IV Complications Recognition Matrix: Local vs Systemic
An IV site that looks cool and puffy is not the same as one that is warm and streaky — but under exam pressure students grab the wrong finding and choose an intervention that delays care. Knowing whether the problem is local tissue damage or a systemic emergency determines whether you slow the rate or call a code.
Master this comparison — play it or drill it.
Practice 17 NCLEX-style questions
Practice nowCheat sheet
Quick reference
Comparison
- Local: non-vesicant fluid leaks into tissue
- Local: vesicant drug leaks into tissue
- Local: vein inflammation / irritation
- Systemic: drug infused too rapidly
- Systemic: air enters line / disconnection
- Systemic: excess volume / too-fast rate
- Cool, puffy, taut skin
- ★Dull ache, tightness
- Cool, puffy, taut skin
- ★Burning, stinging at site
- ★Warm, red streak along vein
- Tenderness along vein
- minimal edema
- Chest tightness, pounding headache
- ★Flushed face, irregular pulse, syncope
- Sudden chest pain, dyspnea
- ★Churning sound over precordium
- Dyspnea
- distended neck veins
- ★Crackles, bounding pulse, I > O
- Flow sluggish/stopped
- cool, swollen, non-vesicant
- Flow sluggish/stopped
- vesicant infusing
- May keep flowing
- warm red streak along vein
- Onset right after a too-rapid infusion
- Disconnection or air visible in the line
- Running too fast
- I > O on the record
- Stop infusion
- elevate extremity
- Stop infusion
- aspirate residual drug
- DO NOT flush
- notify provider
- Stop infusion
- restart at new site
- Stop infusion
- place supine
- monitor VS
- Clamp tubing
- left Trendelenburg
- Call provider
- Slow rate
- elevate HOB
- notify provider
- Warm compress to site
- Antidote per drug if available
- Warm compress to site
- Restart at new IV site
- Supportive care
- treat reaction
- 100% O₂
- resuscitate as needed
- O₂
- diuretics as ordered
- Secure site
- report swelling or coolness
- Give vesicants via patent central line
- Rotate sites
- dilute irritating drugs
- Use infusion pump
- verify rate
- Prime tubing
- Luer-lock all connections
- Pump-control rate
- monitor I&O
- Severe swelling, blanching, ↓ pulse
- Blistering, necrosis then tissue loss
- Purulence + fever then catheter infection
- Syncope, cardiac arrest
- Hypotension, cyanosis, collapse
- Pink frothy sputum then pulmonary edema
- Compartment syndrome (large volume)
- Tissue necrosis
- loss of function
- Thrombophlebitis
- bloodstream infection
- Cardiovascular collapse
- Stroke
- cardiac arrest
- death
- Pulmonary edema
- heart failure
Infiltration
- Local: non-vesicant fluid leaks into tissue
Extravasation
- Local: vesicant drug leaks into tissue
Infiltration
- Cool, puffy, taut skin
- ★Dull ache, tightness
Extravasation
- Cool, puffy, taut skin
- ★Burning, stinging at site
Infiltration
- Flow sluggish/stopped
- cool, swollen, non-vesicant
Extravasation
- Flow sluggish/stopped
- vesicant infusing
Infiltration
- Stop infusion
- elevate extremity
Extravasation
- Stop infusion
- aspirate residual drug
- DO NOT flush
- notify provider
Infiltration
- Warm compress to site
Extravasation
- Antidote per drug if available
Infiltration
- Secure site
- report swelling or coolness
Extravasation
- Give vesicants via patent central line
Infiltration
- Severe swelling, blanching, ↓ pulse
Extravasation
- Blistering, necrosis then tissue loss
Infiltration
- Compartment syndrome (large volume)
Extravasation
- Tissue necrosis
- loss of function
★ marks the fact that sets a column apart.
Loading Blood Rush…
Tap the column each item belongs to — jump in and play, or just watch it run.
Play full screen for XPClinical Pearl
Cool + swollen = infiltration. Warm + red streak = phlebitis. Vesicant running + swollen = extravasation — stop and aspirate.
Component Topics
Ready to master this comparison?
Get a personalized study plan built around this topic — free to try, no card needed.