When an IV goes astray: Infiltration and Extravasation
Intravenous (IV) therapy is a standard medical procedure used to deliver fluids, medications, and nutrients directly into a patient’s bloodstream. While generally safe and effective, complications can arise, especially if the IV catheter is not properly seated within the vein. When this occurs, fluids leak into the surrounding subcutaneous tissue, leading to distinct and potentially serious conditions known as infiltration and extravasation. The severity of the outcome largely depends on the nature of the fluid being infused.
Infiltration: Leakage of Non-Irritating Fluids
Infiltration is the most common type of IV complication, defined as the inadvertent leakage of non-vesicant (non-irritating) fluids from the vein into the surrounding tissue. This can be caused by the catheter dislodging, puncturing the vein wall, or being improperly secured. In most cases, infiltration is benign and resolves with proper care.
Signs and symptoms of IV infiltration include:
- Swelling: A tight or puffy feeling around the IV site as fluid accumulates under the skin.
- Coolness: The skin around the affected area may feel cool or cold to the touch due to the temperature of the infused fluid.
- Pain or discomfort: A dull ache or tenderness is common, though often less severe than with extravasation.
- Skin changes: The skin may appear pale or blanched.
- Slowed infusion: The flow of the IV infusion may slow or stop entirely as resistance increases.
If infiltration is suspected, a healthcare provider will immediately stop the infusion, remove the IV line, and elevate the affected limb to encourage fluid reabsorption. Depending on the fluid, warm or cold compresses may be applied to alleviate discomfort and reduce swelling.
Extravasation: The Danger of Vesicant Drugs
Extravasation is a more dangerous form of fluid leakage, involving vesicant medications. Vesicants are fluids or drugs that can cause severe local tissue damage, blistering, and necrosis (tissue death) if they leak into the surrounding tissue. Certain chemotherapy drugs, pressors like dopamine, and high-osmolarity solutions are classified as vesicants. The consequences of extravasation can be devastating, potentially requiring surgical intervention, skin grafts, or in severe cases, amputation.
Signs and symptoms of extravasation include:
- Severe pain or burning: This is a hallmark symptom, often appearing immediately at the site.
- Blistering: The skin may form blisters over the affected area.
- Necrosis: Discoloration, peeling, and darkening of the skin, indicating tissue death.
- Severe swelling: The area swells rapidly and can feel hard or firm to the touch.
- Impaired circulation: Signs of poor blood flow, such as a cold, pale extremity with a weak or absent pulse, may indicate nerve or vascular damage.
Management of extravasation is complex and depends heavily on the specific medication involved. Some protocols involve leaving the catheter in place to attempt aspiration of the vesicant and injecting specific antidotes. Immediate treatment, including elevation of the limb and administration of medication, is critical to minimizing long-term damage.
Related Complications from a Misplaced IV
While infiltration and extravasation are the most common issues, other complications can arise from a misplaced or poorly managed IV.
- Phlebitis: Inflammation of the vein's inner lining caused by irritation from the catheter or the infused solution. Symptoms include pain, redness, warmth, and a hard, cord-like feeling along the vein.
- Hematoma: A localized collection of blood outside the vessels, appearing as a bruise or swelling. It usually occurs due to trauma during insertion or inadequate pressure after removal.
- Nerve Damage: A rare but serious complication, often caused by direct needle insertion into a nerve or compression from severe infiltration/extravasation. Symptoms include sharp, electric-shock-like pain, tingling, numbness, or loss of function.
Immediate steps when an IV isn't in your vein
If you or someone you are with experiences symptoms indicating an IV is no longer in the vein, immediate action is necessary to prevent further harm. Always alert a healthcare professional immediately.
- Stop the Infusion: Turn off or clamp the IV tubing to prevent more fluid or medication from entering the tissue.
- Notify Healthcare Staff: Inform a nurse or doctor right away. Do not attempt to fix or flush the line yourself.
- Remove the Catheter: The nurse will safely remove the IV catheter from the affected site.
- Elevate the Limb: Elevating the affected limb above heart level helps reduce swelling and promotes fluid reabsorption.
- Apply Compresses: The provider will determine whether to use warm or cold compresses based on the fluid type.
- Assess and Document: The area will be assessed, measured, and documented to monitor for changes.
- Relocate the IV: A new IV will be inserted in an unaffected location, preferably in the opposite limb.
Infiltration vs. Extravasation: A Comparison
| Feature | Infiltration | Extravasation |
|---|---|---|
| Leaked Fluid Type | Non-vesicant (non-irritating) fluids, such as saline or standard antibiotics. | Vesicant (tissue-damaging) fluids, such as chemotherapy drugs, vasopressors, or specific high-concentration solutions. |
| Tissue Effect | Non-damaging to tissue; fluids are generally reabsorbed by the body over time. | Can cause severe tissue damage, necrosis (tissue death), and blistering. |
| Signs & Symptoms | Swelling, coolness, pain, skin blanching, slowed infusion rate. | Severe pain/burning, rapid swelling, blistering, tissue discoloration, potential nerve damage. |
| Risk Level | Low to moderate. Usually resolves without long-term complications. | High. Potential for permanent damage, scarring, or amputation if not treated promptly. |
| Management | Stop infusion, remove IV, elevate limb, apply warm/cold compress. | Stop infusion, possibly aspirate fluid, administer specific antidotes, elevate limb, and specialist consultation may be required. |
Conclusion: Vigilance and action are key
Recognizing the signs of IV complications is a critical aspect of patient care and safety. A misplaced IV, causing either infiltration or extravasation, can range from a minor annoyance to a life-altering event. The key to mitigating harm lies in vigilant monitoring by healthcare staff and an understanding by patients of what to report. Prompt identification of symptoms like swelling, pain, or skin changes, followed by rapid and appropriate medical intervention, is essential. For patients and caregivers, being aware of these risks and knowing the immediate steps to take can make a significant difference in preventing complications and ensuring the best possible outcome. For more information on preventing and managing infusion complications, see the Infusion Nurses Society standards of practice.
