Situation: A 40-year-old man with dengue is admitted on the fourth day of illness; his fever subsided this morning. He weighs 60 kg and has no history of heart or kidney disease. He is receiving intravenous (IV) fluids through a 20-gauge catheter in his left forearm. On day 5 the nurse finds a red, warm, tender streak running up the vein above his left forearm catheter, with a firm cord about 4 cm long. There is no swelling, the infusion is running well, and his temperature is 36.9 °C. He still needs IV fluid. What should the nurse do?

Redness, warmth, and tenderness along the vein with a palpable cord are phlebitis, not infiltration, which is cool, pale, and swollen. Phlebitis is managed by removing the catheter, applying a warm compress, and elevating the arm. The new catheter goes in the other arm or proximal to the site, never in a vein below the inflamed segment.

Clinical situation A 40-year-old man with dengue is on day 5 of illness. The fever has subsided, but the nurse finds a red, warm, tender streak with a firm cord above the IV site. The infusion still runs well, and there is no swelling. This presentation points to phlebitis, not infiltration.

Why phlebitis is the priority In phlebitis, the vessel wall becomes inflamed. The classic findings are erythema, warmth, tenderness, and a palpable venous cord. The absence of swelling and the fact that the infusion is running well help rule out infiltration, which would present as cool, pale, edematous skin around the site. The patient’s normal temperature (36.9 °C) does not rule out phlebitis; local inflammation can occur without systemic fever.

Immediate nursing actions The catheter must be removed because leaving it in place allows the inflammatory process to continue and increases the risk of thrombus extension or infection. After removal, a warm compress is applied to promote vasodilation, improve local blood flow, and reduce discomfort. The affected arm should be elevated to decrease venous stasis. The new IV must be started in the opposite arm or at a site proximal to the inflamed segment. Never restart the IV in a vein below the inflamed area, because the infused fluid would pass through the damaged segment and worsen the phlebitis.

Watch out! Option 1 suggests restarting in the left hand, which is distal to the inflamed forearm vein. Fluid would flow through the inflamed segment, so this is unsafe. Option 2 uses a cold compress, which is appropriate for infiltration but not for phlebitis. Option 3 keeps the catheter in place, which allows ongoing irritation of the vessel wall.

Why the opposite arm is correct The right arm provides a vein that is completely separate from the inflamed left forearm segment, so infused fluid does not traverse the damaged vessel. This matches the management principle of removing the source of irritation and selecting a new site that avoids the inflamed venous pathway. The patient still needs IV fluid, so the nurse must remove the old catheter and establish new access in a safe location.

Evidence-based context A Delphi study on PVC-related phlebitis management emphasizes that care practices should be standardized through multidisciplinary consensus, with catheter removal and local warm application as core interventions ^[1]. A scoping review from a nursing perspective also identifies warm compresses and catheter removal as commonly recommended nursing interventions for treating phlebitis secondary to peripheral venous catheter insertion ^[2]. These sources support the clinical priority of discontinuing the catheter and applying warmth rather than cold.

Key comparison for the licensure exam

Feature	Phlebitis	Infiltration
Skin temperature	Warm	Cool
Skin color	Red streak along vein	Pale
Swelling	Usually absent or minimal	Present, edematous
Palpable cord	Yes, firm cord	No
Infusion flow	Often still runs well	May slow or stop
Immediate action	Remove catheter, warm compress, elevate	Remove catheter, cold compress, elevate
New IV site	Opposite arm or proximal to site	Opposite arm or different site

Key point! The palpable cord is the hallmark that separates phlebitis from simple irritation or infiltration. A warm compress is used for phlebitis because heat dilates vessels and improves circulation; cold is used for infiltration to reduce swelling. When restarting the IV, the new site must not be distal to the inflamed vein because the fluid would still pass through the damaged segment.