Nursing care
Peripheral IV Complications, explained for the bedside and the exam
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
The three main peripheral IV complications are phlebitis, infiltration, and extravasation. Phlebitis is a red, warm, tender cord along the vein. Infiltration is cool, pale swelling from non-vesicant fluid leaking into tissue. Extravasation is the same leak, but with a vesicant drug, and causes tissue damage. Any of the three means the site changes now.
The idea in one paragraph
Three complications, three distinct pictures, and they're often confused because they all present as 'something's wrong at the IV site.' Phlebitis is inflammation of the vein itself — the site is red, warm, tender, and a palpable cord may run along the vein above the insertion point. Infiltration is fluid leaking out of the vein into surrounding tissue, and because the fluid is a non-vesicant, the tissue is cool, pale, and swollen, without the redness or warmth of phlebitis.
Extravasation is the same mechanical event as infiltration — fluid escaping the vein into tissue — but the fluid is a vesicant, a drug capable of causing blistering or necrosis, such as vancomycin, certain chemotherapy agents, or calcium chloride. That single difference, vesicant versus non-vesicant, is what turns a manageable complication into a tissue-damaging one, and it's why the same physical sign — swelling around the site — carries a very different level of urgency depending on what was infusing.
Why it matters clinically
Misreading one for another changes the response, and the wrong response has consequences. Treating extravasation like ordinary infiltration — stop, elevate, observe — allows a vesicant to keep damaging tissue that a faster, drug-specific antidote or protocol could have limited. Treating phlebitis as infiltration misses the risk of it progressing to thrombophlebitis, which carries its own risk of clot and, rarely, systemic infection if bacterial.
The stakes also differ in reversibility. Phlebitis generally resolves once the site is removed and warm compresses are applied. Infiltration resolves once the leaking fluid stops and the tissue reabsorbs it. Extravasation can leave permanent tissue damage, including necrosis requiring surgical debridement, which is why it's treated as the most urgent of the three and why vesicant infusions get closer, more frequent site checks than routine fluids.
How to apply it at the bedside
Check the site at the interval your facility requires for what's infusing — more frequently for a vesicant than for maintenance fluids — and know what you're looking for at each check: redness and a palpable cord for phlebitis, cool pale swelling for infiltration, the same swelling plus a vesicant drug for extravasation.
The nursing action that matters most across all three is the same principle: change the site at the first sign, not the third. Don't wait for the redness to spread, the swelling to worsen, or the patient to report pain building over the shift. Stop the infusion, discontinue the IV, and restart in a new site, ideally in the opposite limb if a vesicant was involved. For suspected extravasation specifically, follow your facility's vesicant protocol, which may include a specific antidote, elevation, and provider notification before the site is even removed.
Where students get it wrong
The most common error is confusing infiltration and phlebitis because both involve a 'bad-looking' site, without checking temperature and colour specifically. Warmth and redness point to phlebitis; coolness and pallor point to infiltration. Getting this backwards on an exam item usually means picking the wrong first intervention, since warm compresses help phlebitis but aren't the priority for infiltration.
The second error is treating extravasation as a severity variant of infiltration rather than a separate category defined by the drug, not the volume of swelling. A small amount of extravasated vancomycin is more concerning than a large amount of infiltrated normal saline, and students who rank complications by swelling size alone will misjudge urgency.
The third error is delaying the site change to 'monitor and reassess,' which is rarely the correct nursing action once any of the three signs is present and confirmed.
Worked examples
A patient's forearm IV site is red, warm, and tender along a two-inch line above the insertion point, with no swelling. This is phlebitis — discontinue the site, apply a warm compress, and restart elsewhere.
A patient receiving maintenance normal saline develops cool, pale swelling around the insertion site with no redness. This is infiltration — stop the infusion, discontinue the site, elevate the limb, and restart in a new location.
A patient receiving IV vancomycin develops swelling and blanching at the site, with the patient reporting a burning sensation. This is extravasation — stop the infusion immediately without flushing the line, leave the catheter in place briefly per protocol to aspirate residual drug, notify the provider, and follow the facility's vesicant extravasation procedure.
How the exam tests it
Expect questions that give you the physical assessment findings, temperature and colour especially, and ask you to identify the complication before asking for the intervention, testing recognition and action together in one scenario. Expect a select-all-that-apply item listing signs of phlebitis with a distractor drawn from infiltration, such as 'cool to touch,' to see if you know the two are opposites on that specific finding.
Priority questions frequently pair extravasation with a named vesicant drug — vancomycin, doxorubicin, calcium chloride — specifically to test whether you know the drug class matters, not just the visual presentation. And expect a 'first action' question where the correct answer is stopping the infusion and discontinuing the site, with a distractor offering 'continue to monitor' as the wrong, delayed choice.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our reduction of risk potential practice questions are the closest set to what this page covers.
One question from the reduction of risk potential set
Four hours after a cardiac catheterization via the right femoral artery, the nurse notes the client's right dorsalis pedis pulse is now faint and the foot is cool and pale. What is the nurse's priority action?
Rationale
A pulse that was present and is now faint, with a cool, pale extremity distal to the puncture site, is arterial occlusion until proven otherwise — a limb-threatening complication that needs the provider now. Documenting and rechecking wastes the window, warming treats the symptom and masks the change, and asking the client to move the ankle neither restores flow nor gives you new information.
Answer: C
Common questions
What's the difference between infiltration and extravasation?
Both are fluid leaking from the vein into surrounding tissue, and they look similar at first. The difference is the fluid itself: infiltration involves a non-vesicant, and extravasation involves a vesicant capable of causing tissue damage. That single distinction changes the urgency and the treatment.
How do you tell phlebitis from infiltration at the bedside?
Check temperature and colour. Phlebitis is warm, red, and often has a palpable cord along the vein. Infiltration is cool, pale, and swollen, without the redness or warmth. Pain can occur in both, so temperature and colour are the more reliable distinguishing signs.
When should you change a peripheral IV site showing signs of a complication?
At the first sign, not after it worsens or after a set number of occurrences. Redness, coolness, swelling, or a palpable cord are all reasons to discontinue the current site and restart elsewhere, regardless of how mild the sign initially appears.
What drugs are considered vesicants for extravasation risk?
Common examples include vancomycin, calcium chloride, and several chemotherapy agents such as doxorubicin. Any drug on your facility's vesicant list warrants closer, more frequent site monitoring than a routine maintenance fluid.
More on reduction of risk potential