#269 Infiltrated IV Crisis: Managing Complications and Keeping Patients Safe

Every anesthesia professional has encountered IV infiltration—but when neuromuscular blocking agents are involved, this common complication becomes a complex patient safety challenge with no established guidelines.This episode delves into the critical management of infiltrated paralytics, a complication affecting 14% of peripheral IV catheterizations that can lead to delayed induction, compromised emergence, and potentially serious tissue injury. We're joined by Dr. Govind Rangrass, Professor of Anesthesiology and Critical Care, who shares why this overlooked issue deserves urgent attention: "When a paralytic is involved, the complexity skyrockets and there's almost no literature to guide us."We break down a comprehensive management algorithm, from the counterintuitive first step of leaving the infiltrated catheter in place to attempt medication aspiration, through systemic absorption enhancement techniques using hyaluronidase and nitroglycerin paste. The episode covers detailed reversal strategies based on monitoring capabilities, explaining how to prevent recurarization and safely manage these patients postoperatively.Beyond immediate management, we look toward a future where infiltration detection technologies and standardized guidelines are integrated into residency training and crisis checklists. This episode provides the missing guidance that anesthesia professionals need to navigate this surprisingly common complication with confidence.Have you experienced neuromuscular blocker infiltration in your practice? What strategies have worked for you? Share your thoughts or questions at [email protected] and join us in building a safer future where no one is harmed by anesthesia care.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/269-infiltrated-iv-crisis-managing-complications-and-keeping-patients-safe/© 2025, The Anesthesia Patient Safety Foundation