Detecting an infiltrated intravenous catheter using indigo carmine: a novel method

Anesth Analg 2007;105:1130-1131

Chen M, Habib AS, Panni MK, Schultz JR




Purpose            The purpose of this case report was to describe a new method for assessing a peripheral intravenous(IV) catheter for intravascular vs. subcutaneous placement.

Background            A supposedly intravenous catheter that is actually subcutaneous may be uncomfortable for the patient. It may also prevent the timely administration of critical medications or allow the extravasation of a drug that causes tissue damage. Traditional methods of diagnosing a misplaced IV are usually, but not always, sufficient.

Methodology            A peripheral IV was started in a woman with a body mass index (BMI) of 44 who was edematous due to her medical illness. After the catheter was placed there was some question about whether or not it was in the vein. Traditional methods of making that determination were equivocal. Administering a small dose of epinephrine and observing for an increase in heart rate was considered but ruled out as having more risk than benefit. Finally, 1 mL of indigo carmine dye was injected into the IV. The dye was seen to flow through superficial veins of the skin in a branching pattern. Within 2 seconds it disappeared, leaving no trace of blue dye. Half an hour later the IV site was swollen and the IV had stopped dripping. A second 1 mL injection of indigo carmine resulted in a localized blue discoloration at the catheter tip which did not quickly fade away.

Result            In both cases, injection of indigo carmine dye in the IV was a useful tool to help determine the proper placement of a peripheral intravascular catheter.

Conclusion            Injection of indigo carmine dye in an IV may help the observer determine if the IV is placed intravascularly or is subcutaneous.



This is a nice, concise report that suggests one more tool to keep in my bag. I doubt I’ll need it often, but when I do I’ll thank these authors for teaching it to me.


Michael Fiedler, PhD, CRNA