A client is receiving an IV antibiotic infusion and reports pain, redness, and swelling at the IV site. What does this indicate and what should the nurse do first?

IV site complications:

Phlebitis: Inflammation of the vein wall — redness, warmth, pain, and a palpable cord along the vein; can be caused by mechanical trauma, chemical irritation from medications, or infection.

Infiltration: IV catheter has displaced from the vein — fluid infusing into surrounding tissue; swelling, pallor, cool skin, pain.

Extravasation: Infiltration of vesicant (tissue-damaging) medication — more serious; requires specific antidote in some cases.

Immediate action: Stop the infusion; remove the IV catheter; do NOT continue infusing through a compromised site.

Treatment: Elevate the extremity; warm compress for phlebitis; cold or warm compress per policy for infiltration (depends on infiltrated substance); document the complication; notify RN for assessment and orders.

Vesicant extravasation: Some chemotherapy agents and vasopressors require specific antidotes (hyaluronidase for some agents, phentolamine for norepinephrine extravasation) — report immediately.