Guide — IV Therapy
IV Infiltration vs Extravasation
Infiltration and extravasation are both IV complications involving fluid leaking into surrounding tissue — but extravasation involves vesicant agents capable of causing severe, permanent tissue damage. Early recognition and immediate action are critical for both.
9 min read · IV Therapy
Educational use only. IV complications require immediate nursing action and provider notification. Follow facility-specific protocols for extravasation management, especially for chemotherapy and vasopressor extravasation. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Definitions
Infiltration
Accidental leakage of non-vesicant (non-irritating) IV fluid or medication into the surrounding interstitial tissue. Does not cause permanent tissue destruction, but can cause pain, swelling, and delayed infusion.
Examples
Normal saline, D5W, Lactated Ringer's, most antibiotics, most routine medications
Extravasation
Accidental leakage of a vesicant (tissue-damaging) IV medication into surrounding tissue. Can cause severe, progressive, and permanent tissue damage including necrosis, nerve injury, and tendon damage.
Examples
Vasopressors (norepinephrine, dopamine), chemotherapy (doxorubicin, vincristine), concentrated electrolytes (KCl >40 mEq/L), phenytoin, vancomycin (high concentration)
Risk Factors
Patient Factors
- Elderly patients — fragile, thin-walled veins
- Pediatric patients — small vein caliber
- Obesity — poor vein visualization and palpation
- History of multiple IV insertions or chemotherapy — vein sclerosis
- Peripheral edema — poor visualization
- Confused or agitated patients — IV manipulation
- Diabetes mellitus — microvascular disease
Site and Infusion Factors
- IV insertion over a joint — catheter bends with movement
- Antecubital fossa site — high movement area
- Small gauge catheter for vesicant infusion
- High infusion rates or pressures
- Long duration of infusion at same site
- Vesicant medication through peripheral IV (risk factor for extravasation)
- Inadequate catheter securement
Assessment Findings — Comparison
| Finding | Infiltration | Extravasation |
|---|---|---|
| Swelling at site | ✓ Present | ✓ Present — may be severe |
| Skin color | Pallor, blanching, or mottling | Pallor, blanching, erythema |
| Skin temperature | Cool/cold around site | Cool initially, then erythema |
| Pain / discomfort | Mild pressure or aching | Burning, stinging, intense pain |
| Blood return | Absent or sluggish | Absent or sluggish |
| Infusion rate | Slowed or stopped | Slowed or stopped |
| Blistering | Not typical | Blisters develop — early sign of vesicant damage |
| Tissue necrosis | Not expected | Progressive — may occur within hours to days |
| Nerve/tendon injury | Not expected | Possible — especially with large volume extravasation |
Immediate Interventions
Step 1 — STOP the infusion immediately
Stop the infusion as soon as infiltration or extravasation is suspected. Every additional drop of vesicant increases tissue damage. Do NOT wait for confirmation before stopping.
Do NOT remove the catheter yet
Leave the catheter in place and attempt to aspirate any residual medication from the catheter and site before removal. This may reduce the volume of vesicant in the tissue.
Estimate and document the extent of leakage
Outline the area of swelling with a marker. Document size, skin appearance, patient symptoms, and time of discovery.
Remove the catheter after aspirating
After aspirating residual medication, remove the catheter. Apply gentle pressure with dry gauze.
Elevate the affected extremity
Elevate the limb above heart level to reduce swelling and promote fluid reabsorption.
Apply compress (heat or cold depending on medication)
Cold compress (ice): most medications — reduces spread of irritant, decreases pain. Warm compress: vinca alkaloids (vincristine, vinblastine) — promotes systemic absorption. Check facility protocol and drug-specific guidance.
Notify provider and pharmacy
Notify the prescriber and pharmacy immediately. Some extravasations require specific antidotes or surgical consultation.
Administer antidote if ordered
Antidotes must be given promptly. See antidote table below.
Document and monitor
Document all assessments, interventions, provider notifications, and patient responses. Continue monitoring the site for progression of injury.
Antidotes for Extravasation
| Agent / Class | Examples | Antidote / Management |
|---|---|---|
| Vasopressors | Norepinephrine, dopamine, epinephrine, phenylephrine | Phentolamine (alpha-adrenergic blocker) injected subcutaneously into affected area |
| Anthracyclines (chemo) | Doxorubicin, epirubicin, daunorubicin | Dexrazoxane (Totect) IV within 6 hours; cold compresses (NOT warm) |
| Vinca alkaloids | Vincristine, vinblastine, vinorelbine | Hyaluronidase SQ into affected area; warm compresses (promotes absorption) |
| Cisplatin | Cisplatin, carboplatin | Sodium thiosulfate injected locally; cold compresses |
| Concentrated electrolytes | KCl >40 mEq/L, calcium gluconate, NaHCO₃ 8.4% | Hyaluronidase SQ; elevate; warm compress; provider notification immediately |
| Phenytoin | Fosphenytoin is less vesicant; avoid phenytoin peripherally | Hyaluronidase; warm compresses; surgical consultation if severe |
Prevention
- Use a central venous access device for all vesicant medications — PICC, CVC, or port; do not infuse vesicants through peripheral IVs unless no alternative is available
- Select the largest appropriate catheter gauge and most stable site for vesicant infusions
- Assess IV site at a minimum every 1–2 hours during vesicant infusions
- Verify catheter patency with a saline flush before beginning a vesicant infusion
- Confirm blood return before initiating chemotherapy infusion
- Educate patients to report any burning, pain, or swelling at the IV site immediately
- Avoid placing peripheral IVs over joints — high movement increases risk
- Use electronic infusion devices with pressure-sensing alarms for high-risk infusions
NCLEX Pearls
- ✦Extravasation involves a vesicant — infiltration does not. Vesicants cause tissue destruction; non-vesicants do not.
- ✦Stop the infusion immediately if either complication is suspected — do NOT continue while assessing.
- ✦Do NOT remove the catheter first — aspirate residual medication before removing.
- ✦Vasopressor extravasation: antidote is phentolamine (alpha-blocker) — given into the affected site.
- ✦Vinca alkaloid extravasation: warm compress + hyaluronidase. Anthracycline extravasation: cold compress + dexrazoxane.
- ✦Vesicant medications should be administered via central access — not peripheral IVs when avoidable.
- ✦When asked about first action for IV complications: STOP the infusion. Always.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Infusion Nurses Society (INS) Standards of Practice · CDC (CLABSI prevention) · Institute for Safe Medication Practices (ISMP). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →