Understanding IV Therapy and Failure
Intravenous (IV) therapy is one of the most common invasive medical procedures, used to deliver fluids, medications, and nutrition directly into a patient's bloodstream [1.3.2]. Despite its routine nature, the failure rate for peripheral IV catheters is unacceptably high, with some studies reporting failure in 35% to 50% of cases [1.2.6]. When an IV stops working, it can delay critical treatment, cause patient pain and anxiety, and increase healthcare costs [1.3.6]. The reasons for failure are varied, ranging from physiological complications at the insertion site to mechanical issues with the equipment.
Infiltration and Extravasation
Infiltration is the most common cause of IV failure, with an average incidence of 24% [1.2.1]. It happens when the IV catheter dislodges or punctures the vein wall, causing IV fluid to leak into the surrounding tissue [1.3.4, 1.3.5].
Signs of infiltration include:
- Swelling or puffiness around the IV site [1.5.4]
- Skin that feels cool to the touch [1.5.4]
- Blanching or pale skin color [1.5.4]
- Pain or tenderness [1.5.4]
- The IV infusion pump may alarm for an occlusion, or the drip may stop [1.5.4]
Extravasation is a more serious form of infiltration. The key difference is the type of fluid that leaks. While infiltration involves non-vesicant (non-irritating) fluids, extravasation occurs when a vesicant—a fluid or medication that can cause tissue damage—leaks into the tissue [1.5.1, 1.5.3]. Vesicant drugs include certain antibiotics like vancomycin, chemotherapy agents, and vasopressors [1.5.6, 1.9.2]. The consequences of extravasation can be severe, leading to blistering, tissue necrosis (death), and even compartment syndrome [1.3.4, 1.5.6].
Phlebitis
Phlebitis, or the inflammation of a vein, is another frequent complication, occurring in about 15.5% of peripheral IVs [1.2.1]. It presents with redness, warmth, swelling, and pain along the path of the vein, which may feel like a hard, palpable cord [1.6.2, 1.6.3].
There are three primary causes of phlebitis [1.6.2, 1.6.6]:
- Mechanical Phlebitis: Caused by the catheter irritating the vein wall, often because the catheter is too large for the vein or it's placed in an area of flexion like the wrist or elbow [1.3.6, 1.6.2].
- Chemical Phlebitis: Results from the irritation caused by the medication or fluid being infused, especially those that are acidic, alkaline, or have high osmolarity [1.6.2, 1.6.4].
- Infectious Phlebitis: Occurs when bacteria are introduced during insertion or through contamination, leading to an infection at the site [1.6.2, 1.6.4].
Occlusion and Mechanical Failures
An occlusion, or blockage, accounts for roughly 19% of all IV catheter failures [1.2.3]. This blockage prevents fluid from flowing through the catheter.
Common causes of occlusion include:
- Thrombotic Occlusion: A blood clot forms at the tip of the catheter [1.7.5].
- Mechanical Blockage: The IV tubing may be kinked, or a clamp may be closed [1.8.1]. The patient's position, such as a bent arm, can also physically obstruct the line [1.8.5].
- Precipitate Occlusion: Incompatible medications can mix in the line and form solid particles, or precipitates, that block the flow [1.7.3, 1.7.4].
- Pump Alarms: Infusion pumps are designed to alarm for occlusions when they detect high pressure in the line. Troubleshooting involves checking the entire system, from the IV bag to the patient's insertion site, for kinks or clamps [1.8.1, 1.8.3].
Catheter Dislodgement
Dislodgement is a purely mechanical complication where the catheter is accidentally pulled out of the vein [1.2.3]. This can happen when a patient moves, is transferred between beds, or if the tubing gets caught on something [1.2.3]. Dislodgement is responsible for around 7% of IV failures [1.2.3].
Comparison of Common IV Complications
| Complication | Key Signs & Symptoms | Primary Cause | Severity |
|---|---|---|---|
| Infiltration | Swelling, coolness, pallor, pain [1.5.4] | Leakage of non-vesicant fluid into tissue [1.5.1] | Mild to moderate; can cause discomfort and treatment delays [1.3.4]. |
| Extravasation | Burning, stinging, swelling, redness, blistering, tissue death [1.3.4, 1.5.6] | Leakage of vesicant (damaging) medication into tissue [1.5.1] | Can be severe, leading to tissue necrosis, nerve damage, or compartment syndrome [1.3.4, 1.5.6]. |
| Phlebitis | Redness, warmth, pain along the vein, palpable cord [1.6.2, 1.6.3] | Inflammation of the vein (mechanical, chemical, or infectious) [1.6.6] | Ranges from mild irritation to serious infection if not addressed [1.6.3]. |
Prevention and Management
Preventing IV failure is key. Best practices include [1.9.1, 1.9.2, 1.9.5]:
- Proper Site Selection: Avoiding areas of flexion (like the wrist or elbow) and using the smallest appropriate catheter gauge.
- Secure Catheter: Ensuring the catheter and tubing are well-secured to prevent movement and dislodgement.
- Aseptic Technique: Using proper sterile technique during insertion to prevent infection.
- Regular Monitoring: Frequently checking the IV site for early signs of complications like swelling, redness, or pain.
- Patient Education: Advising patients to report any discomfort at the IV site immediately and to be mindful of the tubing.
If an IV does fail, the first step is always to stop the infusion [1.9.1]. The subsequent actions depend on the cause, but generally involve removing the catheter, elevating the limb, applying a warm or cool compress as appropriate, and restarting the IV in a different location, preferably on the opposite arm [1.9.2].
Conclusion
An IV can stop working for many reasons, with the most common being infiltration, phlebitis, occlusion, and dislodgement. These failures can compromise patient care by delaying essential treatments and causing unnecessary pain. By understanding the signs of each complication and adhering to best practices for insertion, maintenance, and monitoring, healthcare providers can significantly reduce the high rate of IV failure and improve patient outcomes.
For more in-depth clinical guidelines, refer to resources like the Lippincott NursingCenter. [1.9.1]
