Intravenous therapy, or IV therapy, is a key medical practice, used on a daily basis in hospitals, clinics, and other medical locations around the globe. It helps to deliver nutrients, medications, and fluids directly into a patient’s body, and it can be useful for treating a wide range of conditions, from dehydration to cancer.

IV therapy has many advantages, but it’s not perfect. There are risks associated with this procedure, and it is possible for patients to suffer pain, discomfort, swelling, and other issues as a direct cause of the IV insertion. Two of the most common issues are IV Infiltration and IV Extravasation. In this guide, we’ll explain exactly what infiltration and extravasation are.

What Is IV Infiltration? 

IV site infiltration is one of the most common complications that can occur when administering IV therapy. It occurs when IV fluids or non-vesicant drugs, meaning drugs that do not cause blisters or tissue necrosis, escape from the vein or are infused outside of the blood vessel, passing into the soft tissue area around the vein.

What Causes IV Infiltration? 

There are several different ways in which IV infiltration can occur. One of the most common ways is through improper insertion of the IV line. If the IV line is pushed too far in, for example, it may pierce the wall of the blood vessel, creating a hole and allowing fluids to pass out of the vein and into the surrounding area, leading to an infiltration. 

Choosing and using the wrong size of catheter can also be a cause of IV infiltration, as the catheter may be too large for the patient and lead to an injury in the vein, which allows fluids or medications to escape. It’s also possible that the catheter may initially be inserted correctly, but could become dislodged or fall out of position due to the patient’s movement.

It may also be that the patient’s own body has an impact on the odds of infiltration occuring. Someone with weak or thin veins, for example, will be more likely to suffer from issues like IV infiltration. 

What Are the Signs of IV Infiltration? 

There are many potential signs and symptoms associated with IV infiltration. One of the first things to look out for is the patient complaining of discomfort or pain around the IV site. Sometimes, patients may experience IV site pain without any major cause, but if the pain is severe or comes on suddenly, it could be a sign of IV infiltration. 

Other common symptoms and signs include: 

• Discomfort in the IV area 
• Swelling of the skin around the IV 
• A feeling of coolness in the IV area 
• The skin feeling tight or taut 
• Skin that looks particularly white or pale

In the long-term, it’s possible that IV infiltration can cause some tissue damage, but because this involves solutions and medications that are non-vesicant, the risks are lower than they would be with extravasation.

How to Prevent IV Infiltration

The best way to prevent infiltration from occurring in the first place is through good practice when it comes to IV insertion. It’s important for medical teams to use the appropriate type and size of catheter and follow proven practices during the insertion process to reduce the risks of this problem. 

Other methods of prevention include: 

• Choosing an appropriate size of IV catheter for each patient 
• Selecting IV insertion sites that are easy to access and not around any joints 
• Not reusing the same IV site multiple times 
• Removing and reinserting an IV if it doesn’t seem stable 
• Carrying out regular checks of patients who are undergoing IV therapy 
• Communicating with the patient to check for any pain or discomfort

What Is IV Extravasation

IV extravasation is another common complication which may occur when administering IV therapy to a patient. It has some similarities with IV infiltration, as it also involves the flow of fluids from the IV into the area outside of the vein. However, the key difference is that IV extravasation occurs when vesicant drugs or solutions – those that can cause blisters and tissue damages – leak out or infuse into the area around the vein, rather than inside it.

What Causes IV Extravasation? 

There are several potential causes of IV extravasation. One of the most common reasons why this issue occurs is because of improper IV placement. If the needle or catheter is pushed too far into the body, it can pierce the blood vessel. This can create a hole that allows the IV fluids or medications to escape the vein and damage the surrounding area of soft tissue.

Other causes of extravasation may include using the wrong size of catheter or something dislodging the catheter. If you use a catheter that is too large for the patient’s veins, for example, the risk of injury is high. In addition, if the catheter isn’t secured properly and moves around too much, it could damage the inside of the vein wall.

There are other possible causes of IV extravasation which are less common but still possible, such as weak veins in the patient, some sort of obstruction along the IV line that causes a buildup of pressure, or the usage of certain drugs.

What Are the Signs of IV Extravasation? 

Extravasation can have a range of potential signs and symptoms associated with it that medical personnel should watch out for. One of the main signs is some sort of pain or discomfort, which is usually quite severe, around the IV site. The patient may complain of this quite suddenly and it should be investigated right away.

Other common symptoms and signs include: 

• Discomfort around the IV site 
• Swelling of the skin 
• Redness around the insertion site 
• A blocked cannula 
• Feeling of hotness around the skin 
• Discoloration of the skin 
• Blistering

In the long-term, IV extravasation can be a very serious issue, as the presence of vesicant solutions around the soft tissue may lead to serious tissue damages and even necrosis.

How to Prevent IV Extravasation

The most common cause of extravasation is poor insertion technique. Therefore, the best way to prevent this issue is to make sure that you insert the IV correctly to begin with. Any member of the medical team responsible for IV insertions should have the appropriate training and follow best practices to reduce the risk of extravasation or other issues.

Other preventative measures include: 

• Selecting the right catheter size for the patient
• Speaking with the patient before insertion to check for any history of IV issues
• Choosing an appropriate IV insertion site
• Not reusing the same IV insertion site
• Reinserting the IV if it doesn’t feel secure or stable
• Checking on the patient often and inspecting the cannula

IV Infiltration vs Extravasation: What Are the Key Differences?

Infiltration and extravasation have a lot in common in terms of how they can occur and the fact that they both involve the flow of fluids or medications into the wrong areas outside of the vein. But there are some key differences, including:

• Symptoms – Symptoms of infiltration and extravasation may vary. With extravasation, the patient will usually be more likely to complain of severe pain, as well as burning sensations around the insertion site.
• Solution – Of course, one of the main differences between infiltration and extravasation is the type of fluid involved in the process. Infiltration is only with non-vesicant drugs or solutions, while extravasation involves vesicant solutions.
• Long-Term Risk – The other major difference between infiltration and extravasation is long-term risk. Extravasation can lead to tissue necrosis and major long-term damages if left untreated for too long, while this is less likely with infiltration.

Can IV Infiltration and Extravasation Exist at the Same Time?

Yes, it is technically possible for both infiltration and extravasation to exist at the same time if a patient is receiving IV therapy with both vesicant and non-vesicant solutions together. If the IV is placed incorrectly, both vesicant and non-vesicant solutions could escape the vein and flow out into the surrounding tissue.

How Are IV Infiltrations and Extravasations Treated?

The usual treatment methods for infiltration and extravasation include: 

• Stopping the IV infusion immediately 
• Raising the affected limb into the air to help with swelling 
• Removing the cannula 
• Administering pain relief medication 
• Using a syringe to draw the drug out
• Using cold or warm compresses 
• Administering an antidote, depending on the IV drugs that were used
• Possible surgery to remove dead tissue in case of extravasation

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