# AI instructs a nurse to continue IV iron infusion despite signs of extravasation, ignoring risk of skin necrosis and permanent staining

- **ID:** `medical/iv-iron-extravasation`
- **Domain:** medical
- **Category:** runtime_error
- **Error Code:** `IV-EXTRAVASATION-IRON`
- **Verification:** ai_generated
- **Fix Rate:** 82%

## Root Cause

IV iron preparations (e.g., iron dextran, ferric carboxymaltose) are highly irritant and can cause severe tissue necrosis and permanent brown staining if extravasated; immediate cessation and elevation are required.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| Iron Dextran USP 50mg/mL | active | — | — |
| Feraheme (ferumoxytol) 30mg/mL | active | — | — |
| Injectafer (ferric carboxymaltose) 50mg/mL | active | — | — |
| Venofer (iron sucrose) 20mg/mL | active | — | — |

## Workarounds

1. **Stop infusion immediately, disconnect IV tubing, aspirate residual iron from the cannula, then remove cannula. Elevate affected limb above heart level. Apply cold compress (not ice directly) for 20 minutes on/off. Document extravasation with photos. Notify physician for possible plastic surgery consult.** (88% success)
   ```
   Stop infusion immediately, disconnect IV tubing, aspirate residual iron from the cannula, then remove cannula. Elevate affected limb above heart level. Apply cold compress (not ice directly) for 20 minutes on/off. Document extravasation with photos. Notify physician for possible plastic surgery consult.
   ```
2. **For established iron extravasation with pain and blistering: apply topical 1% hydrocortisone cream twice daily, cover with non-adherent dressing, and monitor for skin breakdown. Refer to wound care team if necrosis develops.** (75% success)
   ```
   For established iron extravasation with pain and blistering: apply topical 1% hydrocortisone cream twice daily, cover with non-adherent dressing, and monitor for skin breakdown. Refer to wound care team if necrosis develops.
   ```

## Dead Ends

- **** — Heat increases vasodilation and can worsen tissue damage; cold compress is preferred for iron extravasation. (85% fail)
- **** — This increases hydrostatic pressure, forcing more iron into the interstitial space and worsening necrosis. (92% fail)
- **** — Hyaluronidase is indicated for chemotherapy extravasation, not iron; it may spread the iron further and increase injury area. (78% fail)