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Intravenous Therapy  Complications
 

Intravenous Therapy Complications

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    Intravenous Therapy  Complications Intravenous Therapy Complications Presentation Transcript

    • Intravenous Complications
    • Objectives
      Enumerate the kinds of intravenous therapy complications.
      Identify the types of each kind of intravenous therapy complications and describe them according to the following:
      Definition
      Causes
      Signs & Symptoms
      Nursing Interventions
    • Intravenous Therapy Complications
      LOCAL COMPLICATIONS
      Infiltration
      Extravasation
      Thrombosis
      Thrombophlebitis
      Phlebitis
      SYSTEMIC COMPLICATIONS
      Embolism
      Pulmonary embolism
      Air embolism
      Catheter embolism
      Hematoma
      Systemic infection
      Speedshock
      Circulatory overload
      Allergic reaction
    • Infiltration
      Extravasation
      Thrombosis
      Thrombophlebitis
      Phlebitis
    • Infiltration
      • Results when the infusion cannula becomes dislodged from the vein and fluids are infused into the surrounding tissues.
    • Signs & Symptoms
      • Increasing edema at the site of the infusion
      • Discomfort, burning, pain at site
      • Feeling of tightness at site
      • Decreased skin temperature around site
      • Blanching at site
      • Absent backflow of blood
      • Slower flow rate
    • Cause
      Device dislodged from vein or perforated vein
    • Nursing Interventions
      Remove the device
      Apply warm soaks to aid absorption
      Elevate the limb
      Notify the doctor if severe
      Assess circulation
      Restart the infusion
      Document the patient's condition and your interventions
    • Prevention
      Check the I.V site frequently
      Don't obscure area above site with tape
      Teach the patient to report discomfort, pain, swelling
    • Extravasation
      It occurs when fluids seep out from the lumen of a vessel into the surrounding tissue.
      CAUSES:
      • Damage to the posterior wall of the vein
      • Occlusion of the vein proximal to the injection site
    • Signs & Symptoms
      • Swelling
      • Discomfort
      • Burning
      • Tightness
      • Coolness in the adjacent skin
      • Slow flow rate
    • Truth about common Misconception:
      • Extravasation doesn’t always cause a hard lump.
      • Patient may not always experience coldness or discomfort with extravasation
    • Nursing Interventions
      • Immediately stop the infusion and remove the device
      • Elevate the affected limb
      • Apply cold compress to decrease edema and pain
      • Apply moist heat to facilitate the absorption of fluid at grossly infiltrated sites
    • Drugs Associated with Extravasation Necrosis
      • Generic Name    Brand Name
      • Calcium chloride Various
      • Calcium gluconate Various
      • Dacarbazine DTIC
      • DactinomycinCosmogen
      • DaunorubicinCerubidine
      • Dopamine Various
      • Doxorubicin Adriamycin
      • IdarubicinIdamycin
      • MechlorethamineMustargen
      • Mitomycin C Mutamycin
      • PlicamycinMithracin
      • StreptozocinZanosar
      • TeniposideVumon
      • Vancomycin Various
      • VinblastineVelban
      • VincristineOncovin
      • VinorelbineNavelbine
    • Thrombosis
      • Occurs when blood flow through a vein is obstructed by a local thrombus.
      • Catheter-related thrombosis arises as a result of injury to the endothelial cells of the venous wall.
    • Signs & Symptoms
      Painful, reddened, & swollen vein
      Sluggish or stopped I.V flow
    • Cause
      Injury to endothelial cells of vein wall, allowing platelets to adhere and thrombus form
    • Nursing Interventions
      Remove the device; restart the infusion in the opposite limb if possible
      Apply warm soaks
      Watch for I.V therapy – related infection
    • Prevention
      Use proper venipuncture techniques to reduce injury to the vein
    • Thrombophlebitis
      • Occurs when thrombosis is accompanied by inflammation.
      • Infusions allowed to continue after thrombophlebitis develops will slow and eventually stop, indicating progression to an obstructive thrombophlebitis.
      • Various terms can be used to distinguish the type of phlebitis a patient experiences.
    • Signs & Symptoms
      • Local tenderness
      • Swelling
      • Induration
      • A red line detectable above the IV site.
    • Thrombophlebitis
      • All thrombotic complications have the associated danger of embolism, especially in cases where the thrombus is not well attached to the wall of the vein.
      • The risk for the development of thrombotic complications can be greatly reduced when certain preventive measures are taken.
    • Recommendations to Reduce the Risk of Thrombotic Complications
      1. Use veins in the upper extremities2. Avoid placing catheters over joint flexions3. Select veins with adequate blood volume for solution characteristics4. Anchor cannulas securely5. Avoid multiple venipunctures
    • Phlebitis
      Causes:
      • Injury during Venipuncture
      • Prolonged use of the same IV site
      • irritating./incompatible IV additives
      • Use of vein that is too small for the flow rate
      • Use of needle size too large for the vein size
    • Signs & Symptoms
      • Pain
      • Vein that is sore, hard, cord like and warm to touch
      • Red line above the site
      • Signs of infection
    • Phlebitis Rating
      0 = No symptoms
      1 = Erythema at site with or without pain
      2 = pain at site, erythema and/or edema; no streak, no palpable cord
      3 = pain at site, erythema and/or edema; streak
      present; palpable cord
      4 = pain at site, erythema and/or edema; streak
      present; palpable cord > 1 inch; purulent drainage
    • Common Medication that can cause Phlebitis
      • Phenytoin
      • Diazepam
      • Erythromycin
      • Tetracycline
      • Vancomycin
      • Amphothericin B
      • 40 mEq/L or more doses of KCL
    • Nursing Interventions
      • Upon assessment of phlebitis, removal the needle
      • Avoid multiple insertion
      • Application of warm compress
      • Continuously monitor the patient- vital signs
    • Embolism
      Hematoma
      Systemic infection
      Speedshock
      Circulatory overload
      Allergic reaction
    • Pulmonary Embolism
      It associated with venous access devices is usually the result of a thrombus that has become detached from the wall of the vein. It is carried by the venous circulation to the right side of the heart and then into the pulmonary artery.
      Circulatory and cardiac abnormalities are caused by full or partial obstruction of the pulmonary artery, with possible progression to pulmonary hypertension and right-sided heart failure.
    • Air Embolism
      Occurs most frequently with the use of central venous access devices.
      Occur with the insertion of an IV catheter, during manipulation of the catheter or catheter site when the device is removed, or when IV lines associated with the catheter are disconnected.
    • Catheter Embolism
      This can occur during the insertion of a catheter if appropriate placement techniques are not strictly adhered to.
      The tip of the needle used during the placement of the catheter can shear off the tip of the catheter.
      The catheter tip then becomes a free-floating embolus.
      This can occur with both over-the-needle and through-the-needle catheters. If this happens, cardiac catheterization may be required to remove the embolus.
    • Signs & Symptoms
      Sudden vascular collapse with the hallmark symptoms of cyanosis, hypotension, increased venous pressures, and rapid loss of consciousness.
      Respiratory distress
      Unequal breath sounds
      Weak pulse
    • Causes
      Empty solution container
      Solution container empties; next container pushes air down line
      Tubing disconnected from venous access device or I.V bag
    • Nursing Interventions
      Discontinue the infusion
      Place the patient in Trendelenburg position on his left side to allow air to enter the right atrium and disperse through the pulmonary artery.
      Administer oxygen
      Notify the doctor
      Document the patient's condition and your interventions.
    • Hematoma
      The seepage of blood into the extravascular tissue
      Causes::
      • Coagulation defects
      • Inappropriate use of tourniquet
      • Unsuccessful insertion attempts
      • Little pressure upon removal of cannula
      • Discoloration of the tissue at the IV site
    • Nursing Interventions
      • Frequent assessment of the site
      • Upon insertion, slowly advance the needle to prevent puncturing both vein walls
      • Discontinue therapy if with edema
      • Apply pressure for at least 5 minutes upon removal
    • Systemic Infection
      • Is the successful transmission or encounter of host with potentially pathogenic organism.
      • Major hazard - can be local or systemic (septicemia)‏
      • Caused by: Staphylococcuaureus, Klebsiella, Serratia, Pseudomonas Aeruginosa
    • Signs & symptoms
      Fever, chills, & malaise for no apparent reason
      Contaminated I.V site, usually with no visible signs of infection at site
    • Causes
      Failure to maintain aseptic technique during insertion or site care
      Severe phlebitis, which can set up ideal conditions for organisms growth
      Poor taping
      Prolonged indwelling time of device
      Immunocompromised patient
    • Nursing Interventions
      Notify the doctor.
      Administer medications as prescribed
      Culture the site and the device
      Monitor the patient's vital signs
    • Prevention
      Use scrupulous aseptic technique
      Secure all connections
      Change I.V solutions, tubing and venous access device at recommended times
      Use I.V filters
    • Management and Prevention Tips
      • Assess catheter site daily
      • Accurately document visual inspection and palpation data.
      • Refer to physician for any suspected infection.
      • Use maximal sterile-barrier precautions during insertion (sterile technique)‏
      • Practice good hand hygiene before and after palpating, inserting, replacing, or dressing any intravascular device.
      • If any part of the system is disconnected, don’t rejoin it
      • Remove at first sign of infection
      • Replace site, tubings and bags per policy
      example: change set= 72 hours, TPN and single use of antibiotics=24 hrs
    • Speedshock
      Rapid introduction of a foreign substance, usually a medication, into the circulation.
    • Signs & Symptoms
      • Flushed face
      • Headache
      • Tight feeling in the chest
      • Irregular pulse
      In extreme cases:
      • Loss of consciousness
    • Nursing Interventions
      • STOP the infusion
      • Careful monitoring of IV flow rate and patient response. Maintain prescribed rate.
      • Know the actions and side effects of the drug being administered
    • Nursing Interventions
      Use of IV pumps when indicated
      Begin infusion of 5% dextrose at a KVO rate in emergency cases
      Evaluate circulatory and neurologic status
      Notify the physician
    • Circulatory Overload
      • An excess of fluid disrupting homeostasis caused by infusion at a rate greater than the patient’s system is able to accommodate
    • Signs & Symptoms
      • Shortness of breath
      • Elevated blood pressure
      • Bounding pulse
      • Jugular vein distention
      • Increased Respiratory rate
      • Edema
      • Crackles or rhonchi upon auscultation
    • Causes
      Roller clamp loosened to allow run – on infusion
      Flow rate too rapid
      Miscalculation of fluid requirements
    • Nursing Interventions
      Raise the head of the bed
      Slow the infusion rate
      Administer oxygen as needed
      Notify the doctor
      Administer medications as ordered
    • Allergic Reaction
      • Maybe a Local or generalized response to tape, cleansing agent, medication, solution or intravenous device
    • Signs & Symptoms
      SYSTEMIC
      • Runny nose
      • Tearing
      • Bronchospasm
      • Wheezing
      • Generalized rash
      LOCAL
      • Wheal
      • Redness
      • Itching at the site
    • Nursing Interventions
      • If reaction occurs, stop the infusion immediately and infuse normal saline solution.
      • Maintain a patent airway.
      • Notify the doctor.
      • Administer antihistaminic steroid, anti – inflammatory, & antipyretic drugs, as ordered.
      • Give 0.2 to 0.5ml of aqueous epinephrine subcutaneously. Repeat at 3-minute intervals and as needed, as ordered
    • Lets have an exercise!
    • Identify a local complication and describe according to the following:
      Definition
      Causes
      Signs & symptoms
      Nursing Interventions
    • Identify a systemic complication and describe according to the following:
      Definition
      Causes
      Signs & symptoms
      Nursing Interventions
    • Questions?