An intravenous (IV) line delivers fluids, medications, nutrients, or blood products directly into a patient’s bloodstream, typically through a vein in the arm or hand. While IVs are a routine procedure and generally safe, proper insertion and ongoing care are important to prevent complications.
Common Complications of Improper IV Insertion
Improper IV placement or issues after insertion can lead to several complications.
Infiltration
Infiltration occurs when IV fluid or medication leaks out of the vein into surrounding soft tissue. This happens if the catheter moves out of or punctures the vein, or if the vein is damaged, causing fluid to accumulate.
Extravasation
Extravasation is a more serious form of infiltration where a vesicant (irritating medication) leaks into surrounding tissue. This can cause chemical burns, severe tissue damage, blistering, and tissue death. Leakage occurs if the catheter dislodges or ruptures the vein, or if medication is administered through an improperly secured or too-small IV line.
Phlebitis
Phlebitis is inflammation of the vein. It can result from mechanical irritation by the catheter, chemical irritation from medications, or bacterial infection. Mechanical phlebitis is caused by the catheter rubbing against the vein wall, chemical phlebitis is a reaction to the infusate, and bacterial phlebitis involves microorganisms.
Hematoma
A hematoma forms when blood leaks out of the vein and collects in surrounding tissue, creating a bruise. This usually occurs during IV insertion if the needle passes through the vein, or if insufficient pressure is applied after removal.
Infection
Infection can develop at the IV insertion site (local infection) or spread into the bloodstream (systemic infection or sepsis). Bacteria on the skin can enter through the small opening created by the IV catheter, especially if aseptic techniques are not strictly followed.
Nerve Injury
Nerve injury occurs when the IV needle or catheter punctures or irritates a nearby nerve. This can happen during insertion, particularly where nerves are close to the chosen vein. It can result in sensory changes and, in some cases, motor dysfunction.
Air Embolism
Air embolism, though rare, is a serious complication where air enters the bloodstream. This can occur if air is not properly removed from IV tubing before infusion, if tubing disconnects, or during improper removal of certain IV lines. The air bubble can block blood flow to organs.
Recognizing the Signs of IV Complications
Early identification of IV complications is important for prompt intervention.
For infiltration, signs include swelling, pain, coolness, or tightness around the IV site. The skin may appear pale, and fluid flow might slow or stop. With extravasation, similar swelling and pain are present, along with burning, stinging, blistering, or changes in skin color/texture.
Phlebitis presents with redness, warmth, and tenderness along the vein path. The vein might feel hard or cord-like, with localized swelling and pain. A hematoma is noticeable as bruising, swelling, and tenderness at the IV site.
Signs of a local infection include increased pain, redness, swelling, and warmth, sometimes with pus or drainage. If the infection becomes systemic, generalized symptoms like fever, chills, and weakness may develop. Nerve injury can manifest as tingling, numbness, burning, or sharp pain radiating from the IV site. Weakness or difficulty moving the affected limb can also occur.
An air embolism may present with sudden, severe symptoms. These include abrupt shortness of breath, chest pain, dizziness, or a sudden drop in blood pressure. Neurological changes, such as confusion or loss of consciousness, are also possible.
Immediate Steps and When to Seek Medical Attention
If you suspect an IV complication, do not attempt to remove the line yourself. Promptly notify a healthcare professional, such as a nurse or doctor. They are trained to assess the situation and intervene safely.
When reporting an issue, clearly describe any pain, swelling, skin changes, or unusual sensations. Persistent or worsening pain, rapid swelling around the IV site, or significant changes in skin color or temperature warrant immediate medical attention.
Seek urgent medical attention for signs of a systemic reaction or severe localized issues. These include high fever, chills, or generalized weakness, which could indicate a spreading infection. Difficulty breathing, chest pain, or sudden confusion could point to an air embolism and require emergency care. Spreading redness or streaks from the IV site, or significant loss of sensation or movement in the affected limb, also needs urgent professional evaluation.
Factors Contributing to IV Complications
Several factors can contribute to the occurrence of IV complications, ranging from patient characteristics to insertion procedure and equipment. Patient physiology plays a role, as individuals with fragile veins (such as the elderly or very young) or those with underlying conditions like poor circulation or bleeding disorders may be more susceptible to issues like hematomas or infiltrations. Additionally, patients who are restless or uncooperative can inadvertently dislodge the IV catheter, leading to complications.
The insertion technique itself is a significant factor. Multiple attempts to insert the IV, selecting an inappropriate vein or insertion site, or using a catheter that is too large for the chosen vein can increase the risk of complications. Inadequate stabilization of the IV catheter after insertion can also lead to movement and subsequent infiltration or phlebitis.
Equipment issues can also contribute to problems. Damaged IV tubing, improper priming of the line where air is not fully removed, or a catheter that is not properly secured can lead to complications like air embolisms or dislodgement. While IV therapy is generally safe, these contributing factors highlight the importance of careful technique and vigilance to minimize potential adverse events.