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.
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Practice 18 NCLEX-style questions
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Side-by-side6 compared
Focus
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: IV drug given too fast
- Systemic: air enters line / disconnection
- Systemic: too much fluid volume
Signs & symptoms
- Cool, puffy, taut skin
- ★Dull ache at site
- Cool, puffy, taut skin
- ★Burning, stinging at site
- ★Warm, red streak along vein
- Tenderness along vein
- Minimal local edema
- Chest tightness, pounding headache
- ★Flushed face, irregular pulse, syncope
- Sudden chest pain, dyspnea
- ★Churning sound over precordium
- Orthopnea, moist cough
- Distended neck veins (JVD)
- ★Crackles, bounding pulse, I > O
Assessment clues
- Flow sluggish/stopped
- Non-vesicant fluid infusing
- Flow sluggish/stopped
- Vesicant drug infusing
- Flow often unaffected
- Graded by phlebitis scale 0–4
- Onset right after a rapid IV push
- Disconnection or air visible in the line
- Large volume in HF/renal/older pt
- I > O on the record
Nursing priorities
- Stop infusion
- Elevate extremity
- Restart at new site
- Stop infusion
- Aspirate residual drug
- Do not flush the line
- Elevate extremity
- Notify provider
- Restart at new site
- Stop infusion
- Restart at new site
- Stop infusion
- Notify provider
- Clamp tubing
- Left side + Trendelenburg
- Notify provider
- Slow the infusion rate
- Elevate HOB (high Fowler's)
- Notify provider
Management
- Warm or cold compress per agent
- Drug-specific antidote
- Warm or cold compress per agent
- Warm compress to site
- Supportive care for drug toxicity
- High-flow 100% O₂
- CPR/ACLS if arrest
- Loop diuretic (furosemide)
- Fluid restriction as ordered
Prevention
- Secure catheter, check site often
- Report site swelling or coolness
- Give vesicants via patent central line
- Report site swelling or coolness
- Rotate sites per policy
- Dilute irritating drugs
- Use an infusion pump
- Push IV drugs over correct time
- Prime tubing to remove air
- Luer-lock all connections
- Use an infusion pump
- Monitor I&O, daily weight
Red flags — escalate
- Severe swelling, blanching, ↓ pulse
- Blistering, skin necrosis
- Purulent drainage + fever
- Syncope, shock
- Hypotension, cyanosis, collapse
- Pink frothy sputum
Complications
- Compartment syndrome (large volume)
- Tissue necrosis
- Loss of function
- Thrombophlebitis
- Bloodstream infection
- Cardiac arrest
- Stroke
- Cardiac arrest
- 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 at site
Extravasation
- Cool, puffy, taut skin
- ★Burning, stinging at site
Assessment clues
Infiltration
- Flow sluggish/stopped
- Non-vesicant fluid infusing
Extravasation
- Flow sluggish/stopped
- Vesicant drug infusing
Nursing priorities
Infiltration
- Stop infusion
- Elevate extremity
- Restart at new site
Extravasation
- Stop infusion
- Aspirate residual drug
- Do not flush the line
- Elevate extremity
- Notify provider
- Restart at new site
Management
Infiltration
- Warm or cold compress per agent
Extravasation
- Drug-specific antidote
- Warm or cold compress per agent
Prevention
Infiltration
- Secure catheter, check site often
- Report site swelling or coolness
Extravasation
- Give vesicants via patent central line
- Report site swelling or coolness
Red flags — escalate
Infiltration
- Severe swelling, blanching, ↓ pulse
Extravasation
- Blistering, skin necrosis
Complications
Infiltration
- Compartment syndrome (large volume)
Extravasation
- Tissue necrosis
- Loss of function
★ marks the fact that sets a column apart.
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Clinical Pearl
Cool + swollen = infiltration. Warm + red streak = phlebitis. Vesicant running + swollen = extravasation — stop and aspirate.
Component Topics
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Go further
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