IV Therapy Complications: Infiltration, Extravasation, Phlebitis

Infiltration

Leakage of a non-vesicant IV solution (e.g., normal saline) into the surrounding subcutaneous tissue.

Common Causes of Infiltration

Dislodged or poorly secured IV catheter, catheter punctured through the vein wall, fragile or damaged veins (common in elderly patients), excessive movement at the IV site, improperly placed IV.

Signs & Symptoms of Infiltration

Coolness at or around the site, swelling or edema in insertion site, pale or blanched skin tone, discomfort or tightness at the IV site, sluggish or stopped IV flow rate, no blood return when aspirating (may be absent in small veins).

Interventions for Infiltration

STOP the infusion immediately, remove the IV catheter, elevate the affected limb, apply warm compress, monitor the site for changes or improvement, document findings, actions taken, and patient response, restart IV at a different site, preferably the opposite limb if possible.

Prevention Tips for Infiltration

Frequently check IV site for early signs of infiltration, secure IV catheter to minimize movement, avoid sites over joints or areas of flexion, use the smallest gauge catheter needed, educate the patient to report any discomfort, swelling, or coolness.

Extravasation

Leakage of a vesicant IV solution or medication into surrounding tissue (extracellular space).

Definition of Vesicant

A drug or medication that can cause tissue damage, necrosis, or blistering if it leaks outside the vein.

Common Causes of Extravasation

Dislodged IV catheter, fragile/compromised veins, incorrect insertion or movement of IV, high-pressure infusion of vesicants, poor vein selection.

Signs & Symptoms of Extravasation

Pain, burning, or stinging at IV site, redness, swelling, or blistering, cool skin around IV site, slowed or stopped IV flow rate, skin discoloration, necrosis (in severe cases).

Interventions for Extravasation

STOP the infusion immediately, leave the IV catheter in place (do not remove yet), aspirate any remaining medication from the IV site using a syringe, do NOT flush the IV, elevate the affected limb, notify the provider immediately, administer antidote (if ordered and appropriate), apply a warm or cold compress depending on the drug involved.

Examples of Vesicants (High-Risk Drugs)

Chemotherapy agents (e.g., Doxorubicin, Vincristine), Vancomycin, Potassium chloride, Dopamine, Calcium chloride, Promethazine.

Phlebitis

Inflammation of the vein wall, often at or near an IV insertion site.

Types & Causes of Phlebitis

Mechanical: IV catheter too large for the vein, improperly secured catheter, long dwell time (PIV > 72-96 hrs); Chemical: irritating medications (e.g., vancomycin, potassium, phenytoin), rapid infusion rate of fluids or meds; Bacterial: poor aseptic technique, contaminated IV site or dressing, long-term dwell without proper site care.

Signs & Symptoms of Phlebitis

Redness along the vein (erythema), pain or tenderness at the IV site, warmth over the vein, swelling and possible palpable cord (hard, rope-like vein), sluggish infusion rate, may or may not have fever (bacterial).

Interventions for Phlebitis

STOP the infusion and remove the IV catheter, apply a warm compress or moist heat to reduce discomfort and inflammation, elevate the limb if swelling is present, document location, severity, and nursing actions, restart IV in opposite limb or above previous site (if needed), monitor for signs of infection or thrombophlebitis (if bacterial), if bacterial phlebitis is suspected, notify provider—antibiotics may be needed.

Prevention Tips for Phlebitis

Use proper insertion technique and aseptic practices, choose the appropriate catheter size, rotate sites regularly (every 96 hrs for PIVs), dilute irritating medications, monitor IV sites frequently for early signs.