What is the treatment for blisters around an intravenous (IV) line site?

Treatment for Blisters Around an Intravenous (IV) Line Site

For blisters around an IV line site, the primary treatment is removal of the peripheral venous catheter, followed by appropriate local wound care based on the severity of the condition. 1

Assessment and Immediate Management

• Remove the peripheral venous catheter immediately if blisters, pain, induration, erythema, or any exudate is present at the insertion site 1
• Submit any exudate from the insertion site for Gram staining and culture, particularly in immunocompromised patients 1
• Evaluate the extent of tissue damage, as blisters may indicate infiltration or extravasation of IV fluids or medications 1, 2
• Document the type of catheter used, duration of placement, and any infused medications that might have contributed to the reaction 2, 3

Treatment Based on Severity

For Minor Blisters/Infiltration:

• Clean the area with an appropriate antiseptic (2% chlorhexidine-based preparation preferred, or 70% alcohol) 1
• Apply sterile dressing appropriate to the condition of the site:
  • For weeping/oozing sites: sterile gauze dressing 1
  • For dry sites: transparent semi-permeable dressing 1
• Elevate the affected limb to reduce swelling 2
• Monitor the site daily for signs of improvement or deterioration 1

For Severe Blisters/Complications:

• If signs of infection are present (increasing erythema, warmth, purulence), initiate empiric antibiotic therapy directed against common skin pathogens (Staphylococcus species) 4
• For extensive tissue damage or necrosis, surgical consultation may be necessary 2
• For compartment syndrome or severe infiltration injuries, immediate surgical evaluation is required 2

Prevention of Future Occurrences

• Select catheters based on intended purpose and duration of use 1
• Avoid steel needles for administration of fluids and medications that might cause tissue necrosis if extravasation occurs 1
• For adults, use upper extremity sites rather than lower extremity sites for catheter insertion 1
• Replace peripheral venous catheters at least every 72-96 hours in adults 1
• Minimize prolonged continuous IV fluid infusion (>24 hours increases risk by 5.2 times) 3
• Avoid use of infusion pumps when possible, as they increase risk of soft tissue damage 3
• Evaluate catheter insertion sites daily through visual inspection if transparent dressing is used or by palpation if opaque dressing is used 1

Special Considerations

• Older patients (>50 years) and women appear to be at higher risk for both minor and major IV catheter complications 2
• Patients receiving anticoagulation therapy are at increased risk for hematoma formation at IV sites 2
• Chemotherapeutic agents can contribute to more severe complications and require special attention 2
• Neurological or neurosurgical patients have a 3.6 times higher risk of developing IV-related soft tissue infections 3

Common Pitfalls to Avoid

• Do not delay removal of the catheter if complications are suspected 1
• Avoid placing new catheters in the same area where blisters or other complications have occurred 1
• Do not routinely apply prophylactic topical antimicrobial or antiseptic ointment to insertion sites of peripheral venous catheters 1
• Do not submerge the affected area in water until healing is complete 1
• Avoid lower extremity placement of IV catheters when possible, as this increases risk of complications by 8.5 times 3