Intraoperative peripheral intravenous complications in adults: a summary of evidence for prevention and management of infiltration/extravasation.

OBJECTIVE: To systematically synthesize the best available evidence and develop an evidence-based practice framework for the prevention, early identification, and management of intraoperative intravenous infusion complications, including non-cytotoxic drug infiltration and cytotoxic drug extravasation, in perioperative adult patients.

METHODS: Methodological standards for evidence summaries were strictly followed. Research questions were formulated using the PIPOST framework. Databases searched included PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, SinoMed, VIP, and evidence-based platforms (UpToDate, BMJ Best Practice, JBI, GIN, NICE, RNAO). All sources were systematically searched from database inception to September 3, 2025. Following the 6S evidence pyramid, we prioritised guidelines, systematic reviews, expert consensuses, evidence summaries, and clinical decision tools over primary studies. Literature screening was conducted according to predefined inclusion and exclusion criteria. The quality of included clinical guidelines, systematic reviews, evidence summaries, expert consensus statements, and clinical decision tools was appraised using AGREE II, JBI critical appraisal tools, CASE checklists, and other appropriate instruments. Evidence was graded using the JBI evidence pre-grading system, and recommendation strength was classified as level A (strong) or level B (weak) through multidisciplinary expert consensus based on feasibility, appropriateness, clinical significance, and effectiveness.

RESULTS: Thirteen publications were included, comprising six clinical guidelines, three systematic reviews, one evidence summary, one expert consensus, and two clinical decision tools. A total of 41 evidence statements were extracted and synthesized into four thematic domains: prevention strategies; early identification and monitoring; treatment measures; and system management and improvement. Key areas included venous access planning, catheter and site selection, puncture techniques, safe administration of high-risk drugs, patient risk assessment, dynamic intraoperative monitoring principles, standardized assessment tools, and stepwise management protocols. System-level strategies such as adverse event reporting, staff training, quality improvement, and multidisciplinary collaboration were also emphasized.

CONCLUSION: This evidence summary integrates current best evidence and provides a structured and practical framework for comprehensive perioperative management of intravenous infusion complications. Implementation of evidence-based strategies may enhance early risk detection and response, reduce complication incidence and severity, and ultimately improve patient safety and clinical outcomes.