What are the treatment options for left arm pain after intravenous (IV) placement?

Management of Left Arm Pain After IV Placement

For left arm pain following intravenous catheter placement, immediately remove the IV catheter if still in place and assess for peripheral nerve injury, thrombophlebitis, or compartment syndrome, as these complications require urgent intervention to prevent permanent morbidity. 1, 2

Immediate Assessment and Triage

Determine the specific complication type through focused clinical examination:

• Assess for nerve injury: Elicit whether the patient experienced paresthesias (shooting, electric-like sensations) during IV insertion or currently has numbness, tingling, or weakness in the hand or forearm 2
• Examine for thrombophlebitis: Look for erythema, warmth, tenderness along the vein track, and palpable cord-like induration 1
• Evaluate for compartment syndrome: Check for severe pain out of proportion to examination, pain with passive stretch, tense forearm compartments, and diminished sensation—this is a surgical emergency 1
• Rule out infiltration/extravasation: Assess for localized swelling, coolness, blanching, and skin tightness at the IV site 1

Risk Stratification

Patients at highest risk for major complications include: 1

• Women (82% of major complications)
• Age ≥50 years (90% of major complications)
• Patients on anticoagulation (risk of large hematomas)
• Hand and wrist IV sites (>50% of major complications occur here)

Diagnostic Workup Based on Clinical Presentation

For Suspected Nerve Injury

If paresthesias occurred during insertion or patient reports numbness/tingling: 2

• Remove IV catheter immediately if still in place
• Document sensory distribution affected (radial nerve territory most common with cephalic vein cannulation)
• Consult hand surgery specialist promptly—nerve recovery may take weeks to over a year, and some patients sustain permanent damage 2
• Consider electrodiagnostic studies if symptoms persist beyond 2 weeks to assess nerve conduction 3

For Suspected Thrombophlebitis or DVT

If unilateral arm swelling persists or worsens: 4

• Obtain urgent duplex ultrasound of the upper extremity to exclude deep vein thrombosis (UEDVT accounts for 10% of all DVTs and can cause pulmonary embolism)
• Ultrasound should assess vein compressibility, echogenic thrombus, and Doppler flow patterns
• Initiate therapeutic anticoagulation immediately if UEDVT confirmed

For Suspected Compartment Syndrome

If severe pain with passive stretch or tense compartments: 1

• Emergent surgical consultation for fasciotomy
• Do not delay for imaging—this is a clinical diagnosis requiring immediate intervention

Treatment Algorithm

Minor Complications (Infiltration, Superficial Thrombophlebitis, Cellulitis)

First-line management: 1

• Remove IV catheter immediately
• Elevate affected extremity
• Apply warm compresses for thrombophlebitis (15-20 minutes, 3-4 times daily)
• Topical NSAIDs for localized pain (superior safety profile compared to systemic agents) 4
• Oral NSAIDs (ibuprofen) or acetaminophen for systemic analgesia if no contraindications 5

Antibiotic therapy indications: 1

• Cellulitis with spreading erythema, warmth, and systemic signs
• Septic thrombophlebitis (requires 6 weeks of IV antibiotics per endocarditis protocols)

Major Complications (Nerve Injury, Compartment Syndrome, Septic Thrombophlebitis)

Nerve injury management: 2

• Immediate hand surgery consultation
• Document baseline neurological examination with sensory mapping
• Avoid further trauma to affected area
• Reassess at 2-week intervals for recovery trajectory
• Consider electrodiagnostic studies if no improvement by 2-4 weeks

Compartment syndrome: 1

• Emergent fasciotomy
• Do not elevate extremity (decreases perfusion pressure)
• Remove all constrictive dressings

Follow-Up Protocol

Reassessment timeline: 4

• 48-72 hours: Evaluate response to initial management and ensure no progression
• 2 weeks: If symptoms persist, consider nerve conduction studies or specialist referral
• 6 weeks: Formal evaluation if pain/dysfunction continues to detect delayed complications

Critical Pitfalls to Avoid

• Never continue IV infusion if patient reports paresthesias—immediate catheter removal prevents progression of nerve injury 2
• Do not dismiss unilateral arm swelling as benign—this indicates venous obstruction requiring urgent ultrasound to exclude UEDVT 4
• Avoid probing/repositioning IV catheter after initial insertion—this increases risk of nerve and vascular injury 2
• Do not delay compartment syndrome treatment for imaging—clinical diagnosis requires immediate surgical decompression 1
• Recognize that women ≥50 years have disproportionately higher risk—maintain higher index of suspicion in this population 1

Pain Management Considerations

For moderate pain not requiring opioids: 5

• Oral ibuprofen (avoid if bleeding disorder, renal disease, or anticipated surgery)
• Oral acetaminophen (avoid if hepatic dysfunction)
• Topical NSAIDs for localized pain

For severe pain requiring stronger analgesia: 5

• Oral oxycodone may be appropriate for short-term use
• Reassess pain scores regularly to determine treatment effectiveness