Intravenous (IV) access is a common medical procedure used to deliver fluids, medications, or blood products directly into a patient’s bloodstream through a vein. The process involves inserting a small plastic tube, known as a catheter, into a peripheral vein, typically in the arm or hand. The procedure requires precision to ensure the catheter remains properly seated within the vessel. When the insertion is not precise, or the catheter becomes dislodged, the intended flow of fluid is disrupted, leading to localized problems or, in rare cases, more severe complications. Understanding the potential issues that can arise from improper placement can help patients recognize when a problem has occurred and seek prompt assistance.
Immediate Minor Issues During Insertion
The attempt to access a vein can sometimes result in immediate, temporary issues. One common event is a “blown vein,” which occurs when the needle passes completely through the vessel wall or causes the vein to rupture. This damage allows a small amount of blood to leak into the surrounding soft tissue, immediately forming a bruise or hematoma.
The result is noticeable discoloration, swelling, and mild discomfort at the insertion site, but this is usually a localized and temporary effect. Multiple insertion attempts may be necessary if the vein is fragile, rolls away from the needle, or is difficult to locate, increasing the likelihood of a hematoma. The complications are typically minor, resolving within one or two weeks as the body reabsorbs the leaked blood. When a vein is blown, the catheter must be removed, and a new site must be chosen.
Fluid Leakage and Localized Inflammation
A more sustained problem occurs when the catheter is not fully seated in the vein or punctures the vessel wall, allowing the infused fluid to leak into the surrounding tissues. This fluid leakage is categorized based on the nature of the substance being infused. The most common form is infiltration, which involves the inadvertent administration of non-vesicant solutions, such as normal saline or common antibiotics, into the subcutaneous tissue.
Signs of infiltration include localized swelling, skin blanching, and the area feeling notably cooler to the touch because the fluid temperature is typically lower than body temperature. While uncomfortable, infiltration of non-irritating fluids rarely causes lasting tissue damage. A more serious form of leakage is extravasation, which involves a vesicant, or an irritating medication like certain chemotherapy drugs or high-concentration potassium solutions, escaping the vein.
Because vesicant medications are corrosive to tissues, extravasation can cause severe burning pain, blistering, and tissue necrosis. Separately, the vein wall itself can become inflamed, a condition known as phlebitis, which may occur due to mechanical irritation from the catheter rubbing the inner wall or chemical irritation from the medication. Phlebitis is characterized by warmth, redness, tenderness, and sometimes a visible, palpable cord-like structure along the course of the affected vein.
Injury to Nearby Vessels and Nerves
Improper IV placement can result in the needle or catheter damaging structures adjacent to the vein. Accidental arterial puncture occurs when the needle is mistakenly inserted into an artery instead of the intended vein. This complication is immediately identifiable by bright red blood that flows out with a pulsatile pressure, reflecting the higher pressure within the artery.
If the mistake is not recognized and an infusion is started, the injection of medication into an artery can lead to intense pain, spasm of the arterial wall, and a reduction of blood flow to the extremity. This blockage can potentially cause tissue ischemia, and in extreme instances, lead to gangrene and the loss of the limb. Another serious complication is nerve injury, which occurs when the needle directly contacts or compresses a nerve that runs close to the chosen vein.
A patient experiencing nerve injury often reports an immediate, sharp, shooting pain or an electric shock sensation during the insertion attempt. If the injury is sustained, symptoms can evolve into persistent numbness, tingling, or a “pins and needles” sensation in the affected limb, sometimes accompanied by muscle weakness. While many nerve irritations resolve, direct trauma can rarely lead to permanent sensory or motor impairment, making immediate recognition paramount.
Recognizing and Reporting IV Problems
Patients should be aware of specific warning signs that indicate a complication. The first step is a simple visual and tactile assessment of the site for any changes in appearance or sensation. Look for any new or increasing swelling, redness, or leakage of fluid around the dressing.
Gently touching the skin near the catheter can reveal if the area feels abnormally cool, which is a sign of infiltration, or warm, which suggests inflammation like phlebitis. Any complaint of persistent pain, a burning sensation, or the onset of numbness or tingling should be reported immediately, as these can signal nerve irritation or extravasation. A feeling of tightness in the skin or a noticeable slowing or stopping of the fluid drip is also cause for concern.
If any sign or symptom suggests a problem, the patient should immediately notify a nurse or healthcare provider. It is important to avoid adjusting the tubing or attempting to remove the catheter, as this could worsen the complication or cause unnecessary bleeding. Prompt identification and removal of the faulty IV line, often followed by the application of a warm or cool compress, is the standard action to prevent further tissue damage and allow for treatment to begin.