Intravenous (IV) therapy is a standard procedure in modern healthcare, used to deliver fluids, medications, and nutrients directly into a patient’s bloodstream. A common complication is infiltration, which involves a disruption where the catheter enters the vein, leading to unintended leakage of the solution.
Defining IV Infiltration
IV infiltration occurs when the solution being infused leaks out of the vein and into the surrounding subcutaneous tissue. This is a common complication of peripheral IV therapy, typically in the hand or arm. The catheter becomes dislodged from the vein’s inner channel, or lumen.
The mechanical cause often involves the catheter tip puncturing the vein wall or the device being pulled back slightly. Patient movement, improper securing, or fragile vein walls can contribute to this displacement. Infiltration specifically refers to leakage of “non-vesicant” fluids, meaning they do not typically cause severe tissue damage.
How to Recognize the Signs
Recognizing an IV infiltration requires observing both visual changes and physical sensations around the insertion site. The most immediate and common sign is localized swelling or puffiness where the catheter enters the skin, resulting from the accumulating leaked fluid. The site may feel tight or firm to the touch due to fluid pressure.
The skin’s appearance and temperature change noticeably. The skin often appears cool compared to unaffected areas, as the room-temperature IV solution collects beneath the skin. Skin color may also become pale or blanched, caused by fluid pressure restricting local blood flow.
A patient may experience pain, discomfort, or a stinging sensation at the insertion site. Additionally, a noticeable sign for caregivers is a significant slowing or complete stop of the infusion flow rate, even if the pump settings have not changed.
Immediate Steps and Management
If any sign of infiltration is observed, the first action is to stop the flow of the IV fluid or medication to prevent further leakage into the tissue. The infusion pump should be paused, or the roller clamp should be closed entirely. It is important to notify a healthcare professional right away to assess the site and determine the next steps.
The healthcare provider will then typically remove the intravenous catheter carefully to minimize any additional trauma. After removal, the affected limb should be elevated above the level of the heart, if possible, to encourage the reabsorption of the leaked fluid and help reduce the swelling. The nurse will then decide whether to apply a warm or cold compress to the area. Application of temperature is based on the type of fluid that infiltrated. The area will be monitored closely for any worsening symptoms, and a new IV line will likely need to be started in a different location.