IV Complications on the NCLEX
Infiltration vs phlebitis vs extravasation: recognition, grading basics, and the right response to each.
Three look-alike complications, three different responses. The exam wants you to tell them apart at the bedside.
Infiltration
A nonvesicant solution leaks into surrounding tissue. Findings: swelling, cool pale skin, taut tissue, sluggish or stopped infusion, discomfort. Compare arms. Response: stop the infusion and remove the catheter, elevate the limb, apply a compress (cool or warm depending on the solution and policy), and restart the IV proximal to the site or in the other arm. Document site, size, and grade.
Phlebitis
Inflammation of the vein itself: mechanical (catheter movement), chemical (irritating drugs, hypertonic fluids), or bacterial. Findings: redness, warmth, tenderness along the vein, and a palpable cord-like streak in later grades. Response: remove the catheter, warm compress, restart elsewhere. Bacterial phlebitis with fever or purulence gets the provider. Prevention is dilution, the smallest adequate gauge, and secure stabilization.
Extravasation
Infiltration's dangerous cousin: a vesicant (chemotherapy agents, vasopressors, calcium chloride, hypertonic dextrose, certain antibiotics) enters tissue and can cause blistering and necrosis. Response: stop the infusion immediately but leave the catheter in place so the antidote can be given through it and residual drug aspirated. Notify the provider, give the antidote per protocol (for example, phentolamine for norepinephrine), elevate, and follow compress guidance for that specific drug. Photograph and document per policy. Vesicants belong in a central line whenever possible.
Grading basics
Standard infusion-nursing scales grade both infiltration (0 to 4) and phlebitis (0 to 4) by findings, not by guesswork: 0 is no symptoms and 4 is the severe end (large swelling with circulatory change, or a palpable cord longer than an inch with purulence). You do not memorize every criterion for NCLEX; you do chart the grade, the site, your intervention, and the recheck.
Frequently asked
Cool and swollen vs red and warm?
Cool, pale, swollen is infiltration. Red, warm, tender along the vein is phlebitis. The temperature of the skin is the fastest discriminator.
Vasopressor site blanches and swells?
Extravasation. Stop the drug, leave the cannula, call for phentolamine per protocol, and get a new access site for the pressor now.
Why leave the catheter in after extravasation?
It is the route for aspirating drug and delivering the antidote into the affected tissue. Pull it only after those steps.
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