How to Handle IV Site Complications, Pain, Swelling, & Bruising

Intravenous therapy, or IV therapy, is an essential medical technique that helps to get nutrients, fluids, and medicine into a patient’s body in the most direct and efficient way possible. This technique has been used for many years and fine-tuned over time to become safer and more efficient, but it’s not without its drawbacks.

One of the main issues with IV therapy is that the actual IV insertion site (the place where the skin is punctured and the tubing is inserted into the body) may suffer certain problems like aches, pains, hematoma, bruising, swelling, and more. In this guide, we’ll go over some of the most common IV site complications, along with some potential solutions for each one.

Common IV Site Complications, Causes, & Solutions

There are many possible IV site complications. Some are relatively minor and shouldn’t be a cause for too much concern, but others may be more serious and could require urgent medical attention. Read on through the list to find out some of the causes and possible solutions of various common IV site complications.

1. IV Site Infiltration

IV site infiltration is one of the most common complications associated with IV therapy. Infiltration occurs when IV fluids or medications are infused outside of the blood vessel, into the soft tissue surrounding the vein. This usually occurs due to the improper placement of the needle, and it can lead to various symptoms and signs, such as swelling, discomfort, and potentially either a very cold or very warm feeling in and around the area.

If the fluid being used is safe and only a small amount is allowed to leak out, this issue may not be too serious, but in some cases, the fluid could be toxic and damaging to the tissue. As soon as any infiltration is detected, it’s vital to stop the infusion and remove the tubing. The patient’s pulse should be taken and the limb should be elevated. The infusion can later be restarted in a different location.

2. IV Site Extravasation

IV site extravasation is another common issue that occurs at a similar rate to infiltration. This is also when injected fluids or drugs get into the wrong area, leaking out from the vein and into the surrounding area, coming into contact with soft tissue and potentially causing pain, discomfort, swelling, and a stinging or burning sensation.

Usually, the main cause of IV site extravasation is the cannula piercing the blood vessel wall, creating a hole through which the fluid can escape. It’s also possible that the extra pressure in the vein can simply cause the fluid to burst out around the original site. The infusion should be stopped right away and the limb will need to be elevated. In more serious cases, if tissue has been damaged, there may be a threat of necrosis and surgery might be required, along with pain relief for the patient.

3. IV Site Erythema

Erythema refers to any kind of redness of the skin. It may appear like a rash, and it’s quite common for patients who are undergoing IV therapy to have red rashes and areas of inflammation appear around their IV sites. There are a few possible causes of this, such as infiltration, extravasation, or an adverse reaction to the drug or fluid that is being infused. It can also be a sign of infection.

The infusion should be stopped if notable IV site erythema is present. The site can then be examined closely to determine the possible cause, and it’s important to ask the patient about any other possible symptoms they may be experiencing to find out more about the problem. Depending on the cause of the issue, the patient may need various forms of medication.

4. IV Site Edema

The term “edema” refers to swelling, so IV site edema simply refers to a swollen area around the IV insertion site. This may or may not be accompanied by other symptoms, such as pain, discomfort, redness, burning sensations, or cold sensations, and there are several possible causes. Edema is usually linked to a buildup of fluid in the area, which is usually due to infiltration or extravasation.

As with other common IV site complications, the main cause of action with IV site edema is to stop the infusion as soon as the issue is detected. The patient’s limb should then be elevated, as this will help the swelling to go down over time. Cold or warm compresses may also be applied to ease discomfort, and pain medication may be ordered, depending on how the patient is feeling.

5. IV Site Phlebitis

The term “phlebitis” refers to an inflammation of a vein. It can also be referred to as superficial thrombophlebitis. There are many reasons why IV site phlebitis may occur, and it can usually be seen in the form of redness of the skin, discomfort in the IV site area for the patient, and the formation of painful lumps below the surface of the skin.

Phlebitis may be a sign of issues like infiltration or extravasation. If the phlebitis is spotted early, the infusion can be stopped and the cannula repositioned in a new site. But if the issue is allowed to persist too long and causes great pain and other issues like induration and pyrexia, additional treatment of the area may be required.

6. IV Site Hematoma

A hematoma is simply a kind of bruise. Hematomas typically form when some sort of injury occurs under the surface of the skin, leading to a pooling of blood that makes the skin appear discolored, as well as giving it a soft or lumpy feeling. In the case of IV site hematomas, these usually appear due to blood leaking out from the vessel and pooling around the IV site.

Typically, a hematoma will form if the IV needle or tubing has passed through the wall of the blood vessel, creating a hole and allowing blood to leak out. This can be unpleasant for the patient, but it shouldn’t be classed as a major IV site problem in most cases. Pressure will help to control the hematoma and it should clear away on its own within a matter of days or a maximum of two weeks.

7. IV Site Bruising

Following on from the previous point about hematomas, a bruise usually occurs due to some sort of injury to a blood vessel under the skin, causing blood to pool and the area to become discolored temporarily. Bruises can occur from IV insertion too, and it’s quite common for patients to notice mild bruising after the catheter has been removed as some blood will leak out through the blood vessel wall before it clots and heals.

Bruising around an IV site may also occur if multiple entry attempts were made before the tubing was inserted successfully. Usually, this kind of bruising should go away within a few days and shouldn’t be a major problem. However, some patients may experience abnormal or severe bruising due to issues like blown veins or poor clotting. If the bruising remains for two weeks or more, additional treatment may be needed.

8. IV Site Cool, Pale, and Edematous

If an IV site feels cool to the touch and appears to be pale and/or swollen, this is usually a sign of either infiltration or extravasation. In either case, it usually means that fluid has leaked out from the vein or passed into the wrong area, coming into contact with soft tissue around the vein.

In this case, the infusion needs to be stopped right away, and a doctor should evaluate the situation and the type of fluid or medication used to determine the next step of action. Some fluids are relatively safe, but others may be toxic and could do serious damage to the tissue, leading to the possibility of surgery to repair the area or drainage to deal with any major swelling around the IV site.

9. IV Site Hot, Red, and Swollen

As with the previous point about the IV site feeling cold and swollen, if an IV site seems hot, red, and swollen, it may also be a sign of infiltration or extravasation. This occurs when the tubing is improperly placed or the blood vessel wall is damaged in some way, allowing fluid or medication to pass out from the vein and into the soft tissue surrounding it, rather than remaining exclusively in the bloodstream.

Some cases of infiltration and extravasation can be quite severe, while others are mild. It mainly depends on how much fluid has been allowed to leak out and what kind of fluid is being infused. In cases like this, the infusion should be stopped right away and cold compresses can be used to ease the swelling and discomfort for the patient. The site may then need to be monitored and examined to evaluate the next course of action.

10. IV Site Blood Clot

Superficial thrombophlebitis is the technical term to describe blood clots that develop within the veins, causing inflammation of the veins. There are various reasons why this may happen, like old age or pregnancy, and it’s also possible for superficial thrombophlebitis to occur when someone has recently undergone IV therapy.

This may lead to pain and discomfort for the patient, and it’s usually caused by the IV line damaging the vein in some way and causing the body to respond with clotting. Usually, the affected limb will need to be elevated and warm compresses may be applied to ease pain or discomfort. Anti-inflammatory medication may also be given to the patient to help reduce the inflammation.

11. IV Site Burning

Patients who experience a burning sensation around the IV site will most likely be suffering from infiltration. This is when the tubing has not been placed in the correct area and fluid is being infused into the soft tissue, rather than the intravascular space. If burning sensations are present, it’s usually because the fluid in question is damaging the soft tissue, and the longer this issue is left untreated, the worse it can become.

It’s vital to cease infusion and remove the device as soon as the issue is detected. If a particularly dangerous or toxic fluid has been used for the infusion, the tissue may be seriously damaged and the area might require surgery to get rid of any necrotic tissue. If the issue is spotted sooner, elevation of the limb and pain medication may be sufficient treatment options.

12. IV Site Bleeding After Removal

There should only be minimal bleeding after IV therapy, but some risk factors could raise the risks of a patient bleeding. For example, poor insertion or removal technique may lead to damaging of the blood vessels and skin, or the type of catheter used could also raise the risk of bleeding. It’s important for practitioners to remove IV tubing carefully to reduce the risk.

If bleeding does occur after an IV is removed, the first course of action should be to apply pressure to the area and to make use of some sort of dressing, like medical gauze or bandages. This can help to absorb blood while also forming a barrier to reduce the risks of any infection in the area. In the vast majority of cases, the bleeding should subside quite quickly, as long as prompt action is taken.

13. IV Site Hurts After Removal

A lot of patients complain of soreness or aching in the areas where they had infusion therapy. It’s common for some tenderness in the area, as the skin has been punctured and the blood vessel will need to repair, so mild sensitivity or tenderness should not be a cause of concern and should fade for most patients quite quickly.

However, if the pain continues or is quite severe, it may be a sign of a more serious issue like a blood clot in the vein causing inflammation or traces of extravasation. In this case, the patient may need to be given pain relief medication, along with possibly anti-inflammatories. If the pain persists even longer, the area may need scanning to look for any signs of possible nerve damage or other problems around the IV site.

14. IV Site Hurts After 2 to 3 Weeks

As stated above, it’s quite common for patients to have some tenderness or soreness in the area around their IV site for a short while after the IV is removed. However, this pain should usually subside within the first few days. If it persists longer, for 2-3 weeks, it is usually a sign of a condition known as thrombophlebitis, which is when a blood clot forms and causes a blockage in the vein.

This usually occurs as the body responds to the IV by forming a blood clot to heal the damage to the blood vessel wall, but the clot formed can become too large and block the flow of blood. This leads to pain, tenderness, redness, and possibly swelling, too. Treatment may include clot-dissolving or blood-thinning medications.