What to do if an IV site is leaking? A guide to infiltration and extravasation

IV infiltration is the most common cause of IV catheter failure, accounting for around 23% of malfunctions. Knowing what to do if an IV site is leaking is crucial for patient safety and preventing serious complications like tissue damage and compartment syndrome.

Quick Summary

Immediate action for a leaking IV involves stopping the infusion, removing the catheter, elevating the limb, and applying a compress. The correct compress type depends on the leaked fluid. Proper site monitoring and prompt medical consultation are essential to prevent complications.

Key Points

• Immediate Action: Stop the infusion and call for medical assistance as soon as a leak is suspected.

• Elevation: Elevate the affected limb above heart level to promote fluid reabsorption and reduce swelling.

• Compresses: Apply a compress as directed by a healthcare provider, who will determine if it should be warm or cold based on the leaked fluid.

• Know the Signs: Watch for key signs of infiltration like swelling, pain, cool skin, and a slowing or stalled drip.

• Monitor for Complications: After the IV is removed, monitor the site for worsening symptoms, signs of infection, or dark skin discoloration.

• Seek Urgent Help: Go to the emergency room for symptoms like high fever, severe pain, loss of limb function, or significant skin discoloration.

Recognizing the signs of a leaking IV

Recognizing a leaking intravenous (IV) site early is essential to prevent complications. When an IV catheter is dislodged or punctures the vein, the fluid is delivered into the surrounding tissue rather than the bloodstream. This is known as infiltration or extravasation, depending on the fluid type.

Common signs to look for include:

• Swelling or puffiness: The area around the IV site may look unusually puffy or feel tight and firm.
• Coolness: The skin around the catheter feels cool or cold to the touch due to the temperature of the leaked fluids.
• Pain or discomfort: You may experience ongoing pain, aching, or a burning sensation that worsens over time.
• Blanching: The skin around the insertion site may appear pale or white because fluid accumulation is constricting blood flow.
• Slowing or stalled infusion: The IV drip rate may slow down or stop completely, as the fluid is not entering the vein correctly.
• Visible leakage: You might see fluid, blood, or pus visibly leaking from the insertion point.

Infiltration versus extravasation

While often used interchangeably, these terms refer to different types of IV leakage, and the distinction is important for treatment.

Feature	Infiltration	Extravasation
Leaked fluid type	Non-vesicant (non-irritating) fluid, such as saline or general hydration solutions.	Vesicant (irritating or damaging) fluid, such as certain chemotherapy drugs, antibiotics, or contrast media.
Effect on tissue	Primarily causes swelling, pain, and cool skin. Typically less severe tissue damage.	Can cause severe tissue damage, blisters, ulcers, and potentially tissue necrosis (death).
Risks	Can lead to temporary discomfort and swelling. If prolonged, compartment syndrome is a rare but serious risk.	High risk of severe, lasting injury, including permanent nerve damage or limb dysfunction if not treated promptly.

Immediate first-aid steps for a leaking IV

If you or someone you are caring for has a leaking IV, follow these steps immediately:

1. Stop the infusion: As soon as you suspect leakage, stop the flow of fluid from the IV bag by closing the clamp on the tubing. This prevents more fluid from entering the tissue.
2. Call for help: Notify a nurse or doctor right away. This is the most crucial step, as a healthcare professional needs to assess the situation and provide further instructions.
3. Elevate the affected limb: Lift the arm or leg with the IV site so it is elevated above heart level. Resting it on a pillow can help. This promotes fluid reabsorption and helps reduce swelling.
4. Remove the catheter: A healthcare provider will likely remove the IV catheter from the site. This is a critical step to prevent further leakage. Do not attempt to remove it yourself unless instructed by a professional.
5. Apply a compress: Depending on the fluid that leaked, a provider will advise whether to apply a warm or cold compress. Applying the wrong one can worsen tissue damage, especially with certain extravasating fluids.

Using compresses: warm vs. cold

After a healthcare provider has been notified, they will determine the correct type of thermal application to use on the site. Their choice depends on the specific medication or fluid involved.

• Cold compress: Often recommended for non-vesicant infiltrations and some extravasations. It causes vasoconstriction, which can limit the fluid's spread and reduce pain and swelling.
• Warm compress: May be used for other types of extravasation. The warmth promotes vasodilation, increasing blood flow to the area to help disperse the leaked fluid and reduce its concentration.

What to expect after the IV is removed

After the initial steps, proper aftercare is crucial for healing. The healthcare provider will likely:

• Mark the affected area's outline to monitor changes in swelling and size.
• Document the incident thoroughly, including the time, estimated fluid amount, and patient symptoms.
• Restart the IV in a different location, typically on the opposite limb.

At home, aftercare may include:

• Rest and elevation: Continue to rest and keep the limb elevated to minimize swelling.
• Keep the area clean and dry: Protect the site to prevent infection. Follow any specific instructions from your provider on cleaning the area.
• Monitor for signs of infection: Watch for increased redness, warmth, pus, or fever.

Monitoring for complications

Even after a leaking IV is addressed, continuous monitoring of the site is important. Be alert for any signs that the condition is worsening. Report any of the following to your healthcare provider:

• Increasing pain or swelling after 24 hours
• Blisters or peeling of the skin
• Skin discoloration that turns dark red, purple, or black
• Increased warmth, redness, or pus at the site
• A developing fever
• Numbness or tingling in the affected limb, which could signal nerve involvement

When to seek immediate medical attention

While most infiltrations resolve without serious consequences, some signs indicate a more urgent situation requiring immediate medical evaluation. You should go to the emergency room or seek urgent care if you observe any of the following:

• High fever: A temperature above 101.5° F (38.3° C) can indicate a serious infection.
• Significant color change: The limb or area around the IV site turns blue, purple, or black, which could indicate a severe lack of blood flow.
• Limited movement: The affected limb becomes so swollen and firm that you cannot move your fingers or toes.
• Visible infection: You see pus draining from the site or notice red streaks spreading from the IV site.

Conclusion

A leaking IV site, whether due to infiltration or extravasation, requires immediate attention to prevent more severe complications like tissue damage and compartment syndrome. The first steps are to stop the infusion, call for a healthcare professional, elevate the limb, and apply a compress as advised. Vigilant monitoring is crucial, even after the IV is removed, to watch for worsening symptoms or signs of infection. By recognizing the signs early and acting quickly, patients can help ensure their safety and promote a faster recovery. For more detailed information on managing IV complications, refer to comprehensive resources like those provided by St. Jude™ on IV infiltration and extravasation.

Frequently Asked Questions

What is the first step if an IV is leaking?

The first and most critical step is to immediately stop the infusion by closing the clamp on the IV tubing and to call a healthcare professional, such as a nurse or doctor.

What is the difference between IV infiltration and extravasation?

Infiltration is the leakage of a non-irritating fluid (like saline) into surrounding tissue, while extravasation is the leakage of a vesicant or irritating fluid (like some chemotherapy drugs) that can cause more severe tissue damage.

Should I use a hot or cold pack on a leaking IV site?

The type of compress depends on the leaked fluid. A healthcare provider must advise you, as applying the wrong temperature can be harmful, especially in cases of extravasation.

What are the signs of a severe IV leak?

Signs of a severe leak include a high fever, blisters, peeling skin, dark red or black skin discoloration, significant pain, and numbness or tingling in the affected area.

Can a leaking IV cause permanent damage?

In severe cases, yes. While most infiltrations are minor, extravasation with certain fluids can cause serious tissue damage, and in rare cases, lead to permanent nerve damage, scarring, or a condition called compartment syndrome.

How can IV leakage be prevented?

IV leakage can be prevented with proper catheter insertion and securement, careful selection of the insertion site, regular monitoring of the site, and patient education.

When should I go to the emergency room for an IV complication?

You should go to the emergency room for symptoms like a high fever, pus draining from the site, red streaks spreading from the site, worsening pain or swelling, or if the limb is so swollen and firm that you cannot move your fingers or toes.