An intravenous (IV) line is a thin, flexible tube, or catheter, inserted into a vein to deliver fluids, medications, or blood products directly into the bloodstream. A common complication known as IV infiltration occurs when the IV fluid accidentally leaks out of the vein and into the surrounding subcutaneous tissue. Although frequent, infiltration generally causes localized swelling and discomfort rather than severe harm, but it requires prompt attention.
Identifying IV Infiltration
Recognizing IV infiltration quickly prevents further tissue exposure. The most noticeable sign is localized swelling, which occurs as the infused fluid collects in the soft tissue around the insertion site. The skin over the affected area often appears pale, or blanched, and may feel unusually taut or puffy.
Another common symptom is a distinct coolness of the skin when touched, resulting from the room-temperature fluid resting underneath the surface. Patients may also report pain, burning, or discomfort at the IV site. A clear sign for a caregiver is a change in the IV flow rate, which may slow down or stop completely, and the inability to draw blood back into the tubing.
Immediate Steps for Management
Upon suspecting infiltration, immediately stop the fluid infusion by clamping the IV tubing or turning off the pump. This prevents additional fluid from leaking into the surrounding tissue. Do not attempt to flush the line, as this would push more fluid into the compromised tissue.
The next step is the removal of the IV catheter to eliminate the source of the leak. After removal, apply gentle pressure to the insertion site to control minor bleeding, and then place a sterile dressing over the puncture wound. The nurse or medical professional should be notified immediately after these actions are taken to assess the severity and determine subsequent steps.
Post-Infiltration Care and Monitoring
Post-infiltration care focuses on promoting the reabsorption of leaked fluid and monitoring the site for healing or complications. Elevating the affected limb, such as resting the arm on a pillow above the level of the heart, helps reduce swelling. This simple mechanical action aids the body in reabsorbing the excess fluid that has accumulated in the tissue.
The application of temperature depends on the type of fluid that infiltrated. Generally, a cold compress is applied first to cause vasoconstriction, which can limit the spread of fluid and decrease swelling and discomfort. After the initial 24 hours, or as directed by a healthcare provider, a warm compress may be used to promote circulation and help the body absorb the fluid more quickly.
The site must be regularly monitored for any worsening signs, such as blistering, increased pain, or numbness, which could indicate a more severe issue like an extravasation or potential infection. If the patient requires continued intravenous therapy, a new IV site must be established in a different extremity or a healthy location away from the compromised area.