Recognizing Complications: When to Call for Help

A patient's guide to recognizing IV and catheter complications — including infiltration, phlebitis, infection, clotting, and air embolism — and knowing when and how to ask for help.

patient-education•Feb 2026•Safety

Recognizing Complications: When to Call for Help

Most IV lines and catheters work without any problems. But complications can happen, and the best outcomes come from catching them early. You are the most important monitor of your own IV site — you can feel and see changes that your care team may not notice between scheduled checks.

This guide describes the most common vascular access complications in plain language, what to look and feel for, and when you need to call your nurse right away.

The Golden Rule

If something seems wrong with your IV or catheter — any time, day or night — call your nurse immediately. Never wait to see if it gets better on its own.

There is no such thing as a concern that is too small to mention. Your nursing team would far rather investigate a false alarm than miss an early warning sign.

Call Your Nurse NOW for Any of These

The following symptoms require immediate attention — do not wait:

  • Sudden shortness of breath or difficulty breathing
  • Chest pain or pressure
  • Rapid or irregular heartbeat
  • Sudden dizziness, lightheadedness, or feeling faint
  • Severe or sudden headache
  • Swelling of the face, lips, tongue, or throat (possible allergic reaction)
  • Hives, rash, or widespread itching that develops during an infusion
  • Fever (temperature ≥ 38°C / 100.4°F) with shaking chills (especially with a central line)
  • Blood coming out of the catheter exit site and not stopping
  • The catheter visibly coming out of the insertion site

Common Complications and What to Look For

1. Infiltration (IV Fluid in the Wrong Place)

What it is: Infiltration happens when IV fluid leaks out of the vein and into the surrounding tissue. This usually occurs because the catheter tip has slipped out of or through the vein wall.

Signs to watch for:

  • Swelling, puffiness, or a “puffy” appearance around the insertion site
  • Coolness or paleness of the skin near the site
  • Firmness or tightness under the skin near the site
  • The IV infusion slowing down or stopping unexpectedly
  • Pain, pressure, or discomfort at the site — or the site feeling more uncomfortable than usual during an infusion

Why it matters: In most cases, infiltration of plain IV fluids (saline, dextrose) causes discomfort and swelling that resolves on its own after the IV is removed. However, some medications — including certain antibiotics, chemotherapy drugs, vasopressors, and concentrated solutions — can cause serious tissue damage (necrosis) if they infiltrate. This is called extravasation and is a medical emergency.

What to do: Tell your nurse immediately if you notice any swelling, coolness, or pain at your IV site, especially during an infusion. Your nurse will stop the infusion, remove the IV if needed, and assess the area. Do not try to adjust the IV or restart the infusion yourself.

2. Phlebitis (Vein Inflammation)

What it is: Phlebitis is inflammation of the vein. It can be caused by the physical presence of the catheter (mechanical phlebitis), by an irritating medication (chemical phlebitis), or — less commonly — by bacteria (bacterial phlebitis).

Signs to watch for:

  • Redness along the vein, extending up the arm from the insertion site
  • Warmth along the vein or at the site
  • A firm, cord-like feeling along the vein (the vein feels like a hard rope under the skin)
  • Swelling at or near the site
  • Pain or tenderness along the arm, not just at the insertion site
  • A red streak extending away from the site

Why it matters: Mechanical and chemical phlebitis are uncomfortable but usually resolve after the IV is removed. Bacterial phlebitis (infection in the vein wall) is more serious and requires treatment. A red streak extending from the site can signal infection spreading along the vein and needs immediate attention.

What to do: Report redness, warmth, or a hard, rope-like feeling along your vein to your nurse. Your nurse will assess the site, possibly remove the IV, and apply warm compresses or other comfort measures. If infection is suspected, treatment will be initiated.

3. Occlusion (Blocked Catheter)

What it is: An occlusion is a blockage inside the catheter that prevents fluid from flowing through it. The blockage can be a blood clot (thrombus) inside the catheter lumen, a buildup of medication residue, or a kink in the catheter.

Signs to watch for:

  • The IV infusion slowing significantly or stopping without an obvious reason (like the IV bag being empty)
  • An alarm on the IV pump that says something like “occlusion” or “pressure high” repeatedly
  • Resistance when your nurse attempts to flush the catheter
  • Blood unable to be withdrawn from the catheter (for central lines where blood return is normally expected)

What to do: Tell your nurse if the infusion seems to have slowed unexpectedly or if the pump is repeatedly alarming. Do not try to flush the catheter yourself or push harder on the syringe if you feel resistance — this can force a clot into your bloodstream or damage the catheter. Your nurse has safe techniques and medications to restore catheter patency.

Prevention: Catheters should be flushed regularly with saline (and sometimes heparin) according to a schedule your nurse manages. If you are going home with a catheter, your home care nurse will teach you exactly how to flush it correctly.

What it is: Bacteria can infect either the insertion site (a local infection, also called an exit-site infection) or travel along or through the catheter into the bloodstream (a bloodstream infection). Bloodstream infections are more serious and require urgent treatment.

Signs of a local (exit-site) infection:

  • Redness, swelling, or warmth around the catheter entry point in the skin
  • Pus or cloudy discharge from around the catheter
  • Tenderness or pain directly at the exit site
  • The skin around the site looking open or broken down

Signs of a possible bloodstream infection (much more urgent):

  • Fever (38°C / 100.4°F or above), especially if it comes on suddenly
  • Shaking chills — sometimes severe, feeling uncontrollably cold even when you are warm
  • Feeling suddenly much more unwell than you did before
  • Confusion or sudden change in mental status (particularly in older adults)
  • Rapid heart rate

Why it matters: A bloodstream infection with a central catheter (called a CLABSI) is a serious medical emergency requiring blood cultures, IV antibiotics, and often catheter removal. Early detection saves lives.

What to do: Report fever, chills, or changes at the insertion site immediately. If you are at home with a PICC or port and develop fever with chills, call your home care nurse or go to the emergency room — do not wait.

5. Deep Vein Thrombosis (DVT) / Catheter-Associated Thrombosis

What it is: A blood clot can form in the vein around the catheter — particularly with PICC lines and other central catheters. This is called a catheter-associated deep vein thrombosis (CA-DVT).

Signs to watch for (for an arm DVT with a PICC or midline):

  • Swelling of the arm, from the insertion site down to the hand, or up toward the shoulder and neck
  • Pain or aching in the arm — sometimes feels like a muscle ache deep in the arm
  • Warmth and redness over the arm (the entire arm, not just the insertion site)
  • Visible swelling of hand or fingers
  • Tightness or heaviness in the arm

Why it matters: A clot in the arm vein is uncomfortable and may require the catheter to be removed and treatment with blood thinners. Rarely, a portion of the clot can break off and travel to the lungs (pulmonary embolism), causing breathing difficulty and chest pain — a life-threatening emergency.

Signs of pulmonary embolism (call 911 / emergency services):

  • Sudden shortness of breath
  • Sharp chest pain, especially when you breathe in
  • Coughing up blood
  • Rapid heart rate
  • Dizziness or fainting

What to do: Tell your nurse immediately if your arm swells, becomes painful, or becomes significantly warmer than the other arm. If you experience shortness of breath or chest pain, this is a medical emergency.

6. Dislodgement (Catheter Moving Out of Position)

What it is: The catheter can be accidentally pulled out (completely or partially) if the securement device loosens, tubing gets caught on something, or the dressing is removed without care.

Signs to watch for:

  • The catheter appears shorter than it normally does at the exit site (for PICC lines, a measurement mark on the catheter may no longer line up with the exit site)
  • The catheter seems to be sticking further out of the skin than before
  • The securement device or dressing is detached
  • Fluid appears to be leaking around the catheter exit site
  • An infusion that previously ran smoothly is no longer working

What to do: Do not push the catheter back in — this is never safe. Notify your nurse right away. Your nurse will assess the catheter position; in many cases an X-ray is needed to confirm whether the tip is still correctly positioned before the catheter can be used again.

Prevention:

  • Be careful when getting dressed or undressed around a catheter
  • Secure tubing so it does not pull on the catheter
  • Let your nurse know before any movement that might strain the line (repositioning in bed, transfers, getting up)

7. Allergic Reaction to Medications or Materials

What it is: An allergic reaction can occur in response to a medication being infused, or to materials used in catheter care (tape, adhesives, antiseptic solutions, latex).

Signs of a mild reaction:

  • Itching at the infusion site or more widespread
  • Rash or hives
  • Redness
  • Runny nose, watery eyes

Signs of a serious allergic reaction (anaphylaxis — call for help immediately):

  • Hives or rash spreading rapidly over the body
  • Swelling of the face, lips, tongue, or throat
  • Difficulty breathing, wheezing, or a tight feeling in the chest
  • Dizziness, lightheadedness, or feeling faint
  • Rapid, weak pulse
  • Nausea, vomiting, or abdominal cramping together with the above symptoms

What to do: Tell your nurse immediately if you feel itchy, notice a rash, or feel unwell during any infusion. If you experience any breathing difficulty or throat swelling — this is an emergency. Your nurse or care team can administer emergency medications (epinephrine, antihistamines, steroids) quickly if they know what is happening. See our guide: Allergies and Sensitivities During IV Therapy.

8. Air Embolism

What it is: Air embolism occurs when air enters the bloodstream through the catheter. Even a small amount of air can cause symptoms; a larger amount is life-threatening.

Why it can happen: Air can enter if IV tubing becomes disconnected, if a syringe is not properly used, or during certain catheter procedures. Your care team uses techniques to prevent this, including keeping tubing connections tight, priming tubing with fluid before connecting it, and having you perform certain maneuvers (like taking a deep breath and bearing down) during catheter removal.

Signs to watch for:

  • Sudden shortness of breath during or after catheter-related activity
  • Chest pain
  • Coughing
  • Feeling lightheaded or dizzy
  • A sudden change in how you feel during catheter use or during dressing changes

What to do: This is a medical emergency. Lie down on your left side, call for help immediately, and do not get up.

Prevention: Never let tubing disconnections go unnoticed. If you notice any open connection at the catheter end, do not touch the open end — clamp the catheter if you have been trained to do so, and call your nurse immediately.

At Home: When to Seek Emergency Care

If you are at home with a PICC, port, or other catheter, go to the emergency room (or call 911) for:

  • Fever above 38°C / 100.4°F with shaking chills
  • Shortness of breath or chest pain
  • Significant swelling of the arm with the catheter
  • Signs of anaphylaxis (throat swelling, difficulty breathing)
  • Uncontrolled bleeding from the catheter site
  • Catheter falls out completely (bring the catheter with you to the ER)

Call your home care nurse or vascular access nurse line (have the number posted at home) for:

  • Dressing that is loose, wet, or peeling
  • The pump alarming repeatedly with an occlusion
  • Site that looks red, swollen, or has discharge
  • Catheter that seems to have shifted position
  • Any question about your catheter or infusion

This guide is for educational purposes and is not a substitute for advice from your own healthcare team. Always follow the specific instructions given to you by your nurses and doctors. In an emergency, call 911.