 skin tears: A case report and literature review. Int Wound J. 2021 Jun 15. doi: 10.1111/iwj.13624. Epub ahead of print. PMID: 34129273.