IV Complications: Infiltration, Extravasation & Phlebitis

The IV site looks swollen and the patient says it burns — but is it infiltration, extravasation, or phlebitis? Your next action depends entirely on which one.

Local IV complications occur at or near the insertion site and include infiltration, extravasation, phlebitis, thrombophlebitis, hematoma, and local infection. Infiltration is non-vesicant fluid leaking into surrounding tissue — the site becomes cool, pale, and edematous with sluggish or absent blood return. Extravasation is the same mechanism but with a vesicant agent (e.g., dopamine, chemotherapy, phenytoin), which causes tissue necrosis and is a medical emergency requiring immediate intervention, often including antidote administration (e.g., phentolamine for vasopressor extravasation). Phlebitis presents as warmth, erythema, tenderness, and a palpable venous cord along the vein; it is graded on a 0–4 scale. Causes include mechanical irritation from catheter size or movement, chemical irritation from medications or hypertonic solutions, and bacterial contamination. For any local complication, the first nursing action is to stop the infusion and disconnect the tubing from the catheter. For extravasation, aspirate residual fluid through the catheter before removal to withdraw as much vesicant as possible. Document the site assessment, time of discovery, and interventions taken. Elevate the extremity for simple infiltration. For phlebitis, apply warm compresses and restart the IV in the opposite extremity or a more proximal site on a different vein — never distal to a failed site.

Key Distinctions

Don't confuse infiltration (cool, pale, edematous) with phlebitis (warm, red, cord-like) — temperature and color point you in opposite directions. Students mix up infiltration and extravasation: infiltration involves non-vesicant fluid and is uncomfortable but not emergent; extravasation involves vesicant agents and risks tissue necrosis. Phlebitis is not the same as a local infection — phlebitis can be sterile (mechanical or chemical), while infection shows purulent drainage and may include fever.

Clinical Pearl

Cool and pale = infiltration. Warm and red = phlebitis. If a vesicant is running, it's extravasation — stop, aspirate, don't flush, call immediately.