How can IV infiltration be prevented?

October 2, 2025 •

4 min read

Intravenous (IV) therapy is a common and critical procedure in modern healthcare, yet studies show that peripheral IV infiltration occurs with varying frequency, underscoring the need for careful prevention. Knowing how to prevent IV infiltration is essential for both healthcare providers and patients to ensure a safer and more effective treatment experience.

Quick Summary

Preventing IV infiltration relies on proper technique, vigilant monitoring using methods like 'Touch, Look, Compare,' appropriate site selection, and effective patient education. Securing the catheter correctly and selecting the smallest, most suitable device are also crucial steps to minimize risk.

Key Points

Optimal Site Selection: Choose veins in stable areas like the forearm and avoid high-movement joints to prevent catheter dislodgment.
Use Smaller Catheters: Employ the smallest gauge catheter suitable for the infusion to reduce vein trauma and maximize fluid dilution.
Secure the Catheter Properly: Use stabilizing devices and transparent dressings to securely anchor the IV and allow for continuous site visibility.
Implement the TLC Monitoring Method: Consistently 'Touch, Look, and Compare' the IV site for early signs of infiltration, such as swelling, coolness, or pain.
Educate Patients and Families: Instruct patients to report any discomfort, swelling, or changes at the IV site to enable early detection.
Act Immediately on Suspicion: If infiltration is suspected, stop the infusion, remove the catheter, and elevate the limb to prevent further complications.

Understanding IV Infiltration

IV infiltration occurs when non-vesicant fluid or medication leaks from the vein into the surrounding tissue, rather than flowing into the bloodstream as intended. While often less severe than extravasation (which involves vesicant, tissue-damaging fluids), infiltration can still cause pain, swelling, and delayed medication administration. Understanding its causes is the first step toward effective prevention.

Factors Contributing to IV Infiltration

Several factors can lead to IV infiltration:

Improper catheter insertion: Incorrect angle or technique can cause the catheter to puncture the vein's opposite wall.
Catheter dislodgment: Inadequate securement or patient movement can cause the catheter to slip out of the vein.
Vein damage: Fragile or damaged veins (due to age, chronic illness, or repeated IV access) are more susceptible to puncture.
Catheter-related issues: Choosing a catheter that is too large for the vein or a clot forming around the cannula can impede flow.

Comprehensive Strategies for Prevention

Optimal Catheter and Site Selection

Prevention begins before insertion. Selecting the right vein and catheter can dramatically reduce the risk of infiltration.

Choosing the right vein

Avoid areas of flexion: Veins in joints like the wrist and antecubital fossa should be avoided as movement can easily dislodge the catheter.
Use the forearm: Veins in the forearm offer better stability as the bones act as a natural splint.
Consider patient history: For patients with conditions like diabetes or hypertension, whose veins may be more fragile, extra care is necessary.

Selecting the correct catheter size

Smaller is better: Use the smallest gauge catheter that will safely deliver the required infusion. This maximizes hemodilution and reduces trauma to the vein wall.

Correct Insertion and Securement Techniques

Proper procedure during and after insertion is critical for stability and longevity of the IV site.

During insertion

Bevel up: Always insert the cannula with the bevel facing up to facilitate a smooth entry and reduce the risk of puncturing the opposite vein wall.
Minimize attempts: If available, using ultrasound guidance can increase the success rate of insertion and prevent repeated, vein-damaging attempts.

Securing the catheter

Proper stabilization: Use a securement device or tape to anchor the catheter and tubing firmly. Movement is a primary cause of dislodgment.
Transparent dressing: Cover the site with a clear, moisture-vapor transmissible dressing. This allows for continuous visual assessment without needing to disturb the site.

The Role of Vigilant Monitoring

Consistent and diligent monitoring is arguably the most important preventive measure. Early detection of a problem can prevent a minor leak from becoming a serious complication.

The 'Touch, Look, Compare' (TLC) Method

This simple yet effective technique can be performed by healthcare providers and taught to patients and their families.

Touch: Gently palpate the area around the insertion site. It should feel soft, warm, and pain-free. Coolness or firmness can indicate fluid leakage.
Look: Visually inspect the site for signs of swelling, redness, or leakage under the dressing. A clear dressing makes this easy.
Compare: Look at the IV limb and compare it to the opposite one. The affected limb should be the same size and color. Swelling or blanching is a warning sign.

Monitoring Frequency

Hourly checks: For patients receiving continuous vesicant or irritant solutions, and for all pediatric and geriatric patients, hourly assessment is recommended.
Regular checks: For other patients on continuous infusions, checking the site at least every four hours is the standard.

Comparison of Monitoring Techniques


Feature	Transparent Dressing Assessment	Opaque Gauze Assessment
Visibility	Allows for continuous visual inspection of the site without removal.	Requires removal to inspect, disrupting securement and increasing infection risk.
Assessment Ease	The TLC method is easily performed, combining visual and tactile checks.	Limits assessment to palpation unless the dressing is removed.
Securement	Strong, adhesive backing secures the site while remaining moisture-permeable.	Less reliable securement, especially if disturbed for frequent checks.
Contamination	Less frequent disturbance reduces the risk of introducing contaminants.	Higher risk of contamination due to the need for frequent dressing changes for visual inspection.

Patient and Family Education

Empowering patients with knowledge can lead to earlier detection and intervention. Educate patients to immediately report any signs of discomfort, tightness, or swelling. Teach them what to look for and to avoid tugging or pulling on the IV line.

What patients should report

Pain, burning, or tightness at the site.
Swelling or puffiness around the IV.
Coolness or paleness of the skin.
Fluid leaking from the dressing.

What to Do If Infiltration is Suspected

If you or a healthcare provider suspects infiltration, immediate action is necessary to prevent further damage. While proper prevention is the goal, knowing how to react is equally important.

Stop the infusion immediately.
Remove the IV catheter.
Elevate the affected limb to help with fluid reabsorption.
Apply warm or cold compresses as directed by hospital protocol. (Warm for normal or high pH fluids, cold for low pH fluids).
Notify the healthcare provider and document the event.
Restart the IV in a new, unaffected site.

For more detailed guidance on proper intravenous procedures and management, refer to the Infusion Nurses Society's standards of practice, which emphasize prevention, early recognition, and proper interventions for complications like infiltration.

Conclusion: A Proactive Approach

Preventing IV infiltration is a team effort involving skilled clinicians, appropriate equipment, and an educated patient. By focusing on proper site and catheter selection, using meticulous insertion and securement techniques, and maintaining vigilant monitoring protocols, the risk of infiltration can be significantly minimized. This proactive approach not only enhances patient comfort and safety but also ensures the seamless delivery of essential intravenous therapy.

Frequently Asked Questions

Early signs of IV infiltration include swelling, coolness to the touch, and blanching or redness around the insertion site. The patient may also complain of pain, discomfort, or a feeling of tightness near the IV.

Infiltration is the leakage of a non-vesicant (non-tissue-damaging) fluid into surrounding tissue. Extravasation is the leakage of a vesicant (tissue-damaging) medication, which can cause severe injury, blistering, and tissue necrosis.

For patients with home IVs, prevention involves following a nurse's instructions for securing the catheter, avoiding bumps or tugs, and regularly checking the site for signs of swelling or pain. Keeping the area visible and reporting any issues promptly is key.

Monitoring frequency varies by patient and solution. For vesicant infusions and for pediatric or elderly patients, hourly checks are recommended. For standard non-irritating fluids, a minimum of every four hours is generally required.

Not necessarily, but pain should never be ignored. Discomfort or burning during an infusion can be an early sign of vein damage that may lead to infiltration. Any pain should be assessed immediately by a healthcare professional.

Using an opaque dressing, such as gauze, can obscure the IV site, making early visual detection of infiltration more difficult. Transparent dressings are often preferred as they allow for continuous monitoring without removal.

The first and most critical step is to stop the infusion immediately to prevent more fluid from leaking into the surrounding tissue. Then, the IV catheter should be removed.