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
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
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
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
Mitomycin C Mutamycin
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.
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
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
A red line detectable above the IV site.
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
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
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
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::
Inappropriate use of tourniquet
Unsuccessful insertion attempts
Little pressure upon removal of cannula
Discoloration of the tissue at the IV site
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
Is the successful transmission or encounter of host with potentially pathogenic organism.
Major hazard - can be local or systemic (septicemia)
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
Tight feeling in the chest
In extreme cases:
Loss of consciousness
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
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
Jugular vein distention
Increased Respiratory rate
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
Maybe a Local or generalized response to tape, cleansing agent, medication, solution or intravenous device
Signs & Symptoms SYSTEMIC
Itching at the site
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