An intravenous (IV) line is a catheter that a healthcare professional inserts into a peripheral vein, typically in the arm or hand. This device is the most common invasive procedure performed in acute care settings globally. Its purpose is to deliver necessary fluids, medications, nutrients, or blood products directly into the bloodstream, bypassing the digestive system for rapid effect. IV failure occurs when the line stops functioning as intended, interrupting treatment and requiring the catheter to be removed and often replaced. Despite the commonality of the procedure, studies indicate that the overall failure rate for peripheral IVs is high, often ranging between 35% and 50% of all insertions.
Recognizing the Signs of IV Failure
The most noticeable sign of a failing IV is localized pain or discomfort that develops at or near the insertion site. Patients may describe this sensation as a sharp ache, burning, or throbbing feeling that persists even when the limb is resting. Any visible changes to the skin around the catheter are also indicators that the line is no longer working correctly.
Swelling or puffiness around the IV site suggests that fluid is leaking out of the vein and into the surrounding tissues. This fluid accumulation can cause the skin to feel tight or firm, and it may also appear noticeably cooler to the touch compared to the skin on the opposite limb. Depending on the type of fluid or medication being infused, the skin may also show discoloration, appearing red, pale, or blanched.
A sign of mechanical failure involves the blood flow within the IV tubing itself. If the IV bag is lowered below the patient’s heart level, blood may back up into the catheter or the clear tubing, indicating a blockage or a misplaced catheter tip. Modern infusion pumps often provide an objective warning, as they may alarm frequently or show a significant drop in the infusion rate due to increased pressure caused by resistance in the line.
Primary Reasons for IV Failure
IV failure stems from a combination of mechanical issues, local tissue reactions, and biological responses within the vein. One of the most frequent causes is infiltration, which happens when the catheter tip moves out of the vein, causing non-vesicant IV fluid to leak into the subcutaneous tissue. A more serious form is extravasation, where a vesicant or irritating medication, such as certain chemotherapy drugs, leaks out, potentially causing tissue damage.
Phlebitis is the inflammation of the vein wall. This inflammation can be triggered by mechanical phlebitis, caused by the friction of the catheter tip rubbing against the vein wall; chemical phlebitis, resulting from the irritating properties of the infused medication; or bacterial phlebitis, which occurs due to contamination at the insertion site.
The physical blockage of the catheter, known as occlusion, is often due to the formation of a blood clot at the tip or inside the lumen of the tube. This clot formation can be encouraged by a lack of proper flushing or by a mismatch between the catheter size and the size of the vein, leading to trauma to the vessel lining. Occlusion can also happen when incompatible medications precipitate and form solid particles within the line.
Mechanical complications are often related to the patient’s movement or catheter security. Catheter dislodgement occurs when the catheter is accidentally pulled out, or partially backed out, from the vein due to patient movement or a loose dressing. Additionally, the line can fail if the plastic tubing or the catheter itself becomes kinked, physically obstructing the flow of fluid. Infection at the site is a less frequent cause of immediate failure, but it can develop over time, presenting with warmth, redness, and sometimes drainage.
Next Steps After IV Failure
Once a failure is suspected, the first step is to stop the flow of the infusion to prevent further leakage of fluid or medication into the surrounding tissue. The patient should alert a nurse or other healthcare provider immediately upon noticing any of the signs of failure, particularly pain, swelling, or a pump alarm. Healthcare staff will then inspect the site to confirm the type and severity of the complication.
If failure is confirmed, the catheter must be removed entirely to prevent infection and allow the vein to begin healing. The affected area is then managed based on the cause of the failure; for instance, a cold compress may be applied to reduce swelling from a recent infiltration, while a warm compress might be used to promote circulation and comfort in cases of phlebitis. The arm or hand may also be elevated to help reduce localized swelling.
After the failed line is removed and the site is addressed, the patient will need a new IV line inserted if the treatment must continue. This process involves finding a different, healthy vein, typically in the opposite limb or a site away from the failed area, to re-establish vascular access. The healthcare team will document the failure and the new site to ensure continuity of care and monitor for any subsequent issues.