Bleeding into the skin

Aside from the common bruise, bleeding into the skin or mucous membranes is a very significant sign and should always be checked out by a health care provider. Redness of the skin (erythema) should not be mistaken for bleeding. Areas of bleeding under the skin do not become paler (blanch) when you press on the area, like the redness from erythema does.

Blown Vein

A blown vein is a vein that’s mildly injured during a blood draw or IV placement. Symptoms include bruising, swelling and discomfort around your vein. While a blown vein isn’t serious, it needs about 10 to 12 days to heal before your provider can use it again. Always tell your provider if you feel pain or discomfort during a needle insertion.

Overview

What is a blown vein?

A blown vein, sometimes called a ruptured vein, is a blood vessel that’s damaged due to a needle insertion. This can happen when a healthcare provider, such as a phlebotomist or nurse, draws blood or inserts a peripheral IV to give you medications or fluids.

During a needle insertion, the tip of the needle should enter your vein wall and land within the opening (lumen) of your vein. Sometimes, though, the tip goes a bit further and pokes through the other side of your vein. As a result, some blood leaks out and pools under your skin (hematoma). This can cause mild, temporary discomfort.

A blown vein usually isn’t dangerous or a cause for concern. It should heal within a couple of weeks. Your provider will wait to use the vein for any further needle insertions until it’s healed.

Symptoms and Causes

What are the symptoms?

Blown vein symptoms occur around the area of your vein and include:

• Skin discoloration.
• Bruising.
• Swelling.
• Pain or discomfort.
• Tenderness to the touch.

What does a blown vein look like?

The area around your blown vein may appear red or purple. This is because some blood has leaked out of your vein and pooled under your skin. The discoloration is temporary and should go away within a couple of weeks.

What causes a blown vein?

A blown vein happens when something doesn’t go right during a needle insertion. The needle punctures or irritates your vein, causing mild and temporary damage.

Here are some common issues that can interfere with a needle insertion and lead to a blown vein:

• Movement (even slight) when the needle goes in. You may accidentally move your arm or flinch, causing the needle to go off-course.
• Rolling vein. A provider may say you have a “rolling vein” if your vein moves easily when touched. Your vein may move to the side, away from the needle, during insertion. You can’t control whether your vein rolls or not. But your provider may check to see if it rolls or is stable before inserting a needle.
• Fragile vein. Your veins naturally grow more fragile as you get older, so they may break more easily. Veins can also become fragile due to long-term medical or nonmedical IV use.
• Unsuitable needle size. Sometimes, a provider may select a needle size that seems appropriate. But in fact, it’s too large for your particular vein.

What are the complications of a blown vein?

When a vein blows during an IV insertion, one possible complication is that the IV substance can leak into nearby tissues. Healthcare providers call this complication infiltration or extravasation, depending on the type of substance that leaks. Extravasation involves substances that may cause greater tissue damage, such as chemotherapy medication.

If you’re on an IV, tell your provider right away if you notice:

• Pain, discomfort or numbness.
• A tight feeling in your skin.
• Swelling of the area around the IV.

These may be signs of a leak. Your provider will also monitor you while you’re on the IV. If they notice a problem, they’ll disconnect you from the IV and give you appropriate treatment.

Diagnosis and Tests

How is a blown vein diagnosed?

Providers usually notice a blown vein right away, while drawing blood or inserting an IV, and take action to correct the issue. If you have symptoms of a blown vein later on, when you get home, call your provider and discuss how you’re feeling.

Bleeding into the skin

Bleeding into the skin can occur from broken blood vessels that form tiny red dots (called petechiae). Blood also can collect under the tissue in larger flat areas (called purpura), or in a very large bruised area (called an ecchymosis).

A black eye is caused by bleeding into the tissue around the eye. This most often follows trauma. The medical term for this type of bruising is ecchymosis.

Considerations

Aside from the common bruise, bleeding into the skin or mucous membranes is a very significant sign and should always be checked out by a health care provider. Redness of the skin (erythema) should not be mistaken for bleeding. Areas of bleeding under the skin do not become paler (blanch) when you press on the area, like the redness from erythema does.

Causes

• Injury or trauma
• Allergic reaction
• Autoimmune disorders
• Viral infection or illness affecting blood clotting (coagulation)
• Thrombocytopenia (low platelet count)
• Medical treatment, including radiation and chemotherapy
• Antiplatelet medicines such as clopidogrel (Plavix)
• Bruise (ecchymosis)
• Birth (petechiae in the newborn)
• Aging skin (ecchymosis)
• Idiopathic thrombocytopenic purpura (petechiae and purpura)
• Henoch-Schonlein purpura (purpura)
• Leukemia (purpura and ecchymosis)
• Medicines — Anticoagulants such as warfarin or heparin (ecchymosis), aspirin (ecchymosis), steroids (ecchymosis)
• Septicemia (petechiae, purpura, ecchymosis)

Home Care

Protect aging skin. Avoid trauma such as bumping or pulling on skin areas. For a cut or scrape, use direct pressure to stop the bleeding.

If you have a drug reaction, ask your provider about stopping the drug. Otherwise, follow your prescribed therapy to treat the underlying cause of the problem.

When to Contact a Medical Professional

Contact your provider if:

• You have sudden bleeding into the skin for no apparent reason
• You notice unexplained bruising that does not go away

What to Expect at Your Office Visit

Your provider will examine you and ask questions about the bleeding, such as:

• Have you recently had an injury or accident?
• Have you been ill lately?
• Have you had radiation therapy or chemotherapy?
• What other medical treatments have you had?
• Do you take aspirin more than once a week?
• Do you take Coumadin, heparin, or other “blood thinners” (anticoagulants)?
• Has the bleeding occurred repeatedly?
• Have you always had a tendency to bleed into the skin?
• Did the bleeding start in infancy (for example, with circumcision)?
• Did it start with surgery or when you had a tooth pulled?

The following diagnostic tests may be performed:

• Coagulation tests including INR, prothrombin time, partial thromboplastin time, and levels of clotting factors
• Complete blood count (CBC) with platelet count and blood differential
• Bone marrow biopsy

References

Hayward CPM, Ma AD. Evaluation of the patient with suspected bleeding disorders. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 126.

Juliano JJ, Cohen MS, Weber DJ. The acutely ill patient with fever and rash. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 57.

Schafer AI. Approach to the patient with bleeding and thrombosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 162.

Version Info

Last reviewed on: 4/27/2023

Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.