Infiltrated Ivy — Infiltration vs Extravasation vs Phlebitis: Cool and Swollen or Red and Warm
Her IV arm is puffy, pale and cool to the touch — the fluid is going into the tissue, not the vein
Ivy's forearm is swollen and cool around her IV. The pump keeps alarming, and there is no blood return.
Ivy teaches the three IV site complications students constantly mix up. INFILTRATION: non-vesicant fluid leaks into tissue — swelling, coolness, pallor, slowed infusion, no blood return. EXTRAVASATION: the same leak with a VESICANT drug — add burning pain and risk of tissue necrosis; stop the infusion, leave the catheter in place to aspirate, and follow the antidote protocol. PHLEBITIS: vein inflammation — redness, warmth, tenderness, a palpable cord along the vein. For all three, stop the infusion and remove or manage the line, elevate the extremity and restart in a different site. Warm versus cold compresses depend on the cause and the drug — follow policy.
Read Infiltrated Ivy's full story →The story arc
The setup
Ivy has an IV in her forearm for fluids and antibiotics. Late in the shift the pump starts alarming.
The turn
Her forearm around the site is puffy, pale and cool. The skin feels tight.
The crisis
The nurse checks the medication list — if the leaked drug had been a vesicant, this would be extravasation with a risk of tissue death.
The save
The infusion is stopped, the site is assessed and documented, the arm is elevated, and a new IV is started in the opposite arm.
NCLEX study section — Infiltration vs Extravasation vs Phlebitis: Cool and Swollen or Red and Warm
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Safety & Infection Control
Take this chapter into practice questions on the same topic.