What is the management plan for patients who develop mild swelling around the area of an intravenous (IV) cannula?

Management of Mild Swelling Around IV Cannula Site

For patients who develop mild swelling around an IV cannula site, immediately stop the infusion, apply ice to the affected area for 10-15 minutes, and elevate the limb while monitoring for progression of symptoms. 1

Initial Assessment and Management

• Evaluate the extent of swelling, presence of pain, redness, or other symptoms that may indicate infiltration or extravasation 1
• Stop the infusion immediately if swelling is observed to prevent further complications 1
• Leave the cannula in place initially to allow for potential aspiration of any infiltrated fluid 1
• Try to gently aspirate as much of the infiltrated solution as possible through the cannula 1
• Apply cold compress or ice pack to the affected area for 10-15 minutes to reduce swelling and limit drug dispersion through vasoconstriction 1, 2
• Elevate the affected limb to promote venous return and reduce swelling 3, 2

Specific Management Based on Severity

For Mild Infiltration:

• Apply ice for a minimum of 10 minutes and avoid maximizing blood pump speed if IV is still being used 1
• Continue monitoring the site for progression of symptoms 1
• Document the event, including time of occurrence, appearance of the site, and interventions performed 1

For Moderate Infiltration:

• Withdraw the needle/cannula and apply manual pressure over the infiltration site 1
• Continue application of cold compress (15-20 minutes every 4 hours for 24-48 hours) 2
• Monitor for signs of infection or tissue damage 1, 4

Follow-up Care

• Reassess the site regularly (every few hours initially) to monitor for progression of symptoms 1
• Document the size of the affected area and any changes in appearance 1
• Consider marking the boundaries of the swelling with a pen to monitor for expansion 3
• Educate the patient to report any increased pain, redness, warmth, or drainage from the site 4, 5

Prevention of Future Complications

• Select appropriate cannulation sites, preferably large veins in the forearm for peripheral administration 1
• Avoid cannulation over joints, in the inner wrist, lower extremities, or areas with poor venous access 1
• Use flexible cannulae rather than winged steel infusion devices ("butterfly" needles) 1
• Check for blood return before administering medications and regularly throughout infusions 1
• Secure cannula properly with adequate dressings to prevent displacement 1
• Flush with 10-20 ml of saline solution between different drug infusions 1

When to Seek Specialist Consultation

• If swelling continues to increase despite initial management 3
• If signs of infection develop (increased redness, warmth, purulent drainage) 1, 4
• If there is evidence of tissue necrosis, blistering, or ulceration 1, 3
• If the patient experiences severe pain or limited mobility of the affected limb 3, 5

Common Pitfalls and Caveats

• Do not rely solely on clinical findings for establishing a diagnosis of catheter-related infection, as they have poor specificity and sensitivity 1, 4
• Avoid confusing normal infusion-related reactions (such as "flare" reactions) with true extravasation 1
• Never apply pressure distal to the infiltration site as this may increase intraluminal pressure and worsen the infiltration 1
• While specialist consultation may seem prudent, most IV infiltrations can be managed by primary care teams with appropriate monitoring and care 3