IV Infiltration vs Extravasation vs Phlebitis: How to Teach Students to Recognize the Differences

IV infiltration, extravasation and phlebitis are three common IV therapy complications that nursing and medical students must learn to distinguish by recognizing their symptoms, causes and appropriate clinical responses.

Key things to know:

• The fundamental differences between IV infiltration, extravasation and phlebitis
• How infiltration occurs when non-vesicant fluids leak into surrounding tissue
• Why extravasation is more dangerous due to vesicant medications that can cause tissue damage
• The typical symptoms of infiltration, including swelling, cool skin and slowed infusion flow
• The warning signs of extravasation such as sharp pain, blistering, severe swelling and tissue damage
• How phlebitis involves inflammation inside the vein rather than fluid leakage
• Common indicators of phlebitis, including warmth, redness and a cord-like vein along the insertion site
• How simulation tools like IV training arms help students recognize and practice identifying these complications

Intravenous therapy (IV) is one of the most common forms of medical treatment in hospital and clinical settings. If a patient suffers from an infection, dehydration, or some other chronic condition, a doctor or nurse will administer an IV treatment by transferring nutrients, blood, medication, or fluids into the patient’s vein and bloodstream.  

Unfortunately, IV treatments come with a certain degree of risk due to the potential complications that can occur. These complications include:

• Infiltration
• Extravasation

• Phlebitis 

Nursing and medical students are usually introduced to these complications early on in their education, but struggle to distinguish them in simulated and clinical environments. The confusion is understandable since they all involve IV-related damage around the site where the catheter was inserted. 

However, the primary differences pertain to the symptoms, risk level, and actions taken to remedy the situation. Your students must understand these differences to know which treatment is the best to apply. 

What is IV Infiltration? 

IV infiltration is a term that describes the accidental leakage of non-vesicant fluid, such as sodium chloride (saline), from the vein into the surrounding subcutaneous tissue. This type of leakage may occur if the catheter was accidentally dislodged, destabilized, or if the vein was pierced during insertion. 

Non-vesicant fluids won’t cause the surrounding tissue to blister or die, but they may cause minor redness, discomfort, or swelling. Overall, the patient faces no serious risk to their life from it. 

Students can identify IV infiltration by looking for the following symptoms:

• Swelling – The tissue becomes swollen and puffy, causing tightness of the skin.
• Coolness – The surrounding skin feels cold or cool when you touch it. 
• Pain – The patient expresses minor pain or discomfort. 
• Infusion Problems – Students may see the IV infusion flow slow down or halt completely.
• Redness – The tissue shows signs of redness and discoloration. 
  

Most of the symptoms are recognizable by seeing, touching, or comparing them. For example, ask your students to touch the affected and unaffected limb using the back of their hand. It will help students recognize the differences in temperature and texture between the two limbs. Of course, they can also visibly observe most of these symptoms to confirm them as well. 

You can simulate arm swelling and coolness by adding a saline solution underneath the skin of an IV training arm. Once your students become more advanced, you can have them train on a simulated human patient who can express the symptoms of pain and discomfort. Students should develop the habit of asking their patients whether they feel any pain or discomfort. That feedback will help them understand whether infiltration is present. 

What is IV Extravasation?

IV extravasation is a term that describes the leakage of vesicant medications, which are medications that can cause blistering or severe tissue damage or death. Some of the most common examples of vesicant medications are calcium solutions, potassium chloride, and chemotherapy drugs. 

Extravasation is much more critical than infiltration. Students should learn to recognize it as a medical emergency due to the enormous threat posed by these more dangerous medications. 

Students can identify IV extravasation by looking for the following symptoms:

• Sharp Pain – The patient will express feeling a severe stinging sensation or sharp pain in the tissue.  
• Blistering – Tiny blisters, such as fluid-filled bubbles, will form on the surface of the skin. 
• Numbing – The patient will experience a numbness or tingling feeling due to local nerve damage. 
• Severe Edema – A more severe type of swelling that can limit the patient’s limb movement. 
• Tissue Necrosis – The affected skin tissue darkens, hardens, and/or peels due to the dead skin cells. 

Students may not even need to ask their patients whether they are in pain because they will clearly express that the pain is intense enough. Not only that, but the visible symptoms will be more than apparent within a short timeframe. When students recognize these signs of extravasation, they should stop the infusion immediately to prevent further damage and worsening symptoms.

Teach your students to identify the drug to confirm whether it is a vesicant medication. From there, they can use a small syringe to practice extracting the residual drug without removing the catheter. 

What is IV Phlebitis?

IV Phlebitis describes inflammation within the inner vein wall. It usually occurs when the catheter is not inserted into the vein correctly, or if an infection or chemical irritation occurs. The biggest difference between phlebitis and the other two complications is that the fluid remains in the vein rather than leaking out. That should make it easier for students to identify. 

The common symptoms associated with IV phlebitis include:

• Warmth – The feeling of warmth on the skin covering the vein. 
• Redness – Visible redness along the vein’s path.
• Burning Sensation – The patient will feel pain in the form of a burning sensation along the vein’s path. 
• Palpable Vein – An intense, cord-like vein from under the skin will be visible. 

Students can quickly detect phlebitis by feeling for warmth and observing the vein texture. Once detected, they should learn to immediately remove the catheter to prevent any further irritation. Then, have your students elevate the impacted limb and apply a warm compress to the site. 

The best way to prevent IV phlebitis is to secure the catheter properly. Make sure you teach your students the importance of using the appropriate gauge sizes, as this can prevent most incidences of phlebitis. 

Grab the Right IV Medical Supplies for Your Students

Do you need high-quality IV medical supplies to properly teach your students the differences between infiltration, extravasation, and phlebitis? Pristine Medical is the premier provider of IV-related medical supplies for students. It has everything you need to teach a comprehensive lesson on the differences of these IV-related complications. 

We recommend starting with a standardized IV insertion kit and training arm. It will make it easier to simulate each type of IV complication.