What to do if an IV site leaks?

Management of IV Site Leakage

When an IV site leaks, immediately stop the infusion, remove the catheter, elevate the affected limb, and apply gentle pressure to the site. 1

Immediate Steps for Managing IV Leakage

1. Stop the infusion immediately when leakage is detected 1, 2
2. Disconnect the IV tubing from the cannula 3
3. Remove the catheter from the site 1
4. Aspirate any remaining medication from the area if possible 3
5. Elevate the affected limb to reduce swelling
6. Apply gentle pressure to the site with sterile gauze

Assessment of Leakage Severity

Assess the site for signs of:

• Extravasation: Leakage of vesicant medications (can cause tissue necrosis)
• Infiltration: Leakage of non-vesicant fluids 4
• Extent of swelling and tissue involvement
• Pain, burning, or discomfort at the site 5
• Skin color changes (blanching, redness)

Thermal Application Based on Medication Type

• For vesicant medications (e.g., chemotherapy agents): Apply cold compress (ice pack) for 15-20 minutes every 4 hours for 24-48 hours 3
• For non-vesicant solutions: Apply warm compress for 15-20 minutes every 4 hours for 24-48 hours 3

Documentation Requirements

Document the following:

• Time of leakage detection
• Type and amount of fluid/medication that leaked
• Appearance of the site
• Interventions performed
• Patient's response to interventions 1

Follow-up Care

1. Monitor the site for 24-48 hours for:

   • Increasing pain
   • Progressive swelling
   • Skin discoloration
   • Signs of infection

2. Notify physician if:

   • Severe pain persists
   • Tissue damage is evident
   • Signs of compartment syndrome develop
   • Neurological symptoms occur 6

Prevention of Future Leakage

1. Select appropriate catheter size for the vein and intended therapy 1
2. Choose upper extremity sites rather than lower extremity sites 1
3. Ensure all components of the IV system are compatible to minimize leaks 1
4. Secure the catheter properly with appropriate dressing 1
5. Evaluate the catheter site daily through visual inspection or palpation 1
6. Replace peripheral venous catheters every 72-96 hours in adults 1
7. Use transparent dressings when possible to allow for visual inspection 1
8. Avoid using steel needles for administering fluids that might cause tissue necrosis if extravasation occurs 1

Special Considerations

• For high-risk medications (e.g., vasopressors, chemotherapy): Consider central venous access instead of peripheral 1
• For prolonged IV therapy (>6 days): Consider midline catheter or PICC line 1
• Bolted catheters are associated with reduced risk of leakage compared to tunneled catheters 1

Remember that prompt recognition and management of IV site leakage is essential to prevent complications such as tissue necrosis, nerve damage, and infection. Always follow institutional protocols and notify the physician for significant extravasation events, particularly with vesicant medications.