Chart — IV Therapy

IV Complication Recognition

Infiltration, extravasation, phlebitis, CLABSI, catheter occlusion, air embolism, and fluid overload — signs and symptoms, nursing interventions, and prevention side-by-side for rapid clinical reference.

Educational use only. 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.

Critical complications requiring emergency response: Extravasation (vesicant), CLABSI (sepsis risk), Air Embolism. Recognize early — act immediately.

Quick Reference — Urgency and First Action

Complication	Type	Urgency	First Action
Air Embolism	Systemic	CRITICAL	Clamp line; left lateral Trendelenburg; O₂; call for help
CLABSI	Systemic	CRITICAL	Blood cultures ×2; notify provider; antibiotics
Extravasation	Local (vesicant)	CRITICAL	Stop infusion; aspirate; notify provider; antidote if ordered
Fluid Overload	Systemic	Moderate–Severe	Slow/stop IV; HOB up; O₂; diuretics per order
Phlebitis	Local	Moderate	Remove catheter; warm compress; resite
Infiltration	Local	Moderate	Stop infusion; aspirate; remove catheter; elevate; warm compress
Catheter Occlusion	Mechanical	Moderate	Check kinking; reposition; gentle aspiration; do NOT force flush

Complication Detail Cards

Infiltration

Non-vesicant fluid leaks into interstitial tissue

LocalModerate

Signs & Symptoms

Swelling at site
Pallor / blanching
Cool, tight skin
Slow/absent flow
No blood return
Mild discomfort

Nursing Interventions

STOP infusion
Aspirate residual, then remove catheter
Elevate extremity
Warm compress
Document extent (mark swelling border)
Resite IV in opposite extremity

Prevention

Avoid inserting over joints
Assess site every 1–4 hrs
Secure catheter well
Educate patient to report pain/swelling

Extravasation

Vesicant medication leaks into tissue — can cause necrosis

Local — VESICANTCRITICAL

Signs & Symptoms

All infiltration signs PLUS:
Burning, stinging, intense pain
Blistering (early vesicant sign)
Progressive erythema/necrosis
Induration (firm tissue)

Nursing Interventions

STOP infusion IMMEDIATELY
Do NOT remove catheter — aspirate first
Outline/document swelling
Remove catheter after aspiration
Elevate; apply compress (cold most drugs, warm for vinca alkaloids)
Notify provider and pharmacy STAT
Administer antidote if ordered

Prevention

Use central access for ALL vesicants
Assess every 1–2 hrs during vesicant infusion
Verify blood return before starting vesicant
Educate patient to report burning immediately

Phlebitis

Vein wall inflammation — chemical, mechanical, or bacterial

LocalModerate

Signs & Symptoms

Redness, warmth along vein tract
Tenderness at site
Palpable firm cord
Swelling proximal to site
Purulent drainage (bacterial)

Nursing Interventions

Remove PIV immediately
Warm compress to affected area
Elevate extremity
Document phlebitis grade
Culture site if purulent drainage
Resite in opposite extremity

Prevention

Replace PIV based on clinical indication (not a fixed interval)
Smallest gauge for infusion type
Dilute irritating medications
Avoid joints and small veins
Aseptic technique at insertion and access

CLABSI

Central line-associated bloodstream infection

SystemicCRITICAL

Signs & Symptoms

Fever >38°C or hypothermia <36°C
Chills / rigors
Hypotension, tachycardia
Site erythema or purulence
No other source of bacteremia

Nursing Interventions

Notify provider STAT
Blood cultures ×2 (catheter lumen + peripheral)
Broad-spectrum antibiotics as ordered
Initiate sepsis protocol if indicated
Assess for catheter removal per order
Monitor VS, labs closely

Prevention

CLABSI bundle: HH + max sterile barrier + CHG prep + optimal site + daily necessity review
Scrub hub ≥15 sec before each access
Remove catheter when no longer needed
Use CHG-impregnated dressings
Minimize catheter lumens

Catheter Occlusion

Partial or complete blockage of catheter lumen

MechanicalModerate

Signs & Symptoms

Sluggish or absent infusion
Unable to aspirate blood return
Resistance when flushing
Pump occlusion alarm
Positional — changes with arm movement

Nursing Interventions

Check for kinking — straighten catheter
Reposition arm/patient
Gently aspirate with syringe
Notify provider if unable to clear
Alteplase (tPA) per order for clot
Do NOT force flush — risk of catheter rupture

Prevention

Push-pause flush technique with 10 mL NS
Flush between incompatible medications
Positive pressure disconnect from catheter
Change TPN tubing every 24 hrs
Use positive-displacement connectors

Air Embolism

Air enters venous system through IV line or catheter tract

SystemicCRITICAL — EMERGENCY

Signs & Symptoms

Sudden dyspnea, tachypnea
Chest pain or tightness
Mill-wheel murmur
Hypotension, tachycardia
Cyanosis, altered LOC
Rapid deterioration

Nursing Interventions

Clamp IV line immediately
Left lateral Trendelenburg position (Durant's maneuver)
Call for emergency assistance
100% oxygen
Provider may aspirate air via catheter (emergent)
CPR if cardiac arrest
Document and notify risk management

Prevention

Prime tubing completely before connecting
Use Luer-lock connections throughout
Clamp catheter before disconnecting tubing
Supine/Trendelenburg positioning during CVC changes
Valsalva or breath-hold during catheter removal
Occlusive dressing over PICC/CVC site after removal

Fluid Overload

Excess intravascular volume beyond cardiac/renal compensatory capacity

SystemicModerate–Severe

Signs & Symptoms

Crackles / rales on auscultation
Peripheral pitting edema (bilateral)
Weight gain (1 kg ≈ 1 L)
Elevated BP, bounding pulse
JVD, dyspnea, orthopnea
Decreased SpO₂
Foamy pink sputum (severe)

Nursing Interventions

Slow or stop IV infusion
Notify provider
Elevate HOB 30–45°
Diuretics as ordered (furosemide)
Restrict fluids as ordered
Apply O₂ if SpO₂ decreased
Monitor I&O, daily weights, electrolytes

Prevention

Accurate I&O every shift
Daily weight at same time/scale/clothing
Smart pumps for rate control
Assess fluid overload risk (CHF, CKD, elderly) before hanging IV
Reassess IV necessity at each assessment

NCLEX Pearls

✦First action for any IV complication: STOP the infusion immediately. Always.
✦Do NOT remove the catheter before aspirating residual medication during extravasation — reducing the volume in tissue matters.
✦Vasopressor extravasation antidote: phentolamine (alpha-blocker). Vinca alkaloid: hyaluronidase + warm compress. Anthracycline: dexrazoxane + cold compress.
✦Air embolism position: left lateral Trendelenburg (Durant's maneuver) — traps air in right ventricle away from pulmonary outflow tract.
✦CLABSI blood cultures: draw one from catheter lumen and one peripheral — both sets needed for NHSN definition.
✦Midline catheters are NOT central lines — cannot be used for TPN or vesicant medications.
✦Daily weight is the most sensitive indicator of fluid balance — 1 kg gain ≈ 1 L retained fluid.

Related Resources

IV Therapy Complications ReferenceFull detail: causes, grading, interventions, and prevention for each complication

Open →

IV Infiltration vs Extravasation GuideVesicant vs non-vesicant, antidotes, and step-by-step interventions

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Vascular Access DevicesWhen central access reduces complication risk

Open →

Peripheral IV Insertion BasicsCorrect technique reduces infiltration, phlebitis, and infection

Open →

Data source: INS Standards of Practice for Infusion Nursing / CDC HAI and CLABSI Prevention Guidelines

Standards & sources

Fact-checked Jun 21, 2026

This page is written to align with INS Standards of Practice for Infusion Nursing / CDC HAI and CLABSI Prevention Guidelines. 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 →