Implementing the NIVAS extravasation toolkit in critical care: observational study and development of local guidelines

BACKGROUND: Extravasation and infiltration injuries are well-documented risks in oncology but remain under-recognised in adult critical care settings. These events can result in significant patient harm, particularly in the absence of formal surveillance systems and standardised response protocols. AIM: This observational study aimed to evaluate the incidence and characteristics of extravasation injuries in a critical care setting following the implementation of a structured surveillance programme and to assess the impact of a multidisciplinary intervention guided by the National Infusion and Vascular Access Society (NIVAS) toolkit. METHODS: A 1-year surveillance programme was initiated across an adult critical care unit following a moderate-harm extravasation incident. Data collection focused on injury type, causative agents, anatomical site, and clinical response. Informed by the findings, a trust-wide protocol was developed and implemented in collaboration with tissue viability, vascular access, medication safety, and practice development teams. RESULTS: The surveillance programme identified previously under-reported extravasation incidents, particularly in non-oncology adult patients. The antecubital fossa was a frequent site of injury, and cannulation practices in the emergency department emerged as a procedural risk factor. Implementation of the NIVAS-aligned protocol led to increased staff awareness, standardised injury staging, and improved documentation and management practices. CONCLUSIONS: Multidisciplinary engagement and structured protocols significantly enhanced recognition and response to extravasation injuries in critical care. Broader adoption of national guidance and continued education may further reduce harm and promote consistency in intravenous therapy practices across acute care settings.