The nurse, after a cardiac catheterization, notes the client's skin at the site is cool, tender to touch, with edema. Which condition would the nurse suspect?

• A. Infiltration
• B. Phlebitis
• C. Hematoma
• D. Infection

Answer: (A)

When tissue around the IV site becomes cool, swollen, and tender after a procedure like cardiac catheterization, the most likely issue is infiltration. That means IV fluid is leaking into the surrounding tissue rather than staying inside the vein. The cool skin and edema arise because the infused solution collects in the interstitial space, causing tissue to feel cool to the touch and become swollen and tender as pressure builds and the tissue irritates.

Phlebitis would present differently—a painful, red, warm streak or vein along the path of the cannula due to vein inflammation, with warmth and tenderness along the vein rather than coolness. A hematoma would show as swelling with bruising or ecchymosis from blood leaking into tissue, often with a bluish-purple discoloration rather than the cool, edematous tissue seen with infiltration. An infection would bring redness, warmth, swelling, possibly purulent drainage and fever, not just cool skin and edema.

So the cool, edematous, tender tissue at the catheter site points to infiltration, the leakage of IV fluid into the surrounding tissue. If this is suspected, stop the infusion, assess and manage the IV site, and communicate with the clinician about the next steps.