IV complications: phlebitis, infiltration and extravasation
- Assessment
Phlebitis is an inflamed vein; infiltration is fluid outside the vein; extravasation is the same with a drug that damages tissue.
What it is
Local complications of peripheral catheters are common and are almost always found by looking at and touching the site. Phlebitis is inflammation of the vein wall; it can be mechanical (the catheter irritates), chemical (the solution irritates) or infectious. Infiltration is a non-irritant solution leaking into the tissue; it is one of the most common complications. Extravasation is a vesicant drug leaking out, which can cause blistering and necrosis. Many institutions record severity with standardised scales.
Reference values
- Normal site: no redness, swelling, pain, coolness or warmth, and the infusion runs freely.
- INS phlebitis scale: grades 0 to 4, by the signs present.
- Commonly used infiltration scales: also 0 to 4, by the extent of swelling and the look of the skin.
- Any extravasation of a vesicant is treated as severe.
- Local infection: typically appears two or three days after insertion.
What you need
- Good light and an uncovered site.
- Comparison with the other arm.
- The scale your institution uses and the catheter record (date, gauge).
How to measure it (and why)
- Uncover the site and compare it with the other arm — mild swelling shows best by contrast.
- Look for colour change, swelling, leaking and blisters along the vein — phlebitis can track along it.
- Feel temperature and firmness: warmth suggests phlebitis; coolness and tightness, infiltration.
- Ask about pain, burning or tingling — burning warns of a vesicant outside the vein.
- Check the infusion runs and flushing causes no pain or swelling — this confirms patency.
- Assign a grade with the institutional scale — lets shifts compare and decide.
- Act on the findings and document grade, findings, actions and response.
Local complications: how to recognise them and what to do
| Complication | What it is | Signs | What the nurse does |
|---|---|---|---|
| Phlebitis | Inflammation of the vein (mechanical, chemical or infectious) | Redness, warmth, pain, swelling, palpable cord, pus | Remove the catheter per protocol; if infectious, culture as ordered and watch for systemic infection |
| Infiltration | Non-irritant solution in the tissue | Swelling, cool tight skin, leaking, slow flow, alarms | Stop the infusion, remove the catheter and follow the protocol |
| Extravasation | Vesicant drug in the tissue | All of the above plus burning, blisters, necrosis | Stop, disconnect, aspirate from the catheter before removal and follow the drug-specific plan |
| Local infection | Germs at the insertion site | Redness, warmth, discharge, sometimes fever | Remove the catheter, clean the site, culture if suspected and report |
| Bleeding | Blood at the site, usually after dislodgement | Visible bleeding under the dressing | Pressure with gauze until it stops and a sterile transparent dressing |
How to read it
- A small saline infiltration resolves when the catheter is removed; extravasation of a vesicant can leave necrosis.
- Preventing mechanical phlebitis: the smallest gauge that works and a well-secured catheter.
- Preventing chemical phlebitis: follow the dilution and rate in the drug reference.
- Preventing infiltration: avoid flexion areas and check blood return before every medication.
- Vesicants are preferably given through a central catheter.
Next step: when to call for help
- Call at once for redness, warmth or blisters at the site.
- Call for any suspected extravasation of a vesicant: there are drug-specific management plans.
- Call for fever, chills or pus, because of the risk of systemic infection.
- Call for shooting pain or tingling: remove the catheter first.
Test yourself
Think of the answer, then tap the question to see it.
What is the difference between infiltration and extravasation?
In infiltration a non-irritant solution leaks into the tissue; in extravasation a vesicant drug leaks out, which can cause blisters and necrosis.
Which finding on touch points to infiltration rather than phlebitis?
Cool, tight skin around the catheter. In phlebitis, by contrast, the area is warm and red.
How many grades does the INS phlebitis scale have?
It runs from 0 (no signs) to 4 (the most severe form). The grade is recorded so shifts can compare.
What do you do first for an infiltration?
Stop the infusion. Then remove the catheter, follow the institutional protocol and document.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing Advanced Skills, 1.3 Peripheral IV Access (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); Nursing Skills, 23.2 IV Therapy Basics (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011): Summary of Recommendations (Centers for Disease Control and Prevention, 2011).
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Representative model, for educational purposes only.