When a patient receives intravenous (IV) therapy, fluids, medications, or nutrients are delivered directly into the bloodstream through a catheter placed in a vein. This method is used to ensure rapid and complete distribution throughout the body. Occasionally, the catheter becomes dislodged or punctures the vein wall, causing the infused solution to leak and collect in the surrounding subcutaneous tissue. This common complication is known as infiltration when non-irritating fluids are involved, or extravasation when the leaking substance is irritating or corrosive to tissue.
Identifying Signs and Symptoms
The first indication that IV fluid is leaking into the tissue often comes from observable physical changes at the insertion site. Localized swelling or puffiness around the IV site is a sign resulting from the pooling of extra fluid in the tissue space. The skin over the affected area will feel noticeably cool or cold to the touch because the fluid is no longer circulating through the bloodstream.
Patients may feel a mild, tight, or puffy sensation, and sometimes pain or discomfort near the site. If the skin is stretched by the accumulating fluid, it may appear pale or blanched compared to the surrounding skin. The fluid flow rate will often slow down or stop completely, and an electronic infusion pump may alarm due to a change in pressure. This means the fluid is no longer entering the vascular system, making the therapy ineffective.
Causes and Immediate Patient Response
Infiltration occurs for several reasons, often related to the catheter’s position or stability within the vein. Patient movement, especially flexing the joint where the IV is placed, can cause the catheter tip to press against or push through the vein wall. If the catheter is not secured properly, it may become dislodged. Fragile veins, common in older or very young patients, can also rupture from the pressure of the infusion, allowing fluid to escape.
If a patient or caregiver observes signs of swelling, coolness, or discomfort, the immediate priority is to stop the infusion flow. This prevents additional fluid from leaking into the tissue, limiting the damage. The healthcare provider must be alerted immediately about the suspected infiltration. The affected limb should be elevated above the level of the heart, if possible, to encourage the fluid to drain away from the site.
Patients should not remove the IV catheter themselves, as medical staff need to assess the site and potentially aspirate residual fluid. The medical team determines whether to apply warm or cold compresses, as the choice depends entirely on the type of fluid or medication that has leaked out. Applying the wrong temperature compress could worsen the injury, especially with certain medications. The primary responsibility of the patient is to recognize the symptoms, stop the flow, and call for medical help without delay.
Medical Assessment and Resolution
Healthcare providers conduct a structured assessment to determine the extent and type of injury, often using standardized grading scales. The initial step is distinguishing between simple infiltration and extravasation. Infiltration involves non-irritating solutions like normal saline or common antibiotics, usually causing temporary swelling and discomfort. Extravasation refers specifically to the leakage of vesicant substances, such as certain chemotherapy drugs, high-concentration electrolytes, or vasopressors. These substances have the potential to cause blistering, ulceration, and severe tissue damage.
For most simple infiltrations, treatment involves removing the compromised IV line and restarting the infusion in a different site. The affected area is monitored closely, and elevation and specific temperature compresses are used to manage swelling and promote fluid reabsorption. In cases of extravasation, the response is more aggressive; the provider may attempt to aspirate any remaining medication from the catheter before removal. Specific antidotes, which counteract the damaging effects of the leaked medication, may be injected into the surrounding tissue.
The concern with large-volume infiltration or chemical extravasation is the risk of compartment syndrome. This serious condition occurs when increased pressure from the accumulated fluid restricts blood flow and can damage nerves and muscle. While most infiltrations resolve with minor bruising, severe extravasation can lead to skin necrosis (tissue death), potentially requiring surgical debridement. Prompt identification and specialized medical intervention are necessary to mitigate long-term complications.