Intravenous (IV) infiltration occurs when fluid administered through an IV line leaks from the vein into the surrounding soft tissue. This happens because the IV catheter, a small tube, either dislodges or punctures the vein wall. Infiltration is a common complication of IV therapy.
Identifying Infiltration
Recognizing IV infiltration involves observing visual cues and patient sensations. Swelling, a cool feeling, skin blanching, or redness can signal infiltration. Patients often report localized pain, discomfort, or a burning or stinging sensation at the IV site. A feeling of tightness in the skin or surrounding tissue is also common. A decreased or stopped IV fluid flow rate is a key sign.
Factors Increasing Risk
Various circumstances increase the likelihood of IV infiltration. Patient characteristics play a role, with very young children and elderly individuals being more susceptible due to their delicate veins. Patients with certain medical conditions, such as chronic kidney disease, diabetes, or peripheral vascular disease, may also have fragile veins. Patient restlessness or excessive movement can contribute to the catheter shifting out of place.
The chosen IV site and procedural elements also influence risk. Areas of the body that bend frequently, like the wrist or the antecubital fossa (inner elbow), are more prone to infiltration. Using previously accessed sites can weaken vein walls. Improper vein selection or poor insertion technique, such as the catheter puncturing through the vein, raises the risk.
Equipment-related factors and the nature of the infused fluid also contribute to infiltration risk. Using a catheter size too large for the chosen vein, or failing to properly secure and stabilize the catheter, can lead to dislodgment. High infusion rates or the administration of certain fluids and medications also increase the risk. Hypertonic solutions like 10% dextrose, high-concentration electrolytes, or specific drugs such as phenytoin and vancomycin, are known to irritate vein walls and make infiltration more likely.
Immediate Actions
Prompt action is important upon identifying IV infiltration to minimize discomfort and complications. Immediately stop the IV infusion. Then, remove the IV catheter from the affected site.
Elevating the affected limb above the level of the heart can help reduce swelling by promoting fluid reabsorption. Applying a warm or cold compress to the site can help manage symptoms, with the specific type depending on the infiltrated fluid and medical advice. For non-irritating solutions, a warm compress may be recommended to aid in fluid reabsorption and improve circulation. Continued monitoring of the site for any worsening redness, pain, or swelling is important. If symptoms persist or worsen, seeking professional medical advice is recommended.