IV Infiltration & Other IV Catheter Complications
IV infiltration and other catheter complications are extremely common. IV catheters are vital tools — but like any invasive procedure, they carry risks. Knowing how to identify and manage each complication keeps your patients safe.
This guide covers the four complications you'll see most: infiltration and extravasation, superficial thrombophlebitis, cellulitis, and catheter breakage — with the signs to catch them and the nursing interventions to manage them.
What Is an IV Catheter?
An IV catheter is a small, thin tube placed into a vein with a needle that is then retracted, leaving only the plastic catheter in place. It's used to administer medications and fluids directly into the bloodstream.
Because IV catheters are invasive, they carry some level of risk — which is exactly why regular assessment of the IV site is essential to keep patients safe and catch infiltration or any other complication early.
Assessment of the IV Site
Monitoring the IV site is an essential part of managing complications. Inspect and palpate not just the insertion site, but also the dressing and any tubes or lines attached to the patient.
1. IV Infiltration & Extravasation
IV infiltration is when IV solution infuses (infiltrates) the surrounding tissue adjacent to the vein instead of into it. This usually happens when the catheter is malpositioned during insertion or after being dislodged — which is why proper placement and securement of the IV, dressing, and tubing matter so much.
As soon as you realize the IV is infiltrated, stop the infusion to prevent more fluid or medicine from infiltrating.
Confirm the site is truly infiltrated. Try to pull back blood return to see if it's still in the vein. Avoid applying pressure to the site.
Raise the extremity above the level of the heart to encourage drainage back into the vasculature.
If a medication has extravasated, notify the provider / pharmacy BEFORE removing the IV — certain vesicants need to be irrigated or have an antidote administered through the IV before removal.
If the fluid contained medication, notify the provider and pharmacy to ensure no additional steps are needed.
For simple fluid infiltration, a compression wrap and time are usually enough. For vesicant extravasation, antidotes may be ordered, administered into the IV, and locally infiltrated into the surrounding tissue.
Remove the bad IV and insert a new one in a different location. If using the same extremity, choose a site proximal to the infiltration.
Common IV Vesicants
These cause tissue damage if extravasation occurs: acyclovir, dextrose >10%, mannitol, nitroglycerin, phenytoin, sodium bicarb, all vasopressors (dopamine, dobutamine, epinephrine, etc.), and many chemotherapeutics (cisplatin, vincristine, etc.).
IV Irritants
These cause irritation but not the same level of tissue damage as vesicants: amiodarone, esmolol, gentamicin, potassium chloride, and vancomycin.
2. Superficial Thrombophlebitis
Superficial thrombophlebitis is inflammation of a vein (phlebitis) with some clot formation (thrombus) in a superficial vein where IVs are placed. It is different from deep vein thrombosis (DVT) and is managed differently. The body mounts an inflammatory response to anything that "doesn't belong," and that inflammation can lead to clot formation.
Bigger Is Not Always Better
Larger IV bores cause more endothelial vein-wall damage and are more likely to cause thrombophlebitis. Place the smallest appropriate IV size for the job.
Stop all medications or infusions currently running into the vein.
Report the suspected inflammation. If the pain or signs are significant, a DVT may need to be ruled out with a venous duplex of the upper extremity.
Remove the affected IV from the patient.
Insert a new IV in a different location — if using the same extremity, choose a site proximal to the affected area.
Most cases don't need anticoagulation like a DVT. Removal, elevation, warm or cool compresses, and NSAIDs make up symptomatic treatment.
3. Cellulitis
Cellulitis is a local skin and soft-tissue bacterial infection, usually caused by a break in the skin barrier. Since an IV breaks skin integrity, it offers a pathway for bacteria to enter and infect — which is why aseptic (sterile) technique during insertion is so important. Patients who are immunocompromised, including those with uncontrolled diabetes, are more prone to it.
Stop all medications and infusions through the vein (it could also be infiltrating, thrombophlebitis, or something else).
Do a full set of vitals including temperature to confirm stability and check for fevers.
Report the suspected infection. They will determine if antibiotics are necessary.
Remove the affected IV and insert a new one in a different location — proximal to the site if using the same extremity.
Most cases require antibiotics, IV or PO. Common IV options: Keflex, Bactrim, clindamycin, ceftriaxone, and vancomycin (if MRSA risk).
4. IV Catheter Breakage
IV breakage is a rare but serious complication. It can occur from catheter damage, improper insertion technique, or excessive manipulation. It must be prevented, because a broken catheter tip can embolize to the heart or lungs.
Never pull out the IV if you feel resistance. Cover the area with a sterile bandage, apply a warm compress to relax the vein, wait 5 minutes, then try again very gently. If resistance continues, contact the provider / vascular surgery or interventional radiology immediately.
Keep the arm still and below the level of the heart to prevent the catheter piece from traveling up toward the heart or lungs.
Apply a tourniquet near the armpit to close off the veins and prevent the piece from passing. Check a radial pulse to ensure it's not too tight.
Notify the hospitalist/attending and/or vascular surgery or interventional radiology.
Imaging (X-ray or ultrasound) may be done and removal performed by specialists. Watch for acute chest pain, SOB, or vital-sign changes that may indicate embolization.
Clinical Pearls
Related Guides
References
- Catheter-related upper extremity venous thrombosis in adults. UpToDate.
- Extravasation injury from chemotherapy and other non-antineoplastic vesicants. UpToDate.
- Peripheral venous access in adults. UpToDate.
- Peripheral intravenous (IV) device management. The Royal Children's Hospital Melbourne.
- What if… You're Starting an IV and the Catheter Breaks off in the Vein? (2009) The Journal of Ambulatory Care Management.
This is very informative. I shared it with my students and they went wild.
Thanks Will
That’s great to hear! Thanks so much for sharing, and I hope your students find it helpful!
This would be excellent to use in a nursing program. It’s a condensed information . Good job putting it all together.
Thank you, a great compliment!
Excellent! Thank you for making this skill’s additional information easy to follow! Great resource for new grads!
Thank you, that’s the goal! 🙂
Educative and very refreshing. Thank you.
You’re welcome!
Yes what is reason for infiltration
Nice job condensing this down to a few pages. Ive been a nurse for 30 years and just reviewing. Thanks for the time you spent on this. Very helpful!!