When receiving intravenous (IV) fluids or medications, swelling at the insertion site can occur. Understanding the potential reasons behind such swelling helps in identifying and addressing the issue. Various factors, from fluid leakage to inflammatory responses, can contribute to swelling around an IV site.
Infiltration
Infiltration occurs when non-vesicant IV fluid, meaning a solution that does not cause tissue damage, leaks from the vein into the surrounding subcutaneous tissue. The accumulation of this fluid in the interstitial spaces outside the vein leads to visible swelling around the IV insertion point.
Signs of infiltration include the skin around the IV site feeling cool to the touch and appearing pale or discolored. The area may also feel taut or tight, and the individual might experience pain or discomfort. Immediate action involves stopping the infusion and removing the IV line to prevent further fluid leakage. Elevating the affected limb can help reduce the swelling by promoting fluid drainage.
Extravasation
Extravasation is a more severe complication, involving the leakage of a vesicant IV fluid or medication into the surrounding tissue. Vesicant solutions are capable of causing significant tissue damage, such as blistering, tissue death (necrosis), or even nerve and tendon damage. The distinction from infiltration lies in the damaging nature of the fluid involved.
Symptoms of extravasation are similar to infiltration, including swelling and pain, but are typically more severe, with a burning sensation at the site. Other indicators include blistering, skin discoloration, and ulcer formation. Due to the potential for serious tissue injury, immediate medical attention is necessary to manage extravasation, which may involve administering specific antidotes or other treatments.
Phlebitis
Phlebitis refers to the inflammation of the vein wall. This inflammation can be triggered by mechanical irritation, such as the catheter moving within the vein, or by chemical irritation from certain medications or solutions. Bacterial presence can also lead to phlebitis.
Signs of phlebitis include redness, warmth, and tenderness along the path of the affected vein. The inflamed vein may feel like a firm, cord-like structure under the skin, and swelling directly over the vein can be observed. The swelling arises from the body’s inflammatory response. Treatment involves removing the IV catheter and applying warm compresses to alleviate symptoms.
Hematoma
A hematoma forms when blood collects outside of blood vessels at the IV insertion site. This can happen if the vein is punctured multiple times during the IV placement process, or if the catheter inadvertently passes completely through the vein. The accumulation of this blood in the surrounding tissues causes localized swelling.
The appearance of a hematoma is an immediate bruise, with discoloration ranging from blue to purple, and sometimes a tender lump at the site. While uncomfortable, hematomas usually resolve on their own as the body reabsorbs the pooled blood. Applying pressure during and after IV removal helps minimize the risk of a hematoma forming.
Localized Infection
A localized infection at an IV site develops when bacteria or fungi enter the insertion point and multiply. This complication is less immediate than other causes of swelling but can become serious if not addressed promptly. Poor aseptic technique during IV insertion or maintenance, or prolonged catheter use, can contribute to infection risk.
Signs of a localized infection include increasing redness, warmth, and pain at the site. Swelling worsens over time, and pus or drainage may be present. A fever can also indicate infection. This type of swelling requires immediate medical attention, often involving IV removal and antibiotic treatment.