Differential Diagnosis for Firm Skin and Edema at the Site of IV Injection
- Single most likely diagnosis:
- Phlebitis: This is the most likely diagnosis given the firm skin and edema at the site of the IV injection. Phlebitis is inflammation of the vein and is a common complication of IV therapy, especially if the catheter has been in place for an extended period or if the infusion is irritating to the vein.
- Other Likely diagnoses:
- Infiltration: This occurs when fluid or medication leaks out of the vein into the surrounding tissue, causing swelling, redness, and firmness of the skin. It's a common issue with IV therapy, especially if the catheter is not properly placed or becomes dislodged.
- Extravasation: Similar to infiltration but typically involves more severe leakage of vesicant medications, which can cause significant tissue damage and necrosis. The presentation can include firm skin and edema, among other symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Sepsis: Although less likely, sepsis is a life-threatening condition that can arise from infected IV sites. Symptoms can include redness, swelling, and firmness of the skin, along with systemic signs of infection such as fever and chills.
- Necrotizing Fasciitis: A rare but deadly infection of the tissue beneath the skin and surrounding muscles and nerves. It can start from a minor injury, including an IV site, and presents with severe pain, swelling, and firmness of the skin, which may progress rapidly.
- Rare diagnoses:
- Deep Vein Thrombosis (DVT): Although more commonly associated with the lower extremities, DVT can occur in the arms, especially with prolonged IV therapy. Symptoms can include swelling, warmth, and firmness of the skin, but it is less common in this context compared to other diagnoses.
- Compartment Syndrome: A condition resulting from increased pressure within a muscle compartment, which can be caused by severe infiltration or extravasation. It presents with pain, pallor, poikilothermia, paresthesia, and paralysis, along with firmness and swelling of the affected limb.