What happens if IV is not in vein?

If an intravenous (IV) line is not properly inserted into a vein, or if it slips out of the vein after insertion, the infused fluids will not enter the bloodstream as intended. Instead, the fluids escape into the surrounding tissues, a common complication known as infiltration or, more severely, extravasation.

Understanding Infiltration and Extravasation

When an intravenous (IV) injection is not properly administered into a vein, the injected fluids may escape into the surrounding tissues instead of remaining within the bloodstream. This typically happens if the catheter pierces through the vein, the vein is fragile and ruptures, or the catheter becomes dislodged from the vein.

• Infiltration occurs when non-vesicant fluids (solutions that do not cause blistering or tissue necrosis if leaked into tissues, such as saline or basic IV fluids) seep into the subcutaneous tissue around the IV site.
• Extravasation is a more serious event where vesicant fluids (solutions that can cause blistering, severe tissue damage, or necrosis, like certain chemotherapy drugs or vasopressors) leak into the surrounding tissue. This can lead to significant localized swelling and tissue damage at the site of the IV insertion.

Common Signs and Symptoms

Recognizing the signs that an IV is not in the vein is crucial for immediate action and preventing further complications.

• Swelling and Edema: The most common and noticeable sign is localized swelling around the IV insertion site as fluids accumulate in the surrounding tissues.
• Pain or Discomfort: The patient may experience pain, tenderness, or discomfort at or near the site.
• Coolness to Touch: The affected area often feels cool due to the presence of fluids that are typically cooler than body temperature.
• Pallor or Blanching: The skin around the site may appear pale or blanched, indicating restricted blood flow or fluid accumulation.
• Absent or Diminished Blood Return: When checking for blood return, there may be none, or it may be significantly reduced.
• Slow or Stopped Infusion Rate: The IV drip rate may slow down or stop completely, despite the clamp being open and the bag being elevated.
• Fluid Leakage: You might observe fluid leaking from the insertion site.
• Tightness or Blistering: In severe cases, especially with extravasation, the skin might feel tight, and blisters could form.

Potential Complications

While infiltration is often manageable, if left unaddressed, or if extravasation occurs, the consequences can range from mild to severe.

• Tissue Damage: As mentioned, the leakage of fluids can lead to tissue damage. With non-vesicant fluids, this might be mild irritation. With vesicant fluids, it can result in severe skin blistering, sloughing, and even necrosis (tissue death) requiring surgical intervention.
• Infection: Any break in the skin barrier and accumulation of fluid creates an environment conducive to bacterial growth, increasing the risk of local infection (cellulitis) or a more widespread infection.
• Compartment Syndrome: In rare, severe cases of massive infiltration, the pressure from the accumulated fluid can become so great that it compromises blood flow and nerve function within the muscle compartment, potentially leading to permanent damage.
• Functional Impairment: Significant swelling and pain can limit the mobility and function of the affected limb.
• Delayed Treatment: If the IV medication is critical (e.g., antibiotics, chemotherapy), infiltration means the patient is not receiving the full therapeutic dose, potentially delaying or compromising their treatment.

Immediate Actions and Management

If an IV is suspected to be out of the vein, prompt action is essential:

1. Stop the Infusion Immediately: Clamp the tubing to prevent further fluid leakage.
2. Remove the IV Catheter: Gently remove the catheter from the insertion site.
3. Elevate the Affected Limb: Elevating the limb above the heart helps reduce swelling and promote fluid reabsorption.
4. Apply Compress:
   • For infiltration with non-vesicant fluids (e.g., saline, dextrose), apply a warm compress to promote circulation and fluid reabsorption.
   • For extravasation with vesicant fluids, a cold compress is often preferred to localize the fluid and minimize tissue damage, though specific protocols for different vesicants may vary.
5. Notify Healthcare Professional: Inform the nurse or doctor immediately for assessment and further instructions. They may prescribe specific antidotes for certain vesicant extravasations.
6. Documentation: Accurately document the event, including the date, time, IV fluid, estimated amount infiltrated, appearance of the site, interventions, and patient's response.
7. Monitor the Site: Continue to monitor the site regularly for changes in swelling, pain, color, and temperature.

Prevention Strategies

Preventing an IV from going out of the vein is paramount for patient safety and comfort.

• Proper Vein Selection: Choose an appropriate vein that is visible, palpable, and relatively straight, avoiding areas of flexion.
• Careful Insertion Technique: Use proper insertion techniques, ensuring the catheter is fully advanced into the vein before advancing the catheter itself.
• Securement: Secure the IV catheter properly with tape or a transparent dressing to prevent accidental dislodgement.
• Regular Monitoring: Routinely assess the IV site for any signs of infiltration or extravasation, especially during fluid administration and before administering new medications.
• Patient Education: Educate the patient on what to report (e.g., pain, swelling, burning) and advise them to avoid excessive movement of the limb with the IV.

Infiltration vs. Extravasation: A Quick Comparison

Understanding the key differences between these two complications is vital for appropriate management.

By understanding the risks, recognizing the signs, and implementing proper management and prevention strategies, healthcare professionals can significantly minimize the impact of an IV not being in the vein.