What Happens If an IV is Left in Too Long?: Risks and Complications

October 12, 2025 •

5 min read

Studies have shown that a significant number of peripheral IVs experience failure due to complications like phlebitis and infiltration. Understanding what happens if an IV is left in too long? is crucial for preventing severe health issues, such as bloodstream infections, tissue damage, and blood clots, which can escalate from an improperly managed intravenous catheter.

Quick Summary

Prolonged use of an intravenous catheter can lead to various complications, including local infection, inflammation of the vein (phlebitis), and fluid leakage into surrounding tissues (infiltration), demanding careful monitoring and timely removal by healthcare professionals.

Key Points

Infection Risk Rises with Time: The longer an IV remains in place, the greater the risk of bacterial contamination leading to local infection or potentially fatal bloodstream infections.
Phlebitis is a Common Complication: Inflammation of the vein (phlebitis) is a frequent issue resulting from prolonged IV use and can present with redness, warmth, and a palpable, cord-like vein.
Infiltration vs. Extravasation: Infiltration is fluid leakage into tissue, while extravasation is the more serious leakage of tissue-damaging fluids, both caused by catheter dislodgement.
Watch for Serious Systemic Signs: Symptoms like fever, chills, and a rapid heartbeat can indicate a systemic infection (CR-BSI) originating from the IV site, requiring immediate medical intervention.
Preventative Care is Crucial: Best practices include meticulous site monitoring, aseptic technique, proper securement, and prompt removal upon any sign of complications to prevent escalation.
Nerve Damage Can Occur: If an IV catheter is improperly placed or a severe infiltration compresses nearby nerves, permanent nerve damage with associated pain and numbness can occur.
Blood Clots are a Possibility: Prolonged catheter presence or irritation can lead to blood clots (thrombophlebitis) in the vein, and for central lines, a more serious DVT is a risk.

The Dangers of Prolonged Intravenous Access

Intravenous (IV) therapy is a common medical procedure used to deliver fluids, medications, and nutrients directly into a patient's bloodstream. While essential for many treatments, the plastic catheter inserted into the vein is a foreign object, and leaving it in place for too long significantly increases the risk of complications. Though some guidelines suggest peripheral IVs can remain in place for longer periods if well-monitored, the risk of issues like infection and inflammation rises over time. Patients receiving long-term IV therapy, whether in a hospital or home setting, must be aware of the signs of potential problems.

Phlebitis and Thrombophlebitis

Phlebitis is the inflammation of the inner lining of a vein. It is one of the most common complications associated with IV therapy and can be caused by the catheter's physical irritation, the chemical nature of the infused solution, or bacterial contamination. Symptoms often include redness, swelling, warmth, and pain along the vein.

When a blood clot forms in an inflamed vein, the condition is called thrombophlebitis. This often results from prolonged catheter use and poor blood flow, leading to increased pain and the formation of a hard, cord-like vein. While superficial thrombophlebitis is often managed with local treatment and IV removal, deep vein thrombosis (DVT) is a more serious concern, especially with central or PICC lines, and requires immediate medical attention and potential anticoagulation therapy.

Infiltration and Extravasation

Infiltration occurs when an IV catheter becomes dislodged or perforates the vein, causing non-vesicant fluid to leak into the surrounding tissues. Signs include swelling, coolness, taut skin, and blanching at the site, along with a sluggish or stopped infusion. While typically resolved by removing the IV and elevating the limb, severe cases can lead to compartment syndrome or nerve damage.

Extravasation is a more severe form of infiltration involving vesicant fluids, such as certain chemotherapy drugs, which can cause significant tissue damage, blistering, ulceration, and necrosis. The severity depends on the type and volume of the fluid involved, and delayed intervention can lead to permanent damage, scarring, or even amputation in rare cases.

Infections: From Local to Systemic

An infection can develop at the insertion site or spread systemically, posing a grave risk to the patient.

Local Infection: This occurs when bacteria enter the site, often due to poor aseptic technique during insertion or maintenance. Signs include increased redness, swelling, pain, and pus or drainage from the site.
Catheter-Related Bloodstream Infection (CR-BSI): This serious, life-threatening complication happens when pathogens from the IV site enter the bloodstream. Symptoms include fever, chills, and an elevated heart rate. If left untreated, a CR-BSI can lead to sepsis, organ failure, and death.

Comparison of Common IV Complications


Feature	Phlebitis	Infiltration	Extravasation
Cause	Irritation or infection of the vein's inner lining.	Leakage of non-vesicant fluids into surrounding tissue.	Leakage of vesicant (tissue-damaging) fluids into surrounding tissue.
Symptoms	Redness, warmth, pain, and a hard, palpable cord along the vein.	Swelling, coolness, skin blanching, discomfort, and a slow or stopped infusion.	Significant swelling, severe pain, blistering, potential tissue death (necrosis).
Severity	Generally manageable, but can lead to thrombophlebitis.	Mild to moderate, but can cause nerve damage or compartment syndrome in severe cases.	Potentially severe and can result in permanent tissue damage, disfigurement, or amputation.
Treatment	Remove IV, apply warm compress, and elevate the limb.	Remove IV, elevate limb, apply warm or cold compress.	Stop infusion, remove IV, apply specific antidote or treatment protocol.

Prevention Strategies and Patient Monitoring

Healthcare providers follow strict protocols to minimize the risks of long-term IV therapy, though patient vigilance is also essential. The Infusion Nurses Society (INS) provides guidelines for best practices, which include:

Regular Site Assessment: IV sites must be assessed frequently for any signs of complications. For inpatients, this can be as often as every four hours, while for critically ill patients, it may be hourly.
Site Rotation: While the practice of routine peripheral IV replacement has been debated, catheters should be changed if there is any clinical indication of a problem.
Proper Aseptic Technique: Meticulous hand hygiene and sterile procedures are used during insertion and maintenance to prevent bacterial contamination.
Securement: Proper securement of the IV line with dressings or other devices is critical to prevent dislodgement and subsequent infiltration or phlebitis.
Patient Education: Patients or their caregivers should be taught to recognize the signs of complications and when to alert a healthcare provider.

What to Do If Complications Occur

If a patient suspects an IV complication, they should take the following steps immediately:

Notify a healthcare provider immediately. Do not wait for symptoms to worsen.
Do not flush the IV or try to adjust it. If a complication like infiltration is suspected, attempting to flush the line could cause further tissue damage.
Elevate the affected limb. This can help reduce swelling in cases of infiltration.
Follow all instructions provided by the care team. This may involve applying a warm or cold compress, depending on the complication.

Conclusion

While an essential tool in modern medicine, leaving an intravenous line in for too long without adequate monitoring and care carries significant risks. Complications such as phlebitis, infiltration, and infection are not uncommon and can range from manageable to life-threatening. Through careful patient monitoring, strict adherence to aseptic techniques, and prompt action when complications arise, healthcare providers and patients can work together to ensure the safe and effective administration of IV therapy. For more information, consult guidelines from authoritative sources like the CDC or Infusion Nurses Society.

Key Takeaways:

Increased Infection Risk: Prolonged IV use increases the likelihood of both local site infections and serious bloodstream infections (CR-BSI).
Phlebitis Development: The inner lining of the vein can become inflamed from mechanical or chemical irritation over time, causing pain and swelling.
Infiltration Threat: A dislodged catheter can leak fluids into surrounding tissue, causing swelling, and in severe cases, nerve damage or compartment syndrome.
Extravasation Danger: If tissue-damaging fluids leak, it can cause severe burns, blistering, and permanent tissue damage.
Patient Vigilance is Key: Patients or caregivers must consistently monitor the IV site for signs of problems and report issues immediately to prevent serious complications.

Frequently Asked Questions

Primary signs include redness, swelling, warmth, tenderness, and pain at the insertion site. For more serious issues, watch for pus, fever, or swelling that spreads up the limb.

Current guidelines recommend changing peripheral IVs based on clinical indication (i.e., when a problem occurs or therapy is complete), rather than a fixed schedule. However, some institutions still follow a 72- to 96-hour routine replacement schedule.

Phlebitis is the inflammation of the vein itself, characterized by pain, warmth, and redness along the vein. Infiltration is when fluids leak from the vein into the surrounding tissue, causing swelling and coolness at the site.

This can be a sign of infiltration. You should immediately notify a healthcare provider. The IV will likely be removed, and the limb may be elevated. Do not attempt to flush or adjust the IV yourself.

Yes, in severe cases, long-term IV complications can lead to permanent damage. This includes nerve damage from severe infiltration, significant scarring, or tissue necrosis from extravasation.

Key preventative steps include ensuring proper hygiene when the IV is accessed, protecting the site from accidental bumps or tugging, and consistently monitoring the area for early signs of problems. If at home, keep the site dry.

Signs of a serious systemic infection (CR-BSI) include fever, chills, an elevated heart rate, and confusion, in addition to localized symptoms. These require immediate medical attention to prevent sepsis.

Yes, the presence of an IV catheter, especially long-term, can cause irritation and inflammation inside the vein, increasing the risk of forming a blood clot. This is known as thrombophlebitis for peripheral IVs or DVT for central lines.