Management of IV Infiltration: Cold Compresses Are Recommended
For infiltrated intravenous lines, apply dry cold compresses for 15-20 minutes, four times daily for 24-48 hours, along with limb elevation—warm compresses are NOT recommended for standard infiltrations. 1, 2
Immediate Management Steps
When infiltration is recognized, follow this sequence:
- Stop the infusion immediately without removing the cannula 3, 1
- Aspirate as much infiltrated fluid as possible through the existing cannula before removal 1, 2
- Avoid applying manual pressure over the infiltrated area, as this worsens tissue damage by forcing fluid deeper into tissues 1, 2
- Apply dry cold compresses for 15-20 minutes, four times daily for 24-48 hours to promote vasoconstriction and limit fluid dispersion 1, 2, 4
- Elevate the affected limb to reduce edema and improve venous drainage 1, 2
- Provide analgesia as needed for patient comfort 1, 2
Why Cold, Not Warm?
The rationale for cold application is physiologically sound: cold causes vasoconstriction, which theoretically limits drug and fluid dispersion into surrounding tissues. 4, 5 While clear benefit has not been definitively demonstrated in controlled trials, cold application remains standard supportive care based on this mechanism. 4
Warm compresses are specifically contraindicated for most infiltrations because they cause vasodilation, which would increase fluid dispersion and potentially worsen tissue damage. 6
Critical Exception: Vesicant-Specific Protocols
The thermal application recommendation changes based on the specific drug extravasated:
- For most infiltrations and contrast extravasation: Use cold compresses 1, 4
- For vinca alkaloid extravasation: Warm compresses may be beneficial (this is the notable exception) 6, 7
- For anthracycline extravasation: Cold compresses are recommended 3, 6
Common Pitfalls to Avoid
- Never remove the cannula before attempting aspiration of infiltrated solution—you lose your only access point to withdraw the fluid 1, 8
- Do not use subcutaneous corticosteroids—retrospective data shows intralesional corticoids actually increased the need for surgical debridement 1, 2
- Avoid alcohol-based compresses—use dry cold compresses only 2, 8
- Do not apply pressure to the site—this forces fluid deeper into tissues 1, 2
When to Escalate Care
Surgical debridement is indicated for unresolved tissue necrosis or pain lasting more than 10 days, consisting of wide three-dimensional excision of involved tissue with delayed skin grafting. 3, 1 If the infiltrated site shows progressive tissue damage despite conservative management, early surgical consultation is warranted.
Documentation Requirements
Document the following for every infiltration event: patient identification, time of occurrence, signs and symptoms, IV access description and location, estimated infiltration volume, management steps with timestamps, and photographic documentation if possible. 1