6 Chapter Seven: Complications of Intravenous Therapy
Learning Objectives
- Discuss common complications associated with intravenous therapy, including infiltration, phlebitis, extravasation, infection, and air embolism.
- Discuss complications of central venous access devices (CVADs).
- Identify and mitigate risk factors associated with IV therapy.
- Recognize the clinical manifestations of common complications of IV therapy and fluid and electrolyte imbalances.
- Discuss how to prevent and manage complications of IV therapy and fluid and electrolyte imbalances.
- Evaluate patient outcomes related to IV therapy complications and the effectiveness of implemented interventions.
Chapter Opener
Takara reiterated the potential complications associated with IV therapy. Takara explained the clinical manifestations that could arise from IV administration, such as swelling, infection, or discomfort at the insertion site, and emphasized the need for Mrs. Dupree to inform her immediately if any complications were experienced.
Introduction
Intravenous therapy is a common medical intervention in patient care which allows for the efficient delivery of fluids, medications, and nutrients directly into the bloodstream. Therefore, it’s imperative that healthcare professionals have a comprehensive understanding of the complications of IV therapy. This chapter will discuss how to identify, assess, and manage complications arising from IV therapy.
Complications of IV Therapy
Complications are categorized as local or systemic. Throughout this chapter, learners will explore common local complications such as infiltration, phlebitis, extravasation, and infection. Additionally, we will discuss systemic complications that can occur with IV therapy such as catheter-related bloodstream infection (CRBSI), air embolism, and fluid overload. Emphasis will be placed on implementing effective preventative measures, recognizing early clinical manifestations, and responding promptly to complications to ensure patient safety and optimal outcomes.
Local Complications
We will start by discussing local IV therapy complications (Table 7.1) including infiltration, phlebitis, extravasation, and infection. Complications can range from non-severe to severe. Extravasation, for example, can lead to tissue damage and necrosis, infection, loss of function, scarring and disfigurement, and compartment syndrome, in rare cases (Ignatavisius et al., 2024). If complications occur, the healthcare professional should stop the IV and remove it immediately and replace it at a different site. Notify the healthcare provider and initiate nursing interventions to relieve symptoms. In some cases of extravasation, an antidote is infused before IV removal, depending on the vesicant. Descriptions, causes, clinical manifestations, nursing interventions, prevention, and images are summarized in Table 7.1 (Ignatavisius et al., 2024; INS, 2024; OpenStax, 2025).
| Complication | Description | Causes | Nursing Interventions | Prevention |
|---|---|---|---|---|
| Infiltration | IV fluid or medication leaks into the surrounding tissue instead of the vein. | Improper insertion, catheter displacement, or occlusion. | Remove the IV, elevate the affected limb, and apply cold or warm compresses. | Stabilize the catheter and use the smallest appropriate size; avoid areas of flexion. If necessary, secure the site with an armboard; Regularly assess the site and educate the patient on activities to avoid, as well as the signs and symptoms of infiltration. |
Can the author send or insert the photo? Very small in the Google Doc and not available to me at the link
| Complication | Description | Causes | Clinical Manifestations | Nursing Interventions | Prevention |
|---|---|---|---|---|---|
| Phlebitis | Inflammation of the vein at the catheter insertion site. | Chemical or mechanical irritation, infection, or prolonged use. | Pain, tenderness, redness, warmth along the vein from the access site, with possible red streaks and/or a palpable cord along the vein. | Discontinue the IV, apply warm compresses, and use anti-inflammatory meds. | Use smallest appropriate size; Avoid areas of flexion; Secure the catheter. |
Can the author send or insert the photo? Very small in the Google Doc and not available to me at the link
| Complication | Description | Causes | Clinical Manifestations | Nursing Interventions | Prevention |
|---|---|---|---|---|---|
| Extravasation | IV infusion of a vesicant (irritant) drug causes tissue damage. | Infusion of chemotherapy or irritant drugs. | Similar to infiltration, blistering and tissue sloughing may not become apparent for several days and can take 1–4 weeks to resolve, especially with the infiltration of certain chemotherapeutic agents. | Stop the infusion, attempt to aspirate the drug, and follow protocols for the specific drug involved (e.g., antidote). | Identical to infiltration; Choose the correct vascular access device and site for administering vesicant medications; Identify the vesicant potential before administering any IV medication. |
| Complication | Description | Causes | Clinical Manifestations | Nursing Interventions | Prevention |
|---|---|---|---|---|---|
| Infection | Local or systemic infection caused by bacteria or fungi. | Poor aseptic technique, prolonged catheter use, or contamination. | Site appears red, swollen, and warm, with tenderness present. Purulent or foul-smelling exudates may also be observed. | Remove the catheter, clean the site, administer antibiotics, and monitor for systemic symptoms. | Always apply strict aseptic technique when inserting, maintain- ing, or removing catheters; Follow evidence- based hand hygiene practices; Ensure the dressing stays clean, dry, and securely adhered to the skin at all times. |
(Insert video(s) of complication intervention)
Systemic Complications
Now let’s review systemic IV therapy complications (Table 7.2). Systemic complications affect the entire vascular system or multiple body systems, not just the IV site. These can be life-threatening and often require urgent medical intervention. If complications occur, the healthcare professional should stop the IV and remove it immediately and replace it at a different site. Notify the healthcare provider and initiate facility protocols. Descriptions, causes, clinical manifestations, nursing interventions, prevention, and images are summarized in Table 7.2 (Ignatavisius et al., 2024; INS, 2024; OpenStax, 2025).
For patients receiving replacement of electrolytes like sodium, potassium, or magnesium via IV route, this route is faster than oral administration. However, nurses must carefully administer the correct doses and maintain therapeutic levels. Monitoring includes regular blood tests for sodium and potassium, along with assessing the patient for signs of overdose or toxicity (OpenStax, 2025).
(Should I do the other table as above? I think the images within the table is too much space-wise but could take a different approach)
Complications of Central Venous Access Devices
Complications specific to central venous access devices include catheter migration, catheter dislodgement, catheter rupture, and lumen occlusion. Notify the healthcare provider and follow facility protocol if complications occur. Descriptions, causes, clinical manifestations, nursing interventions, and prevention are summarized in Table 7.3 (Ignatavisius et al., 2024; INS, 2024).
(Should I do the other table as above? There are no images with this table so more options)
Documentation
Here are examples of documentation for expected findings and unexpected findings.
Expected Findings
Initiated IV infusion of normal saline at 150 mL/hr using existing 20-gauge IV catheter located in the left hand. The IV site is free from pain, coolness, redness, or swelling. (WisTech Open, 2023).
Unexpected Findings
Attempted to initiate IV infusion in left hand with existing 20-gauge IV catheter. IV site free from pain, redness, or signs of infiltration. IV site flushed readily with normal saline. Normal saline IV fluids connected at 175 mL/hour with immediate leaking around infusion site. Swelling noted superior to infusion site. Fluids stopped immediately. (WisTech Open, 2023).
Key Takeaways
Review Questions
References
Centers for Disease Control and Prevention (2024, February 28). Background Information: Strategies for Prevention of Catheter-Related Infections in Adult and Pediatric Patients. CDC. https://www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infection/prevention-strategies.html
Exline, M. C. & Sopirala, M. M. (2017). Prevention of catheter-related bloodstream infections, 2017: An overview of current approaches in diagnosis, management, and prevention. Infectious Disease Special Edition, Spring 2017, 65-72.
Ignatavisius, D. D., Rebar, C. R., & Heimgartner, N. M. (2024). Concepts of infusion therapy. In J. H. Ingalls (Ed.), Medical-Surgical nursing: Concepts for clinical judgment and collaborative care (11 ed., pp. 285-315). Elsevier.
Infusion Nurses Society (INS). (2024). Infusion therapy standards of practice (9th ed.). Journal of Infusion Nursing, 47(Suppl. S1), S1–S285.
OpenStax (2025). Clinical Nursing Skills. Rice University. Creative Commons Attribution 4.0 International License Retrieved from https://openstax.org/books/clinical-nursing-skills/pages/13-3-intravenous-infusion
WisTech Open (2023). Nursing Skills (2nd edition).Creative Commons Attribution 4.0 International License Retrieved from https://wtcs.pressbooks.pub/nursingskills/chapter/23-4-sample-documentation/