What Are Phlebitis (Vein Inflammation) and Infiltration (Leakage)?

This article explains two complications of intravenous (IV) treatment: vein inflammation (phlebitis) and leakage (infiltration) . It discusses the symptoms, treatment and prevention of these unwanted effects, as well as how they can affect daily life.

Another complication of IV treatment is extravasation. This more serious condition is discussed in detail in another article . Extravasation is also a form of leakage, but the type of medicine that escapes the vein makes this complication more harmful.

Comparing Phlebitis, Infiltration and Extravasation

What Is Phlebitis?

Phlebitis is inflammation of a vein. It can commonly occur when a catheter is inserted into a vein. The vein walls may become inflamed at the insertion site, and the endothelial cells lining the veins become irritated.

What Are the Types of Phlebitis?

There are two main types: superficial phlebitis and deep vein thrombosis (DVT).

1. Superficial phlebitis occurs in veins beneath the skin and generally causes less serious complications.
2. Deep vein thrombosis (DVT) occurs in the body's deep veins and may cause serious health problems, particularly when clots travel to the lungs. The two types differ in the extent of phlebitis and their potential health risks.

Causes of Phlebitis:

• Phlebitis may occur as a common side effect of a peripheral IV catheter, placed in the hand, arm, foot or leg. A peripheral IV catheter is a plastic tube that healthcare professionals insert into a peripheral vein to deliver medicines or fluids.
• Phlebitis may be more common when microorganisms such as bacteria or viruses are present. Prolonged IV treatment may also increase the risk of phlebitis and infection.
• Factors affecting the risk of phlebitis from a peripheral IV catheter may also include:
  • The catheter insertion site
  • The duration of IV treatment and hospitalization
  • Antibiotic use
  • The number of previous attempts at the catheter insertion site
  • Whether insertion takes place during an emergency

Symptoms of Phlebitis:

• Symptoms in the affected area may include:
  • Pain or tenderness
  • Swelling
  • Increased skin temperature
  • Itching
  • Skin discoloration
  • Changes such as thickening or hardening of the surrounding skin tissue

Treatment for Phlebitis:

• Treatment for phlebitis may include:
  • Topical applications such as aloe vera or nonsteroidal creams to reduce swelling and inflammation
  • Applying warm and cold compresses to the affected area to help reduce swelling and pain
  • Blood-thinning medicines may be needed to help prevent blood clots and recurrent phlebitis.

To relieve phlebitis symptoms, people can apply warm compresses, elevate the affected area while resting and use over-the-counter pain medicines such as acetaminophen or ibuprofen. Anyone taking a blood thinner should consult a doctor first, as combining it with ibuprofen may not be safe.

Preventing Phlebitis:

According to a 2021 article, healthcare professionals can take the following steps to prevent phlebitis:

• Continuously monitor and assess IV treatment.
• Keep records of dates, sites and the number of IV treatments.
• Remove the catheter if signs of phlebitis appear, such as warmth, redness or tenderness.
• Change catheters and dressings when needed.
• Avoid inserting catheters at sites such as joints and wrists, as this may cause dislodgement and other problems.
• Use antiseptic solutions to eliminate bacteria and other microorganisms.
• Wash hands properly and wear gloves when performing the procedure.

Good communication between healthcare professionals and the person receiving treatment is also important. This may involve discussing the catheter insertion site with the person, explaining which signs of phlebitis to watch for and checking whether they are experiencing any discomfort or symptoms.

What Is Infiltration?

Infiltration is the leakage of IV medicines and fluids from a vein into surrounding tissue.

Infiltration may occur if a catheter is inserted incorrectly or becomes dislodged from the vein.

If the fluid leaking outside the vein is a vesicant (an irritant), the more serious tissue damage known as extravasation may occur.

Below, the mechanisms of infiltration and extravasation are illustrated simply:

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Below, discoloration of the arm can be seen after infiltration in a patient who received a contrast solution for medical imaging:

Causes of Infiltration:

Infiltration can occur as a complication of IV treatment in a peripheral vein. Risk factors include:

• Placing a catheter in an area with little soft tissue
• A large needle
• Frequent cannulation

The type of medicine given intravenously may also affect the risk of infiltration.

Symptoms of Infiltration:

Symptoms may develop in the affected area and include:

• Pain
• Swelling
• Blistering
• Skin blanching
• Tingling, numbness or a "pins and needles" sensation
• A decrease in temperature
• Tenderness at the IV insertion site

Treatment for Infiltration:

Healthcare professionals may treat infiltration by:

• Removing the IV line
• Using medicines such as hyaluronidase if soft tissue damage is present
• Elevating the affected area
• Applying gentle pressure to the affected area
• Prescribing pain relief
• Monitoring for infection, which may require antibiotics

Doctors will also check for complications that can accompany infiltration, such as compartment syndrome. Compartment syndrome is a buildup of pressure in the muscles.

Doctors may refer patients to plastic or orthopedic surgeons for treatment if infiltration occurs during chemotherapy or if there is soft tissue damage.

Preventing Infiltration:

According to a 2018 study, recognizing leakage early and removing the IV line may help prevent infiltration.

It is also important to check the IV site and surrounding area frequently and to use clinical grading systems or scales to assess any problems.

The person receiving treatment should understand infiltration so they can recognize and report symptoms early.

Removing the catheter at the first signs of inflammation may help prevent inflammation from progressing and causing complications.

When to Seek Medical Attention:

People should tell healthcare professionals if they experience symptoms of phlebitis during IV treatment.

Seek immediate medical attention if any of the following symptoms occur:

• Throbbing, cramping or sudden swelling in the neck, arm or leg
• Swollen veins that feel hard or tender to the touch
• Pain with warmth or discoloration in the affected area

Outlook

Phlebitis is usually not serious and may resolve on its own within 1-2 weeks. More serious cases require treatment to help prevent blood clots or other complications.

Complications of infiltration are rare, and the condition can resolve with IV line removal and proper management. Severe IV infiltration may cause complications such as poor circulation and tissue death.

Summary

Phlebitis is inflammation of a vein and can be a complication of IV catheter insertion. Infiltration is another complication of IV catheter insertion, involving leakage of IV fluids or medicines into surrounding tissue. Early recognition and appropriate treatment of phlebitis or infiltration can help resolve these conditions and prevent complications.