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A red electrocardiogram
A red electrocardiogram
A red electrocardiogram

Common Injuries in Iron Extravasation

Scott Harding-Lister, Head of practice at Apex Health Associates

Mr Scott Harding-Lister

Head of practice at Apex Health Associates, Scott Harding-Lister is a trained Nurse, a non-practising solicitor and an experienced expert witness.

In an earlier blog post, we scrutinised the intricacies of iron extravasation and provided general guidance on its avoidance. Here we direct our focus towards the injuries witnessed in our capacity as nursing experts when consulted on such cases, particularly concerning matters of liability, causation, and care (quantum). While iron extravasation may not be a commonplace injury, our extensive expertise in this domain equips us to offer insights into its ramifications.

Physical Staining

An example of physical straining cause by Iron Extravasation

If the iron solution seeps into tissues beyond the vascular space, it results in the permanent staining of affected tissues. The discolouration may manifest as a discreet stain around the cannula site or extend to encompass an entire limb. Regrettably, our experience indicates that this staining tends to be irreversible, with the customary recourse being the application of camouflage makeup. It is advisable to promptly seek the opinion of plastic surgeons following such an incident for specialist support.

Credit: Sage Journal, Link via Sage Journal

Psychological Injury: The Long-Term Struggle

Our role as expert witnesses has highlighted a significant psychological toll experienced by many patients affected by iron extravasation. The psychological aftermath of such an event constitutes an enduring struggle, affecting the mental health of those affected.

  1. Anxiety and Fear of Medical Procedures: Iron extravasation may render medical environments a source of anxiety and fear for affected individuals. The trauma associated with scarring induces a persistent fear of medical procedures, casting a shadow over future treatments. Routine medical check-ups, once benign, can undergo a transformation into anxiety-inducing experiences.

  2. Body Image Concerns: The visible staining left by iron extravasation can extend beyond physical issues to profound body image concerns. Individuals may grapple with heightened self-consciousness about their appearance, resulting in a negative impact on mental health and overall well-being. Social situations may be avoided, and participation in activities curtailed, contributing to a pervasive sense of isolation.

  3. Trust Issues: Iron extravasation incidents can fracture the trust between patients and healthcare providers, sowing seeds of doubt regarding the competence of the medical team. Rebuilding this trust becomes an intricate part of the psychological healing process, necessitating open communication and reassurance.

  4. Post-Traumatic Stress Disorder (PTSD): In severe cases, the psychological impact of iron extravasation can escalate to post-traumatic stress disorder (PTSD). Persistent flashbacks, nightmares, and heightened anxiety related to the traumatic event endure long after the physical injuries have occurred. The emotional scars may be as enduring as the physical ones, requiring specialised psychological support, counselling, and intervention.

  5. Depression and Social Withdrawal: The emotional toll of iron extravasation may precipitate depression and social withdrawal. Individuals may grapple with feelings of sadness, hopelessness and isolation, complicating their journey towards recovery. Addressing these emotional aspects is integral to holistic patient care.


Iron extravasation, often relegated to the periphery in discussions about medical complications, can bring about a lasting psychological impact on affected individuals. Recognition of potential psychological injuries, spanning from anxiety to PTSD, is indispensable for both healthcare providers and patients. By implementing preventive measures, early intervention, and offering comprehensive psychological support, we can work towards mitigating the psychological consequences of iron extravasation. In my professional opinion, it is imperative that patients are adequately informed about the risks of extravasation before receiving iron preparations (case law – Montgomery). Should an extravasation occur, routine referral to plastic surgeons for specialist advice and input is advisable, with a low threshold for involving psychological colleagues in the care pathway.

Apex Health Associates has a team of general nurses who are all experienced experts at dealing with these types of cases. As Head of Practice I have personal interest in this subject and have assisted both Claimant and Defendants by providing an opinion as to the standard of care.

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