What medication can be given to reduce swelling around an intravenous (IV) cannula site?

Management of Swelling Around IV Cannula Site

For mild swelling around an IV cannula site, apply ice for 10-15 minutes, elevate the limb, and consider administering paracetamol (acetaminophen) which can reduce post-traumatic swelling by approximately 30%. 1, 2

Initial Assessment and Management

• Immediately stop the infusion if swelling is observed to prevent further complications 1
• Apply ice to the affected area for 10-15 minutes and elevate the limb while monitoring for progression of symptoms 1
• Leave the cannula in place initially to allow for potential aspiration of any infiltrated fluid 1
• Evaluate the extent of swelling, presence of pain, redness, or other symptoms that may indicate infiltration or extravasation 1

Medication Options for Reducing Swelling

• Paracetamol (acetaminophen) is recommended as it can reduce post-traumatic swelling by approximately 30% while providing pain relief 2
• Paracetamol can be administered intravenously (if another IV site is available) or orally, with similar efficacy whether administered before or 2-3 hours after the injury 2, 3
• Avoid acetylsalicylic acid (aspirin) as it may fail to reduce or even increase swelling in acute trauma 2
• For more significant swelling, a short course of glucocorticoids may be considered as they can reduce post-traumatic swelling by about 50% 2

Specific Management Based on Severity

• For mild swelling: Apply ice, elevate the limb, and consider oral or IV paracetamol 1, 2
• For moderate to severe swelling or if extravasation of a vesicant medication has occurred: Consider phentolamine (0.1–0.2 mg/kg up to 10 mg diluted in 10 mL of 0.9% sodium chloride) injected intradermally at the extravasation site to counteract dermal vasoconstriction 4
• For arterial cannula infiltration: More aggressive management may be needed as complications can include hematoma formation, arteriovenous fistula, pseudoaneurysm, and compartment syndrome 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 ultrasound guidance when available to increase first-attempt success rates and decrease complications 5
• Use smaller diameter catheters when possible to reduce vessel trauma 5

Common Pitfalls and Caveats

• Never apply pressure distal to the infiltration site as this may increase intraluminal pressure and worsen the infiltration 1
• Do not rely solely on clinical findings for establishing a diagnosis of catheter-related infection 1
• A "bad stick" resulting in significant hematoma may require deferral of further cannulations until the hematoma is resolved, which can take up to 3 months 4
• Infiltration injuries can lead to frequent imaging, interventions, and prolonged need for alternative vascular access 4

Special Considerations

• If an arteriovenous fistula is infiltrated, it should be rested until swelling is resolved 4
• For patients on hemodialysis, elevation of the affected arm should be maintained as much as possible until swelling subsides, which may take 3-6 weeks 4
• Pain management should be assessed on an individual basis, with paracetamol being a safe first-line option 1, 2