Understanding Intravenous Therapy
Intravenous (IV) therapy is one of the most common invasive procedures in healthcare settings, used to deliver fluids, medications, blood products, and nutrition directly into a patient's bloodstream [1.2.3]. While it is a vital and generally safe procedure, it is not without risks. Complications can arise, ranging from minor, localized issues to severe, life-threatening systemic problems [1.5.3]. Understanding these potential side effects is crucial for both healthcare providers and patients to ensure safety and treatment efficacy. Complications are broadly categorized as either local, affecting the area around the IV insertion site, or systemic, affecting the entire body [1.5.3].
The Most Common Side Effects: Local Complications
Research and clinical data point to local complications as the most frequent adverse events associated with peripheral IV therapy. A large-scale analysis found that among catheter failures, infiltration/occlusion was the most common complication, with an incidence of 23%, followed by phlebitis at 12% [1.9.1].
Phlebitis: Inflammation of the Vein
Phlebitis, or the inflammation of a vein, is a very common side effect of IV therapy [1.3.1]. It can cause pain, swelling, warmth, and redness along the vein [1.5.3]. The vein may also feel hard or cord-like to the touch [1.3.3]. Phlebitis can be caused by several factors [1.3.3, 1.3.1]:
- Mechanical: Trauma to the vein during catheter insertion or movement of the cannula within the vein can cause irritation [1.3.3]. Using a catheter that is too large for the vein is a common cause [1.2.1].
- Chemical: The medication or solution being infused can irritate the vein lining. This is more common with solutions that are acidic, alkaline, or have a high osmolarity [1.2.4]. Certain medications like potassium chloride and some antibiotics are known irritants [1.2.4].
- Bacterial: An infection at the insertion site, often due to poor aseptic technique during insertion or maintenance, can lead to bacterial phlebitis [1.3.3].
Management of phlebitis involves stopping the infusion, removing the catheter, and applying warm, moist compresses to the affected area to reduce pain and inflammation [1.3.3]. A new catheter must then be inserted at a different site, preferably on the opposite arm [1.3.3].
Infiltration and Extravasation
Infiltration occurs when IV fluid or non-vesicant (non-irritating) medication leaks into the surrounding tissue instead of flowing into the vein [1.2.3, 1.4.2]. This is often caused by improper placement or dislodgment of the catheter [1.2.4]. Symptoms include swelling, puffiness, cool skin, pain or discomfort, and blanching (paleness) around the site [1.4.1, 1.10.4]. The IV drip may also slow down or stop [1.10.4].
A more severe form of infiltration is extravasation, which involves the leakage of a vesicant drug—a medication capable of causing tissue damage—into the surrounding area [1.4.2]. This can lead to severe consequences, including blistering, tissue necrosis (death), nerve damage, and in extreme cases, loss of function or even amputation [1.2.3, 1.2.4].
Treatment for infiltration involves stopping the infusion, removing the IV, and elevating the limb to help drain the fluid [1.4.1]. Warm or cold compresses may be applied based on the fluid that was infused [1.4.1]. Extravasation requires immediate, specific interventions, which may include administering an antidote through the catheter before its removal [1.4.2].
Systemic Complications: Less Common but More Severe
While local issues are more frequent, systemic complications can be far more dangerous. These affect the entire body and require immediate medical attention.
- Infection: A local infection at the IV site can spread into the bloodstream, causing a catheter-related bloodstream infection (CRBSI) or sepsis [1.5.3, 1.10.3]. Symptoms include fever, chills, weakness, and a rapid heart rate [1.10.3, 1.6.2].
- Fluid Overload (Hypervolemia): This occurs when fluids are administered too rapidly, especially in patients with compromised heart, kidney, or liver function [1.2.1, 1.13.3]. Signs include elevated blood pressure, swelling (edema), distended neck veins, and shortness of breath [1.6.3, 1.13.1].
- Air Embolism: A rare but potentially fatal complication where an air bubble enters the vein and travels to the heart, lungs, or brain, causing blockages [1.2.1, 1.5.4]. This can be caused by improper priming of IV lines or disconnections in the tubing [1.5.3]. Symptoms include difficulty breathing, low blood pressure, and a blue hue to the skin [1.2.1].
- Hypersensitivity/Allergic Reaction: The body can have an allergic reaction to the infused medication, ranging from a mild rash and itching to severe anaphylaxis, characterized by throat tightness and difficulty breathing [1.2.3, 1.11.2].
- Speed Shock: A systemic reaction caused by the rapid injection of a medication, leading to toxic levels in the blood [1.12.3]. This can cause a flushed face, headache, irregular pulse, and even cardiac arrest [1.12.3].
Comparison of IV Therapy Complications
| Feature | Local Complications (e.g., Phlebitis, Infiltration) | Systemic Complications (e.g., Infection, Air Embolism) |
|---|---|---|
| Location | Confined to the area around the IV insertion site [1.5.3] | Affects the entire body or major organ systems [1.5.3] |
| Common Symptoms | Swelling, pain, redness, warmth or coolness at the site [1.3.2, 1.5.3] | Fever, chills, shortness of breath, low blood pressure, irregular pulse [1.5.3, 1.12.3] |
| Primary Cause | Catheter irritation, dislodgment, or leakage of fluid [1.3.3, 1.2.3] | Bacteria entering bloodstream, air in IV line, rapid infusion, allergic reaction [1.5.3] |
| Severity | Generally less severe but can lead to tissue damage if ignored [1.3.2] | Often more severe and can be life-threatening [1.2.1, 1.5.3] |
| Management | Remove catheter, apply compresses, elevate limb [1.3.3, 1.4.1] | Immediate medical intervention, antibiotics, oxygen, emergency protocols [1.5.3, 1.6.2] |
Conclusion: Prevention is Key
The most common side effect of intravenous therapy is a local complication like phlebitis or infiltration. While often manageable, they cause significant patient discomfort and can interrupt essential treatment [1.3.1]. Prevention is paramount and involves proper technique from healthcare providers, such as choosing the correct catheter size and insertion site, maintaining strict sterility, and securing the catheter properly [1.2.3, 1.3.2]. Patients also play a role by reporting any pain, swelling, or discomfort at their IV site immediately. Regular monitoring by healthcare professionals and prompt intervention at the first sign of trouble can prevent minor issues from becoming major complications [1.3.2].
For more detailed guidance, the Infusion Nurses Society provides comprehensive standards of practice.
Lippincott NursingCenter [1.2.3]
