Intravenous (IV) therapy is a common medical procedure used to deliver fluids, medications, and nutrients directly into a patient's bloodstream. While generally safe, various complications can occur at or near the IV insertion site. Early detection and intervention are essential to prevent minor issues from escalating into severe medical problems. This guide provides a detailed overview of the most common IV complications and their characteristic symptoms.
Recognizing the Common IV Complications
Infiltration
Infiltration is one of the most common IV complications and occurs when non-vesicant fluid or medication leaks into the surrounding tissue instead of the vein. This leakage typically happens due to improper catheter placement or displacement.
Symptoms of Infiltration:
- Swelling or puffiness around the insertion site.
- Coolness or cold sensation of the skin at the site.
- Pain, discomfort, or burning at the site.
- Blanching or pale appearance of the skin, which can indicate impaired circulation.
- Tightness of the skin around the area.
- A noticeable slowing or stopping of the IV drip rate.
Extravasation
Extravasation is a more severe form of infiltration, involving the leakage of a vesicant drug (one that causes blistering and tissue damage) into the surrounding tissue. The symptoms are similar to infiltration but can lead to more serious consequences.
Symptoms of Extravasation:
- All the signs of infiltration (pain, swelling, coolness, and skin discoloration).
- Burning or stinging sensation that is often more intense than with simple infiltration.
- Blistering, skin sloughing, or peeling in more advanced stages.
- Delayed manifestations like ulceration and necrosis (tissue death) can occur.
Phlebitis
Phlebitis is the inflammation of a vein, often caused by mechanical irritation from the catheter, chemical irritation from the infused solution, or infection.
Symptoms of Phlebitis:
- Pain, tenderness, and warmth along the vein's path.
- Redness (erythema) tracing the vein.
- Swelling over the vein.
- The vein may feel hard and cord-like, also known as a palpable venous cord.
- May be accompanied by a low-grade fever.
Hematoma
A hematoma is a collection of blood outside the blood vessels, resulting in bruising. It can occur if the IV catheter punctures the opposite side of the vein or if insufficient pressure is applied after removal.
Symptoms of a Hematoma:
- Discoloration and bruising at and around the IV site.
- Swelling and firmness at the insertion site.
- Pain and tenderness in the bruised area.
Infection
Infections can be either local at the insertion site or systemic, spreading to the bloodstream (sepsis).
Symptoms of Local Infection:
- Increased pain, redness, and swelling that worsens over time.
- Oozing of fluid, blood, or pus from the site.
- Crusting or scabbing on the skin near the line.
Symptoms of Systemic Infection (Sepsis):
- High temperature or fever.
- Chills and weakness.
- Nausea.
Nerve Damage
Though relatively rare, nerve damage can occur if a nerve is inadvertently hit, compressed, or irritated during IV insertion.
Symptoms of Nerve Damage:
- Sharp, shooting pain at the time of insertion.
- Burning, tingling, or electric shock-like sensations that persist.
- Numbness or a “pins and needles” feeling.
- Weakness or loss of function in the affected limb.
Allergic Reaction (Infusion Reaction)
An allergic reaction to an IV medication can range from mild to severe and may occur during or shortly after the infusion.
Symptoms of Allergic Reaction:
- Itching, rash, or hives on the skin.
- Flushing of the face and neck.
- Shortness of breath, wheezing, or cough.
- Fever or chills.
- Anaphylaxis, a severe, life-threatening reaction, can cause airway tightening, a rapid drop in blood pressure, and loss of consciousness.
General Warning Signs at the IV Site
- Pain that increases or persists long after the IV is inserted.
- Any noticeable change in the flow rate, such as a slowed or stopped drip.
- Leakage of fluid from the insertion site.
- Bruising, redness, or streaks appearing from the site.
- Numbness, tingling, or restricted movement of the limb.
- An overall unwell feeling, including fever, chills, or dizziness.
Comparison of Key IV Complications
| Symptom | Infiltration | Extravasation | Phlebitis | Infection (Local) |
|---|---|---|---|---|
| Appearance | Swelling, pale, blanched skin | Swelling, redness, blistering, skin sloughing | Redness and swelling along vein | Redness, swelling, possibly crusting |
| Temperature | Cool to the touch | Cool or normal; may become hot with severe tissue damage | Warm to the touch | Hot and warm to the touch |
| Feeling | Pain, tightness, discomfort, burning | Intense burning, stinging, intense pain | Pain, tenderness, throbbing | Pain, tenderness |
| Vein | No change in vein's appearance or feel | No change in vein's appearance or feel initially | Hard, cord-like vein | Vein may or may not be hard or tender |
| Other Signs | Slowed or stopped infusion, tight skin | Risk of necrosis and long-term tissue damage | Sometimes low-grade fever | Pus or drainage, potentially systemic fever |
Conclusion
While IV therapy is a routine part of modern healthcare, the potential for complications remains a reality that requires vigilance from both patients and healthcare professionals. Knowing what are the symptoms of IV complications is the first and most critical step toward timely and effective treatment. Patients should be encouraged to report any unusual sensations or changes at the IV site immediately. By staying informed and communicating openly, patients can play a vital role in their own care, ensuring minor complications are addressed before they can cause significant harm. For detailed clinical guidance, healthcare providers can refer to institutional policies and resources such as those from the National Institutes of Health.
