recognition matrix comparison
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.
Comparison
Side-by-side6 compared
Comparevs
Dimension
Infiltration
Extravasation
Phlebitis
Speed Shock
Air Embolism
Fluid Overload
Cause / mechanism
- 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
Signs & symptoms
- 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
Assessment clues
- 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
Nursing priorities
- 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
Management
- 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
Prevention
- 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
Red flags — escalate
- Severe swelling, blanching, ↓ pulse
- Blistering, necrosis → tissue loss
- Purulence + fever → catheter infection
- Syncope, cardiac arrest
- Hypotension, cyanosis, collapse
- Pink frothy sputum → pulmonary edema
Complications
- Compartment syndrome (large volume)
- Tissue necrosis; loss of function
- Thrombophlebitis; bloodstream infection
- Cardiovascular collapse
- Stroke; cardiac arrest; death
- Pulmonary edema; heart failure
Cause / mechanism
Infiltration
- Local: non-vesicant fluid leaks into tissue
Extravasation
- Local: vesicant drug leaks into tissue
Signs & symptoms
Infiltration
- Cool, puffy, taut skin
- ★Dull ache, tightness
Extravasation
- Cool, puffy, taut skin
- ★Burning, stinging at site
Assessment clues
Infiltration
- Flow sluggish/stopped; cool, swollen, non-vesicant
Extravasation
- Flow sluggish/stopped; vesicant infusing
Nursing priorities
Infiltration
- Stop infusion; elevate extremity
Extravasation
- Stop infusion; aspirate residual drug
- DO NOT flush; notify provider
Management
Infiltration
- Warm compress to site
Extravasation
- Antidote per drug if available
Prevention
Infiltration
- Secure site; report swelling or coolness
Extravasation
- Give vesicants via patent central line
Red flags — escalate
Infiltration
- Severe swelling, blanching, ↓ pulse
Extravasation
- Blistering, necrosis → tissue loss
Complications
Infiltration
- Compartment syndrome (large volume)
Extravasation
- Tissue necrosis; loss of function
★ marks the fact that sets a column apart.
Clinical Pearl
Cool + swollen = infiltration. Warm + red streak = phlebitis. Vesicant running + swollen = extravasation — stop and aspirate.
⚡ Speed Sort This Table
Swipe to sort 283 clinical items into the right bucket