[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [IV therapy and fluids](https://durgical.com/en/nursing/areas/iv-fluids/) › IV complications: phlebitis, infiltration and extravasation

# 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.

Updated Nov 5, 2026

## Key points

- Phlebitis: redness, warmth, pain, swelling and sometimes a palpable venous cord.
- Infiltration: swelling, cool, pale, tight skin, leaking at the site, slow flow or pump alarms.
- Extravasation: signs of infiltration plus burning, blisters or necrosis.
- For infiltration: stop the infusion, remove the catheter and follow the protocol.
- For extravasation: stop, disconnect the tubing and aspirate from the catheter before removing it, per protocol.
- The INS (Infusion Nurses Society) phlebitis scale grades from 0 (no signs) to 4 (most severe).

## 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.

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## Connections

## Related 2

- [Caring for a peripheral IV line: flushing, dressing and when to remove it](https://durgical.com/en/nursing/caring-for-a-peripheral-iv-line-flushing-dressing-and-when-to-remove-it/)
- [Central venous catheter care](https://durgical.com/en/nursing/central-venous-catheter-care/)

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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](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Advanced_Skills_(OpenRN)/01%3A_Initiate_IV_Therapy/1.03%3A_Peripheral_IV_Access) (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); [Nursing Skills, 23.2 IV Therapy Basics](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/23%3A_IV_Therapy_Management/23.02%3A_IV_Therapy_Basics) (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); [Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011): Summary of Recommendations](https://www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infections/summary-recommendations.html) (Centers for Disease Control and Prevention, 2011).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/iv-complications-phlebitis-infiltration-and-extravasation/